Uterine fibroids are small growths that can develop within the lining of the uterus in women of reproductive age. They are usually noncancerous, though they can be painful and cause problems with menstruation and urination. Gynecologists typically avoid treating very small, symptom-free fibroids, though large or persistent growths may need to be removed via one of many different methods of surgical excision. The most common techniques for fibroid removal include uterine artery embolization, endometrial ablation, and myomectomy. In addition, some patients undergo partial or full hysterectomies if other methods of fibroid removal are unsuccessful.
Uterine artery embolization is a minimally-invasive procedure that is administered by a radiologist to cut off blood flow to small fibroids. The doctor makes a small incision in the upper groin region and inserts a catheter into the femoral artery. A tiny bit of plastic is injected through the catheter and directed to the blood vessels that feed fibroids. There is a femoral artery on each side of the groin, so the procedure is usually repeated. With blood supply cut off, the growths shrink and fall off within a few days.
Endometrial ablation, another option for fibroid removal, is generally performed when masses are very close to the surface of the uterine lining. A surgeon inserts a long wire into the uterus and supplies an electrical current to burn away surface tissue. Other versions of the procedure involve using concentrated liquid nitrogen to freeze fibroids or a high-intensity laser to cauterize them. Ablation is generally a very effective means of fibroid removal, but the surgery can cause permanent damage to the walls of the uterus. A woman may not be able to get pregnant after undergoing the procedure.
Fibroids that are sporadic, large, and well-defined can often be removed via classical surgical procedures, in which they are simply sloughed off with a scalpel. Modern technology allows surgeons to perform most myomectomies without needing to make large incisions in the abdomen or groin. Instead, a tool called a hysteroscope is inserted through the vagina. A hysteroscope is essentially a long tube with a camera that lets the surgeon locate fibroids and monitor the procedure. The surgeon manipulates tiny scalpels and other equipment through small incisions in the groin region to cut away fibroids.
It is possible for growths to return even after a successful fibroid removal procedure. A woman who experiences repeat episodes may need to undergo a hysterectomy to stop the associated pain and bleeding. The surgery may be performed through the vagina or through incisions in the abdomen, and a woman can expect to be hospitalized for several days so that doctors can monitor her recovery. By having her uterus removed, she can be certain that fibroids will never grow back.