Alternative Uterine Fibroid Treatments

Alternative uterine fibroid treatments at a glance

  • Uterine fibroids affect about 40 percent of women over the age of 35 and while they are not often discussed, there are many nonsurgical treatments for uterine fibroids.
  • Alternative uterine fibroid treatments include medication, uterine artery embolization, MRI-focused ultrasound therapy and laparoscopic radiofrequency ablation.
  • A new medication ulipristal acetate has also been proven to be effective in reducing the size and minimizing the symptoms of uterine fibroids.

What are nonsurgical uterine fibroid treatments?

Uterine fibroids are noncancerous growths on the muscle wall of the uterus. These often cause no symptoms, but if they are large enough they can prevent proper embryo implantation and lead to a miscarriage. Many women do not know about nonsurgical options to treat uterine fibroids. While surgery is a common and effective treatment for uterine fibroids, it is not the only treatment.

Two main types of surgeries are used to treat uterine fibroids, hysterectomy and myomectomy. During a hysterectomy, the entire uterus is removed, along with the fibroids. This treatment will cure the uterine fibroids but will also leave the woman unable to become pregnant and in menopause. Myomectomy surgery removes only the uterine fibroids, leaving the uterus in tact and able to carry a baby, should the woman want to become pregnant in the future.

While surgery is one of the most effective treatments for uterine fibroids, there are other methods to decrease the size and reduce the symptoms of uterine fibroids, such as pain and vaginal bleeding.

Medication

Medication for the treatment of uterine fibroids is a great option for women who do not want to have surgery and do not necessarily want to get pregnant in the future. Hormonal medications can be helpful in reducing the size and symptoms of fibroids. One new medication available in Canada but not yet in the United States for treating fibroid symptoms is ulipristal acetate.

Ulipristal acetate targets progesterone receptors to reduce the size of uterine fibroids and the intensity of vaginal bleeding. The progesterone hormone is normally secreted by the ovary after ovulation and progesterone enhances the growth of uterine fibroids. Blocking the action of progesterone can decrease the fibroid’s size.

If a woman discontinues medication for the treatment of uterine fibroids, the fibroids will gradually return to the pretreatment size and symptoms can return. This medical treatment can be helpful as a pretreatment before surgery or to bide time and try to avoid surgery.

Uterine artery embolization

Uterine artery embolization (UAE), also called uterine fibroid embolization, was introduced in the 1970s and was one of the first nonsurgical treatments for uterine fibroids. Uterine artery embolization involves injecting tiny particles into the blood vessels that supply the fibroid. The particles are designed to block the blood flow to the fibroid, which will cause the fibroid to shrink and die.

During a uterine artery embolization procedure, the doctor inserts a catheter into the femoral artery of the upper thigh. An X-ray contrast dye is then injected through the catheter and travels through the blood vessels to the uterus. The radiologist then uses a real-time X-ray on a screen, called a fluoroscopy, to view the arteries and pinpoint those that supply the fibroid.

The doctor can then guide the catheter to those arteries and deposit polyvinyl alcohol (PVA) particles into the artery to create a blockage. The blockage will prevent blood from reaching the fibroid and the fibroid will shrink and die.

Uterine fibroid embolization is an option for women with fibroids who do not want a hysterectomy, which would remove the uterus along with the uterine fibroids and render the woman infertile. Even though uterine fibroid embolization allows a woman to keep her uterus and delay menopause, it is not a procedure that is recommended for woman who wish to have children because there are risks of damaging the ovaries or uterus, which would make getting pregnant more complicated.

MRI-focused ultrasound therapy

Magnetic resonance imaging (MRI)-focused ultrasound therapy is a noninvasive treatment for uterine fibroids. This procedure uses high doses of focused ultrasound waves to destroy the uterine fibroid without damaging the surrounding tissue.

During the procedure, the patient lies in an MRI scanner while the ultrasound waves, or sonications, are delivered. Through the MRI the doctor can monitor the treatment in real time.

The sonications are targeted to a small section of the fibroid and the energy heats the tissue enough to cause tissue ablation, which occurs when tissue is heated enough to be destroyed. Depending on the size or number of fibroids, the process can take up to three hours and include more than 50 sonications. After the procedure, the patient’s body will gradually dispose of the treated tissue, which will provide symptom relief.

Women who have had previous abdominal surgery or have abdominal scars such as a cesarean section scars are not candidates for MRI-focused ultrasound therapy. Also, pregnancy after this procedure has not been studied, so this treatment is only recommended for women who are no longer interested in becoming pregnant.

Laparoscopic radiofrequency ablation

This procedure involves use of laparoscopy and the insertion of a needle electrode into the fibroid causing tissue destruction and shrinkage of the fibroid. The early studies treated women with fibroids less than 7 cm. The advantages of this approach over laparoscopic s is less blood loss. The technology is known as the Acessa System and has been approved for commercial use in the U.S., Mexico, Canada and the European Union for the treatment of symptomatic uterine fibroids.

There is insufficient data at this time regarding the safety of the Acessa procedure in women who plan future pregnancy and it is not yet known how it may affect fertility. Therefore, the procedure is not recommended for women who are planning future pregnancy.

Why choose nonsurgical treatment for uterine fibroids?

Fibroids are a very common medical condition that affects about 40 percent of women over the age of 35. Each of those women have different health and lifestyle goals that can influence their type of uterine fibroid treatment.

A woman over the age of 50 who won’t have more children may decide to have a hysterectomy for the most definitive treatment. But for younger women or for women who want to avoid a major surgical procedure such as a hysterectomy, UAE, MRI-focused ultrasound, medications or the Acessa procedure offer other options.