Exploring minimally invasive options for fibroids

It can happen to any woman. Your symptoms included heavy or irregular bleeding and pressure in the lower abdomen. On exam your doctor detects an enlarged uterus and further tests (ultrasound, MRI or CT scan) shows uterine fibroids. You may even be anemic, with low blood counts.

Your doctor recommended a hysterectomy, but you are hesitant, and want to make sure you know about all of your options before you make a decision.

Washington University physician Scott Biest, MD, and his team are specialists in minimally invasive gynecology. Dr. Biest says, “For many women, the decision to have a hysterectomy is a quality-of-life-issue. Other treatment choices may be considered, but depending on an individual’s situation, these options may be less effective at resolving a patient’s symptoms.”

For instance, heavy menstruation can be treated with birth control or other types of pills, injections, or an intrauterine device (IUD). There is also a minor surgery called an endometrial ablation, which burns the lining of the uterus. However, all of these options are more effective in women with a normal uterus than in women who have a uterus enlarged by fibroids.

Additionally, these options only treat heavy bleeding and do not do anything to change the size of the fibroids, so any pain or pressure symptoms are not likely to improve. And finally, patients may elect to have a uterine artery embolization. During this procedure, a radiologist injects substances into the blood vessels supplying the fibroids. This can to reduce their size by about by about one-third to one-half, which is sometimes enough to decrease symptoms.

Dr. Biest advises, “Surgical options are very effective to stop bleeding and improve pain, and may be the best option when a woman has large fibroids. Surgeries include myomectomy (removal of fibroids), and hysterectomy (removal of the uterus and fibroids). The ovaries, which produce a woman’s hormones, do not have to be removed.”

Both of these surgeries can be minimally invasive procedures — performed through small incisions. Benefits of minimally invasive surgery include less pain, shorter hospital stay (typically same day or one overnight stay), and faster recovery with fewer complications.

A minimally invasive approach may be possible even if you have large fibroids or multiple prior surgeries. If you have been told you are not a candidate for a minimally invasive surgery, and your doctor is planning on making a large incision, second opinion appointments are available.

Minimally invasive surgery can be utilized not only for fibroids, but also for other conditions such as ovarian masses, pain from endometriosis and uterine prolapse. Your doctor should explain your diagnosis and discuss the full range of treatment options, in order to allow you to make the best decision for yourself. If surgery is planned, your doctor should go over in detail what to expect before, during and after surgery.

Dr. Biest adds, “In all of these cases, our goal is to treat women and resolve the problem with minimal disruption to their life.”

For more information on minimally invasive gynecologic surgery, to make an appointment or arrange a second opinion, please call 314-747-5470. The team sees patients at:

  • Barnes-Jewish Center for Outpatient Health, 4901 Forest Park Ave., Suite 710, St. Louis, MO 63108
  • Missouri Baptist Medical Center, Building D, 3023 N. Ballas Rd., Suite 450, St. Louis, MO 63131