Getting Rid of Fibroids Without Surgery?

For treating uterine fibroids without resorting to surgery, several non-invasive and minimally invasive options are available. However, it is essential to note that not all fibroids require treatment, especially if they are asymptomatic or do not cause significant discomfort. The choice of treatment depends on various factors, including the size and location of the fibroids, as well as the symptoms. Here is an overview of the main non-surgical therapies, their indications, and the conditions required for their application.

1. High-Intensity Focused Ultrasound (HIFU)

Indications:

• Single or multiple fibroids.

• Size: Generally suitable for small to medium-sized fibroids.

• Conditions required: The fibroid should be well-localized, and access to the uterus should be adequate for the technique.

  
  

Principle: HIFU uses focused ultrasound waves to heat and destroy fibroid tissue. This method is non-invasive and does not require incision.

2. Uterine Artery Embolization

Indications:

• Large or symptomatic fibroids.

• No desire for pregnancy: Embolization is not recommended for women who wish to conceive, as it may affect fertility.

  
  

Principle: This procedure involves blocking the arteries supplying blood to the fibroids, leading to their reduction or disappearance.

3. GnRH Agonists

Indications:

• Symptomatic fibroids.

• Short-term goal: Often used as a pre-operative treatment or to reduce symptoms before an intervention.

  
  

Principle: GnRH agonists lower estrogen production, leading to a temporary reduction in fibroids and associated symptoms.

4. Radiofrequency Ablation (Sonata)

Indications:

• Fibroids located inside the uterus.

• Size and location: Fibroids should be well-localized and of moderate size.

  
  

Conditions required: Sonata treatment is generally reserved for women whose fibroids are well-visualized by imaging and whose anatomical conditions allow for an effective intervention.

5. Medical Treatments

Indications:

• Mild to moderate symptoms.

• Option for women: Medical treatments can be used to alleviate symptoms but do not eliminate the fibroids.

  
  

Principle: Medications like progestins or hormonal contraceptives can reduce bleeding and improve symptoms, but do not decrease fibroid size.

Note on Fertility:

• Submucosal Fibroids: Medical recommendations suggest that for a woman wanting to conceive and presenting with a submucosal fibroid of 3 cm, surgical myomectomy may be considered if the fibroid deforms the uterine cavity and is associated with symptoms or infertility. However, there is no clear evidence of the benefit of myomectomy on fertility. Removing a fibroid that deforms the uterine cavity may potentially improve the uterus’s ability to support a pregnancy and increase successful conception chances. After a myomectomy, it is generally recommended to wait between 3 to 6 months before attempting conception, to allow for adequate healing of the uterus and reduce the risk of complications during pregnancy.

  
  

• Other Risks and Recommendations: Although myomectomy is generally safe, it carries risks such as post-operative bleeding (about 3% of cases) and rare complications like uterine perforation (about 0.5% of cases). Subserosal fibroids do not affect fertility, and their removal provides no benefit. Intramural fibroids ≥5 cm may require intervention before in vitro fertilization (IVF). Medical treatments and non-invasive techniques like RFA or HIFU can be considered depending on the size and location of the fibroids.

Conclusion

Non-surgical treatments for fibroids offer effective alternatives tailored to individual needs. The choice of treatment should be discussed with a healthcare professional to determine the best option for your specific situation.

Take care of yourself and consult a specialist to determine the best approach for your case.

Cordialement,

Dr. Sandra Yene Amougui