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Effectiveness of fibroid treatments and the likelihood of recurrence must be weighed carefully
The expanding landscape of fibroid treatments can lead women to choose less effective options that may affect their long-term health, including fertility.
Fibroids are unpredictable. After some treatments, new fibroids can grow again. Depending on a patient’s insurance, or whether or not the specialist even accepts insurance, if multiple treatments are required, it can be expensive. Finding a laparoscopic fibroid expert who specializes in advanced fibroid removal and hysterectomy, who also accepts insurance is important.
“Reviewing all of the fibroid removal treatments available, choosing one that has the best long-term effects and is covered by insurance is essential to great patient care,” said Paul MacKoul, MD. “It is also important to know which treatments are meant to be alternatives to hysterectomy, and which preserve fertility. Treatments like UAE/UFE, and ablation are not advised for women who want to get pregnant. It’s a balancing act for many women navigating the array of options. Cost, effectiveness, and risks to fertility are all important elements to understand before choosing a treatment.”
The long-term effects of alternative fibroid treatments may leave some women who are trying to save their uterus unable to conceive. In some cases, the treatment makes it impossible for an embryo to attach to the uterus.
Alternatives to Surgical Fibroid Removal Have Limitations & Risks
- Radiofrequency ablation, uterine fibroid (or artery) embolization, and MRI guided ultrasound
- Their effectiveness in treating multiple fibroids varies.
- Women with large fibroids are not candidates.
- Fertility is not assured.
- Birth control or progesterone do not affect number or size of fibroids.
- Lupron: Can only be taken for a year. Reduction in size is often not significant enough to put patients through the side effects of temporary menopause, including hot flashes and bone loss. After medical treatment, the fibroids will regrow, and the patient will still require further treatment.
When multiple treatments are required, the same rules about efficacy apply.
“The message here is anyone with fibroids should see a fibroid specialist and determine if they are at a size where they should be addressed right away,” said Rupen Baxi, MD. “If they are really small, the size of seeds, then the patient may not need surgery immediately, however, women who are prone to fibroids should have an ultrasound once a year to make sure that no new ones are growing.”
“Once fibroids are in the uterus they will continue to grow,” said Natalya Danilyants, MD. “Eventually, these fibroids are going to cause problems. Women who are planning to have children, you don’t want to wait to get to the point where your fibroids are large. Those large fibroids can cause irreversible damage to the uterus, or similarly choose a treatment method that affects fertility.”
Facts About Fibroids & Fibroid Removal Surgery
- approximately 30 percent of women by age 35
- between 70 percent and 80 percent by age 50
- fertility, and can cause miscarriage, or pre-term birth
- African American women two to three times more frequently than white and Hispanic women. African American women are more likely to develop problems with fibroids at an earlier age, with the fibroids growing faster, becoming larger, and causing more bleeding and anemia than in women of other races.
Robotic and standard laparoscopic fibroid surgery:
- are limited in the size and number of fibroids that can be removed, and also limited by the location of the fibroids.
- require between 4 to 5 incisions that go through the abdominal muscle.
- recovery is up to 2-4 weeks.
Open procedures are often performed by surgeons who have little to no training in laparoscopy, and in many cases are just to remove one fibroid. This procedure leaves a large scar and has a painful recovery of 6-8 weeks. For women who need multiple surgeries over time, this can be prohibitive both in cost and time.
Thorough Laparoscopic Fibroid Removal Options
For women who are past childbearing, or whose uterus is significantly damaged by the fibroid, hysterectomy is the recommended surgery. Hysterectomy is the cure for fibroids. Once removed, fibroids will no longer grow in the pelvic cavity.
Myomectomy is recommended for women who are of child-bearing age, and based on the condition of the uterus, are able to carry a child to term. The uterus needs to be healthy for an embryo to attach, and strong in order to carry a baby the full length of a pregnancy.
DualPortGYN uses two 5mm incisions, one at the bikini line and one at the belly button. Most hysterectomy procedures are completed in under an hour, and patient recovery is about a week.
LAAM uses 2 small incisions, one 5mm incision at the belly button, and another 1.5 inch incision at the bikini line. LAAM allows the surgeons to thoroughly remove all fibroids, no matter the size, location or number, and the uterus is repaired by hand. The surgeon is able to feel all of the fibroids. This cannot be accomplished by a robot or with standard laparoscopy. LAAM patients are back to themselves in 2 weeks or less.
Knowing what to ask about fibroid treatments, including thoroughness of the procedure, risks to fertility, costs, and ensuring providers accept insurance will help women find the right fibroid specialist from the start.
CIGC is dedicated to providing information and materials for women to help navigate the complicated healthcare system. CIGC minimally invasive GYN surgical specialists Dr. Paul MacKoul, MD and Dr. Natalya Danilyants, MD developed their advanced GYN surgical techniques using only two small incisions with patients’ well-being in mind. Dr. Rupen Baxi, MD is a CIGC-trained minimally invasive GYN specialist with extensive fellowship training and a respected speaker and researcher. Book a consultation at The Center for Innovative GYN Care or call 888-787-4379.