1. The “watch and wait” method
When small fibroids don’t cause significant problems such as abnormal bleeding, infertility, or painful periods many doctors advise ‘watchful waiting’.
Over time, many fibroids start shrinking on their own. These tumors tend to form at reproductive age, grow larger with pregnancy, and shrink after menopause.
If you want to try the watch and wait method, see a doctor first and make sure that what you have is definitely fibroids. Other types of growths need immediate medical intervention.
2. Uterine Fibroid Embolisation (UFE)
UFE is recommended as a non-surgical alternative for patients who want to avoid open surgery or have risks resulting from surgical complications, a history of keloid scars (an overgrowth of scar tissue), blood clots, or medical conditions that may complicate aneasthesia.
In Kenya, the services are available at Agakhan University Hospital. “This procedure is also an option for patients who may wish to conceive in the future,” says Dr Timona Obura, Aga Khan University Hospital. A tiny nick in the skin is made to allow a fine catheter to be passed into a blood vessel.
The catheter tip is moved along the blood vessels until the uterine arteries are reached. A substance is then injected to block the uterine arteries. All this is followed on an X-ray screen by a radiologist.
3. Hysteroscopic fibroid resection
A hysteroscopic fibroid resection is a technique, which uses a telescope inside the uterus to remove fibroids that are protruding into the cavity of the uterus.
No external cut is required, all the surgery is performed via the birth canal. The cervix (neck of the uterus) is gently stretched and a hysteroscope (small telescope) is then inserted through the cervix into the uterus.
The hysteroscope gives a view of the uterine cavity and has a surgical loop at its end that is used to remove (or ‘resect’) the fibroids.
4. Laparoscopic myomectomy
In laparoscopic myomectomy, fibroids are removed surgically via small incisions of 0.5 cm to 1.5 cm made on the abdominal wall.
It is useful where the fibroids are mainly located on the outside part of the uterus. This allows quicker recovery than an open myomectomy.
A myomectomy can help to remove the existing tumors, but it will not prevent them from growing back. (Only lifestyle changes can help to balance the body and promote hormonal balance).
5. Hysteroscopic myomectomy
Only women with submucosal fibroids—fibroids that grow into the inner cavity of the uterus, are eligible for a hysteroscopic myomectomy.
This is an outpatient surgical procedure. A speculum is placed in the vagina. A long, slender ‘telescope’ is placed through the cervix into the uterine cavity.
Fluid is introduced into the uterine cavity to lift apart the walls. Instruments passed through the hysteroscope are used to shave off the submucosal fibroids.
7. Open myomectomy
This is a suitable option for large symptomatic fibroids in a patient aiming to preserve the potential for childbearing.
It involves making an incision through the skin on the lower abdomen, known as a “bikini cut,” and removing the fibroids from the wall of the uterus.
8. Abdominal hysterectomy
This is sometimes recommended for patients who have completed their family and have large fibroids. It is a surgical procedure that removes your uterus through an incision in your lower abdomen.
It is recommended if one has a large uterus.
9. Vaginal hysterectomy
It may be suggested for patients with ‘medium size’ fibroids and have also completed their family.
During a vaginal hysterectomy, the surgeon detaches the uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it.
The uterus is then removed through the vagina. However, only women with a relatively small fibroid, small uterus, and no previous caesarean sections can have this.
10. ExAblate – Focused Ultrasound Therapy (MRgFUS)
A relatively new way to eliminate uterine fibroids is through a non-invasive technique using high doses of focused ultrasound waves (HIFU).
This procedure destroys the uterine fibroids without damaging the surrounding uterine tissue.
As an outpatient procedure, doctors perform ExAblate in a magnetic resonance imaging (MRI) scanner, which allows the doctor to “see” inside of the body and target the uterine fibroids with HIFU.