This content is sponsored by The Center for Innovative GYN Care
Medicine advances over time, often challenging long-held beliefs about what it means to have surgery. When it comes to gynecological conditions, it is important to have the facts based on the most up-to-date research when seeking the best possible treatments.
Women who have fibroids often have difficulty with heavy bleeding, pelvic pain, difficulty going to the bathroom and depending on their location, many experience infertility or miscarriages. When a large number of people have a complex medical condition, it is common that there will be misconceptions about what treatments are most effective. Cost, effectiveness, and risks to fertility are all important elements to understand before choosing a treatment from the array of options.
MYTH NUMBER 1: IT’S OK TO JUST WATCH FIBROIDS AND WAIT ON TREATMENT
FACT: Fibroids are unpredictable. Watching them can lead to complications. In many cases, especially as hormones change, fibroids can grow very large, very fast. Risks of heavy blood loss each month can have serious consequences. When they cause heavy bleeding, there is a high risk of anemia, which can be life-threatening.
“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.”
MYTH NUMBER 2: AFTER EMBOLIZATION OR ABLATION, PREGNANCY IS STILL POSSIBLE
FACT: Alternative fibroid therapies including uterine fibroid embolization or uterine artery embolization (UFE or UAE), radiofrequency ablation or MRI guided ultrasound are not always effective, and are not recommended for women who want to get pregnant. As women look for the best treatment options available, knowing which ones will help maintain fertility is important, especially for women who have faced difficulties getting pregnant due to the fibroids themselves.
The uterine lining needs to be preserved in order for an embryo to attach. If the blood flow to the uterus is compromised due to embolization, or the lining itself is compromised, women have a higher risk of not conceiving or miscarrying.
“Reviewing all of the fibroid removal treatments available, choosing one that has the best long-term effects 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.”
MYTH NUMBER 3: A MYOMECTOMY IS LESS INVASIVE THAN A HYSTERECTOMY
FACT: Even with minimally invasive procedures, a myomectomy is more invasive than a hysterectomy, because the patient has to heal in many layers. The incisions made in the uterus to remove the fibroids need to be thoroughly repaired to ensure it is strong enough to carry a growing fetus. It takes 3 months for full recovery from any myomectomy procedure before it is possible to start trying to conceive.
The benefit of newer minimally invasive techniques is that women are able to return to their lives faster after surgery so that they are in a better place emotionally and physically to start trying to conceive as soon as they are cleared by their doctor. Robotic procedures can take between 4-6 weeks to recover, and open procedures can take up to 2 months. Being in pain and limited mobility for that amount of time can get in the way of planning for a family.
Many women who are done having children and are prone to fibroids need to weigh the pros and cons over keeping their uterus as fibroids do not disappear after menopause. While fibroids will not continue to grow after menopause, and it may appear as though existing fibroids are shrinking, it is the lack of blood supply to the uterus that causes the fibroids to get smaller. In many cases they can become necrotic as they begin to die off, which causes inflammation in the uterus.
A myomectomy after fertility is no longer possible is a much higher-risk surgery than a hysterectomy. For many surgeons, they will not consider performing fibroid removal alone because of the risks to the patient. With safer hysterectomy procedures available that allow a woman to retain her ovaries, surgical menopause can be avoided and patients can recover faster.
MYTH NUMBER 4: ONCE FIBROIDS ARE REMOVED, THEY CAN’T GROW BACK
FACT: Effectiveness of fibroid treatments and the likelihood of recurrence must be weighed carefully. Fibroids are unpredictable. After some treatments, new fibroids can grow. The only cure for fibroids is a hysterectomy.
The financial burden for repeated fibroid treatments can be overwhelming 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.
MYTH NUMBER 5: MY OB/GYN IS THE BEST PERSON TO PERFORM A MYOMECTOMY. I DON’T NEED A SECOND OPINION.
FACT: It is important to have a great relationship with an OB/GYN since often obstetrics or gynecological visits can be stressful. But, when it comes to performing complicated gynecological surgery for complex conditions like removing large fibroids, especially when preparing for fertility treatments or trying to conceive naturally, it is essential to seek a minimally invasive GYN surgical specialist.
Fellowship trained minimally invasive GYN surgeons focus only on advanced laparoscopic procedures and have the skill and experience necessary to remove all fibroids and thoroughly repair the uterus. The best solution is to find a surgeon who is highly skilled to perform a minimally invasive myomectomy, and who consults with an established provider to ensure a full circle of care. Look for a minimally invasive GYN specialist who performs fibroid removal without the use of a robot, to ensure all fibroids can be removed, including small fibroids that are often undetected unless felt by the surgeon’s hand.
ADVANCED FIBROID REMOVAL OPTIONS AT CIGC
The DualPortGYN technique for hysterectomy and LAAM minimally invasive fibroid removal technique for fertility were developed by the minimally invasive GYN surgeons at The Center for Innovative GYN Care.
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 for fertility uses 2 small incisions, one 5mm incision at the belly button, and another 1.5 inch incision at the bikini line. Recovery is 10 days to 2 weeks for a return to a normal routine, and 3 months to begin trying to conceive. Myomectomy is not recommended for women who are past childbearing.
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