Fertility-Sparing Fibroid Treatments: Alternatives to Hysterectomy

Uterine fibroids are an undeniably common condition in reproductive-aged women. Women who have lived with fibroids know that they can cause a whole host of issues, like heavy menstrual bleeding and pelvic pain. Because most cases of fibroids are diagnosed by a surgically-trained gynecologist, women are often offered hysterectomy as a first-line treatment for their fibroids.

It’s no coincidence that 29% of women diagnosed with uterine fibroids in the United States undergo hysterectomy, [1] or that hysterectomies account for around 65% of all fibroid interventions. [2] Hysterectomy is a clinically proven approach to resolve fibroid symptoms and is the only treatment available that completely ‘cures’ fibroids. But this major surgery is not without its drawbacks. One of the biggest downsides of hysterectomy is that it eliminates the potential for any future pregnancy. This can be especially challenging for women who have several childbearing years left, as they may later regret being hysterectomized.

It’s unclear if hysterectomy is the dominant choice amongst women with fibroids because they do not want to bear children down the line, or if any of these women are unaware that alternatives to hysterectomy are available to them. In any case, the decision to be hysterectomized is not a trivial one, which is why I encourage my readers to explore all of their options before deciding that hysterectomy is their best path forward. Modern medicine has seen the advent of ‘fertility-sparing’ fibroid treatments that can provide symptom relief without compromising the function of the uterus.

Fertility-Sparing Fibroid Treatments

Myomectomy

Myomectomy, like hysterectomy, is a major surgical procedure that is used to treat fibroids. Unlike hysterectomy, myomectomy removes the fibroids without removing the uterus, so it’s possible to get pregnant afterward. [3] The two treatments are equally effective according to comparative clinical studies and have similar outcomes when it comes to the hospital stay, recovery time, symptom relief, and patient satisfaction. [4]

Uterine Artery Embolization

Uterine artery embolization also called uterine fibroid embolization (UFE), is a non-surgical procedure that shrinks fibroids by cutting off their blood supply. The UFE procedure involves the injection of micro-sized beads into the arteries that feed the fibroids. Fibroids rely on their own blood supply from the uterine arteries to maintain their size, so cutting off their blood supply causes them to ‘starve’ and shrink. [4] While hysterectomy and myomectomy are usually performed by a gynecologist, the UFE procedure is performed by a vascular specialist, a doctor that specializes in minimally invasive image-guided procedures. Because the procedure does not require any major incisions, it has the added advantage of providing fibroid relief with minimal recovery time. [4] Although this is a unique, non-surgical approach, comparative clinical studies have shown that UFE is just as effective as hysterectomy and myomectomy when it comes to patient satisfaction and symptom relief. [4]

DIETARY SUPPLEMENTS

Preliminary clinical studies have shown that green tea extract (EGCG) or vitamin D supplements (25-OH-D3) may help to shrink fibroids, [5,6] but these findings have not been substantiated to the extent of other approaches. In general, dietary supplements are not recommended as a substitute for evidence-backed treatments like UFE, myomectomy, or hysterectomy.

PRESCRIPTION MEDICATIONS

Hormone-modifying medications, including gonadotropin-releasing hormone (GnRH) agonists, depot-medroxyprogesterone acetate (DMPA), and progestin-based contraceptives (birth control pills) may be prescribed to provide relief from bleeding and painful periods. [7] Medications that are used to manage fibroid symptoms work by altering the balance of hormones in your body. By consequence, they tend to have a number of side effects that some women may find intolerable, and they may not be appropriate if you’re pregnant or planning to get pregnant. We encourage our readers to consult with a physician prior to taking any new medications.

CLOSING THOUGHTS

Hopefully this overview has helped you get a better handle on your treatment options. In general, if you’ve been told that you need to have a hysterectomy, I encourage you to continue exploring your treatment options before deciding on what makes the most sense for you. Hysterectomy is final, after all. And if you’re a practicing medical professional, I encourage you to investigate alternatives to hysterectomy if you haven’t already, especially for patients of yours that express concerns about their ability to become pregnant in the future.

About the Author

Dr. Aaron Fritts is a practicing vascular and interventional radiologist with Interventional and Vascular Care in Dallas, TX. Dr. Fritts is passionate about helping women overcome the debilitating symptoms of uterine fibroids. In addition to patient care, Dr. Fritts is the founder of the BackTable Podcast, an educational platform for practicing vascular and interventional specialists.

References

[1] Zimmermann, A., Bernuit, D., Gerlinger, C., Schaefers, M., & Geppert, K. (2012). Prevalence, symptoms and management of uterine fibroids: An international internet-based survey of 21,746 women. BMC Women’s Health, 12(1), 6.

[2] Bonafede, M. M., Pohlman, S. K., Miller, J. D., Thiel, E., Troeger, K. A., & Miller, C. E. (2018). Women with Newly Diagnosed Uterine Fibroids: Treatment Patterns and Cost Comparison for Select Treatment Options. Population Health Management, 21(S1), S-13-S-20.

[3] Karlsen, K., Hrobjartsson, A., Korsholm, M., Mogensen, O., Humaidan, P., & Ravn, P. (2018). Fertility after uterine artery embolization of fibroids: a systematic review. Archives of Gynecology and Obstetrics, 297(1), 13–25.

[4] Meta-Analysis

[5] Al-Hendy, A., Roshdy, Rajaratnam, Maitra, Sabry, M., & Ait Allah. (2013). Treatment of symptomatic uterine fibroids with green tea extract: a pilot randomized controlled clinical study. International Journal of Women’s Health, 477.

[6] Baird, D. D., Hill, M. C., Schectman, J. M., & Hollis, B. W. (2013). Vitamin D and the Risk of Uterine Fibroids. Epidemiology, 24(3), 447–453.

[7] Singh, S. S., & Belland, L. (2015). Contemporary management of uterine fibroids: focus on emerging medical treatments. Current Medical Research and Opinion, 31(1), 1–12.