Uterine fibroids are more common than most women in the US might think. According to the Office on Women’s Health, the chances of getting fibroids before the age of 50 range between 20% and 50%. For the most part, fibroids are benign (non-cancerous) tumors present inside the uterus. But they can change in size over time and cause painful symptoms, and complications related to pregnancies. When that happens, your doctor will suggest a range of treatment options.
If you have been diagnosed with symptomatic uterine fibroids, there is one thing you need to know above all else: in a vast majority of cases, a hysterectomy is not the optimal treatment solution. In this guide, we will explain why you should consider uterine fibroid embolization over a hysterectomy as a treatment of choice.
What are Uterine Fibroids?
A uterine fibroid is a small growth that can happen anywhere inside your uterus. The number, size, and location of these tumors can vary widely. If you are worried about uterine cancer, rest assured – fibroids don’t have any connection to cancers in 99% of the cases.
Although they are a type of firm tumor, uterine fibroids are benign – meaning they are not cancerous, nor do they increase your risk of catching uterine cancer, or any other type of cancer that happens to women.
What Causes Uterine Fibroids?
The tumors in uterine fibroids start from a single abnormal muscle cell on the walls of the uterus. Abnormal cells are fairly common in our bodies. While most die off quickly, others can persist and multiply, leading to tumors.
In the case of uterine fibroids, the tumor growth is triggered when the abnormal muscle cell comes in contact with the sex hormone estrogen. Since menstruating women have a very high level of estrogen in their bodies, they are at higher risk of developing fibroids between the ages of 20 and 50.
Estrogen is present in all women. However, some women are at a higher risk of getting uterine fibroids than others. This may be due to the following reasons:
- Genetics, being born into families with a history of fibroids
- Being overweight or obese
- Having high blood pressure
- Eating a diet high in red meat
- Deficiency of vitamin D
- Starting menstruation early (before age 10)
Apart from these factors, race/ethnicity also seems to have a huge impact. For instance, the risk of getting fibroids is three times higher in African American women, and two times higher in Hispanic women, when compared to the rest of the female population.
How are Fibroids Diagnosed?
Uterine fibroids are usually discovered during a pelvic exam, conducted as part of an annual women’s wellness check-up. In other instances, doctors usually suspect fibroids when women complain about certain symptoms like heavy irregular periods.
If a doctor suspects the presence of fibroids in your uterus, they will use one of the following procedures for confirmation:
- Ultrasonography
- Magnetic Resonance Imaging
- CT Scans
- Hysteroscopy
- Laparoscopy
When Do You Need Uterine Fibroids Treatment?
Uterine fibroids affect an estimated 40 million women at any given time in the United States. Out of this, around 10 million women suffer from severe symptoms associated with fibroids. Many women may not even realize that they have fibroids.
In relation to this, over time, the fibroids can grow in size and number due to continued exposure to hormones like Estrogen. After a certain point, these growths can result in painful side effects and complications related to childbirth and pregnancies.
The following are some of the common symptoms linked to uterine fibroids:
- Heavy bleeding during your periods
- Bleeding or spotting between your periods
- Pain in your pelvis, legs, or backaches
- Periods that last longer than normal
- Frequent urination, and other bladder problems
- Constipation
- Inability to get pregnant despite constant effort
Left untreated, symptoms like heavy bleeding can lead to the development of anemia in many women. When you get these kinds of severe and debilitating symptoms and have a diagnosis of uterine fibroids, your doctor may suggest further treatment to remove fibroids. In asymptomatic cases, treatment is not recommended – instead, the doctor will keep monitoring your fibroids for any indication of further growth.
Key Treatment Options for Uterine Fibroids
There are many different treatment options available to women who suffer from uterine fibroids. The optimal choice will depend on your age, the size of fibroids, the number of tumors, their location, and the severity of symptoms.
Arguably the most significant factor is your fertility goals – do you plan to have more children? If the answer is yes, then the doctor will have to rule out certain treatment options altogether from the table. We can divide the treatment options for fibroids into three broad categories:
Medications
In some cases, fibroids can be managed without surgery, using a combination of several medicines. These can include over-the-counter pain relievers like acetaminophen, iron supplements (for anemia), and certain pills to reduce bleeding.
Hormonal medications (gonadotropin-releasing hormone agonists) can help reduce the size of your fibroids. But if you stop taking them, the tumors will start growing again. Some birth control pills can also help manage fibroids since they control the supply of hormones.
Generally speaking, medication can be used in milder cases of fibroids, but may not offer lasting relief if the tumors lead to heavy menstrual bleeding, anemia, and fertility issues.
Fibroid Surgery
There are several different kinds of surgical options available to treat fibroids. While some don’t affect your fertility or ability to get pregnant, others remove these options from the table entirely. These are the main surgical options to treat uterine fibroids:
Hysterectomy
A hysterectomy is a surgery where the doctors remove your uterus entirely. In the past it was considered to be the best, most definitive solution for fibroids – when the uterus is gone, fibroids can no longer grow inside your body.
Moreover, this procedure automatically removes your ability to have any children. And if the ovaries are also removed along with the uterus, it will result in immediate menopause. You may have to undergo hormone therapies.
A hysterectomy is one of the first treatment options considered for fibroids, especially in older women nearing the end of their childbearing age. In fact, it’s the second most common surgery among women, after a C-section.
Myomectomy
These are surgical procedures that try to remove the fibroids without damaging the uterus. There are several different approaches:
- A laparoscopy uses a scope inserted into your body through small cuts in the abdomen
- A hysteroscopy uses a scope inserted into the womb through the vagina and cervix
The type of myomectomy chosen will depend entirely on the condition of your fibroids – their location, size, and numbers. Unlike hysterectomies, a myomectomy does not affect your ability to get pregnant. Your uterus will remain intact and functional after a successful myomectomy. These procedures are ideal for younger women and individuals who don’t want to lose their fertility.
But like a hysterectomy, it is still a form of invasive surgery – you will have to spend some time in the hospital. There is also the risk of further complications, albeit on a lower scale than most other surgeries.
Uterine Fibroid Embolization (UFE)
This is a relatively new treatment that emerged in the 1990s as an alternative to invasive hysterectomy and minimally invasive myomectomy procedures. It’s also called uterine artery embolization.
In uterine artery embolization, the doctors don’t cut off and remove the fibroids. Instead, they try to cut off the blood supply to shrink fibroids. This is done using special beads made of either plastic or gelatin,
The beads are inserted via a catheter into the arteries connected to the fibroid tissue. When starved of the blood supply, the tumors will slowly shrink and disappear. This could take a few months.
A UFE procedure does not require a surgeon – it’s performed by a radiologist who works alongside your gynecologist. Since it does not require surgery, UFE reduces or even removes the need for hospital stay altogether.
Uterine artery embolization also leaves your uterus and ovaries intact and unharmed – you don’t have to worry about any impact on your fertility or ability to bear more children in the future. In this regard, it is superior to a hysterectomy in nearly every aspect.
Differences Between Uterine Artery Embolization and Vaginal Hysterectomy
A hysterectomy is often the first treatment option suggested to women who suffer persistent and debilitating symptoms of uterine fibroids. The vast majority of hysterectomies are conducted as a treatment for symptomatic uterine fibroids.
However, since fibroids are not a life-threatening condition, a hysterectomy is a strictly elective procedure – you have the right to make an informed choice and pick from several alternatives.
And among these options, UFE is the one that has several clear advantages, yet remains unknown to most women. This is the reason why we are comparing and contrasting vaginal hysterectomies with uterine fibroid embolization here.
While they are both treatment options for fibroids, there are some significant differences:
Invasiveness of the Treatment
An invasive treatment is one where a surgeon has to make major incisions or cuts to gain access to the internal organs in your body. These surgeries are done either under local or general anesthesia. The wounds caused by invasive surgeries are larger and take more time to heal.
You may also end up with major surgical scars after an invasive procedure. Due to the larger scale of injury to the body, invasive surgical options come with a higher risk of further complications, pain, and infections.
Hysterectomy
Abdominal hysterectomies conducted in the past were invasive procedures where surgeons made cuts in the abdomen to remove the uterus and ovaries. Pertaining to this, over the years, less invasive versions have been developed – a vaginal hysterectomy is one such procedure.
It’s a minimally invasive procedure, where the surgeon makes an incision inside your vagina to gain access to the uterine cavity. They will then cut off and remove the uterus from the womb.
Although it’s less invasive than a total abdominal hysterectomy, a vaginal hysterectomy is still considered a major surgery.
Uterine fibroid embolization
In stark contrast, a UFE is not really a surgical procedure. It doesn’t involve any significant incisions into your skin. The specialist will make a tiny cut near your groin to gain access to an artery. Then a long thin tube is inserted into the artery to cut off the blood supply to the fibroids.
Due to this reason, UFE is considered to be a minimally invasive therapy and not any kind of surgery. The procedure is carried out by a team comprised of a radiologist and a gynecologist. You don’t need the presence of a qualified surgeon.
Hospital Stay & Anesthesia
This one is fairly straightforward and easy to understand – since it is a type of surgery, you will have to spend some time at the hospital after a vaginal hysterectomy. The procedure will also require some form of anesthesia – either general or local (spinal tap).
In rare cases, you may be allowed to leave the hospital on the same day after the surgery. With that said, most of the time, you may have to a day or two at the hospital as an in-patient for further observation.
A UFE is almost always a simpler outpatient procedure. You can leave the hospital/clinic the same day after the procedure. It’s not an in-patient procedure that does not require general anesthesia. You only need local anesthesia near the groin area for this procedure.
The Actual Procedure
There is a considerable difference between the steps involved in a vaginal hysterectomy vs a uterine artery embolization. Here is a brief, step-by-step explanation of both procedures:
Hysterectomy
- The procedure takes place inside a hospital surgery room.
- You will lie down on your back, with a position similar to the one you have during a pap test.
- They will give you general anesthesia, or a spinal tap with local anesthesia.
- The surgical area in and around your vagina is cleaned and disinfected.
- The surgeon will make an incision inside your vagina to gain access to the uterine cavity.
- The surgeon will then clamp all major blood vessels connected to your uterus.
- The uterus is then separated from all other surrounding tissue using surgical instruments.
- The surgeon removes the uterus through your vaginal opening.
- Absorbable stitches are used to prevent excess bleeding inside your womb/pelvis.
Uterine Fibroid Embolization
- The procedure can be performed in a hospital or an outpatient facility.
- You will be given local anesthesia in your groin area.
- The radiologist will make a small incision near your femoral/radial artery.
- They will then insert a thin tube called a catheter into the artery.
- Using a type of x-ray called fluoroscopy as a guide, the radiologist will move the catheter to those arteries that pump blood to the fibroids.
- Small plastic/gelatin beads are then injected into these locations to stop the blood flow.
- Once all fibroids are blocked, the catheter is removed and the incision is covered with bandages.
Healing and Recovery
Hysterectomy
You may take up to 6 – 8 weeks to recover from a hysterectomy. During this time, you will experience vaginal bleeding and discharge. Other changes can also be expected, particularly to your bowel movements, bladder function, and so forth.
Since it removes the uterus and ovaries (in some instances), a hysterectomy will bring an immediate onset of menopause. You will experience numerous physical and emotional changes associated with menopause after the surgery.
Hot flashes, loss of libido, vaginal dryness during intercourse, pelvic pressure, and insomnia are some of the most common side effects of a hysterectomy. Depression, mood swings, and other emotional trauma are also quite common.
Uterine Fibroid Embolization
Compared to a hysterectomy, UFE has a much shorter recovery period – it only takes you about two weeks to feel normal again. Since it does not involve cutting any organs, you will not experience excessive bleeding.
Instead, there may be some thick discharges, and a minor flu-like feeling for several days after the procedure. The fibroids will start shrinking within 3 – 6 months. Since the uterus and ovaries are left intact, you also don’t have to deal with the pain and discomfort of immediate menopause.
Impact on Future Fertility
Hysterectomy
After a hysterectomy, your body can longer get pregnant or give birth. It is a permanent and irreversible change when you remove the uterus and ovaries. You will also have to take hormone treatment to make up for the loss of your ovaries.
Uterine Fibroid Embolization
The UFE does not have a major impact on your fertility. In some instances, it can increase the risk of early menopause. But the procedure does not cause an immediate loss of fertility. Your uterus and ovaries remain in good health.
Recurrence of Fibroids
Hysterectomy
This is one area where hysterectomies have a significant advantage over all other treatments for fibroids – it’s a definitive procedure that successfully prevents any future risk of fibroids. This is also a reason why it is still recommended as a first-line treatment for symptomatic fibroids, despite the many side effects.
Uterine Fibroid Embolization
After a UFE, all your existing fibroids will shrink. This includes both the larger visible tumors, as well as the smaller nodules that are waiting to grow into tumors in the future. As a result, the risk of future fibroids is also considerably reduced after UFE.
Based on this, unlike a hysterectomy, you cannot completely rule out the possibility of fibroids returning after UFE. In this regard, UFE and other surgical options like myomectomy cannot compete with a hysterectomy in treating fibroids. But still, the chances of recurrence are extremely small.
Why Embolization Should be Considered Instead of a Hysterectomy
You may already have gained some ideas why a hysterectomy is not the ideal choice in many cases of uterine fibroids. In fact, according to many experts, in any case, that does not involve a form of cancer, a hysterectomy is not usually necessary.
In the past, when it was the only available effective treatment for many reproductive conditions in women, a hysterectomy for fibroids was an acceptable choice. But over the years, many less harmful alternatives have been developed.
Hysterectomy no longer deserves its status as the gold standard treatment. Here are the main reasons why a uterine artery embolization should almost always be considered as an alternative to a hysterectomy:
Future Fertility
All women deserve to have full control over their reproductive ability. Removal of that power is only acceptable, with their full consent, in situations where it is a life-or-death matter (like cancer). But uterine fibroids are benign in 99% of the cases.
Completely removing a woman’s chance to get pregnant is ethically wrong, especially when safe and viable alternatives exist. UFE has a high chance of success in removing fibroids (more than 90%) and has nearly zero impact on fertility.
If the patient is concerned about her fertility and wants to have children in the future, a hysterectomy should never be considered for the treatment of fibroids.
Emotional Aspects
This is an aspect that is not adequately covered in any discussion of hysterectomy. The uterus is an organ that most women closely identify as a symbol of their sexual/gender identity. Even in older women close to menopause, the removal of the uterus can cause considerable emotional distress.
Along with the physical impact of menopause, a hysterectomy can cause psychological distress, leading to severe depression, PTSD, and even suicidal impulses. It can often take years for many women to come to terms with the loss of their uterus.
With UFE, these concerns do not exist. It allows women to keep their uterus and ovaries intact and in perfect health while removing the fibroids altogether. This is why even in older fibroid patients, UFE is considered better than a hysterectomy.
Risk of Complications/Hospital Costs
All surgical procedures carry an element of risk. Even though a vaginal hysterectomy is a relatively non-invasive procedure, it does create trauma inside your body. The procedure requires general anesthesia and you may have to remain hospitalized for several days.
In stark contrast, UFE is not even a full surgical procedure. It can be done as an outpatient procedure and there is no need for hospitalization in most instances. This also makes better sense from a cost perspective. It’s cheaper and has a much lower risk of infection and other complications.
Visit Mark Medical Care for Safe and Effective Minimally Invasive Treatment of Uterine Fibroids
Mark Medical Care is a leading healthcare provider specializing in the non-surgical treatment of uterine fibroids, varicose vein treatments, endovenous laser treatment (EVT), and other advanced artery treatments and aesthetic care services. We have offices in six locations across Long Island, Manhattan, and Queens.
You can rely on Mark Fibroid Care for a safe, effective, non-surgical treatment of your uterine fibroids using arterial embolization. If you suspect that you have uterine fibroids, and want to explore UFE as an alternative to a hysterectomy, schedule an appointment with us using the form available here at Mark Fibroid Care.