The OBGYN and Non-Surgical Approaches to Care: The Right Approach?
THE SCENARIO
You’ve got fibroids and you’re at your OBGYN’s for treatment advice. You’re experiencing heavy bleeding, pain, pressure, bloating, frequent urination, and you’re concerned about fertility. Your OBGYN says you have “non-surgical” options: embolization, which blocks fibroids’ blood supply, Accessa or Sonata, which heat fibroids in the uterus, or medical therapy. Surgery is also an option to remove the fibroids.
Most patients naturally prefer non-surgical options, especially if they promise less pain while still treating the fibroids.
The reason is simple: Surgery is scary and is associated with a hospital, “going under the knife” or getting “cut open” and with severe pain and a longer recovery than other less invasive non-surgical approaches.
But is that actually true?
In fact it is NOT. Lets take a look at Embolization or UFE, one of the most commonly used “non-surgical” approaches for fibroid treatment.
Embolization (UFE)
Embolization aims to cut off the blood flow to uterine fibroids, but it often leads to increased pain and a lengthier recovery compared to minimally invasive fibroid removal procedures. As the fibroids lose their blood supply, they die within the uterus, triggering uterine contractions and pain, or they may discharge through the vagina.
Embolization may not be suitable for all fibroids. It's crucial to understand that with embolization, the fibroids remain in place; the expectation is that they will shrink over time, alleviating symptoms. However, because the fibroids aren't physically removed, symptoms like bleeding, pain, bloating, and frequent urination may persist for months, years, or indefinitely, as some fibroids may not respond to this treatment.
Minimally Invasive Procedure Vs. Embolization (UFE)
Opting for a minimally invasive fibroid removal procedure, which typically takes an hour or less, swiftly alleviates the bleeding, pain, bloating, distension, and urinary issues associated with fibroids. Upon waking from the surgery, these symptoms vanish, and you can return home the same day, often experiencing less pain and for a shorter duration compared to embolization. Conversely, embolization often induces severe pain lasting two weeks or more, actually intensifying discomfort.
Embolization can impact fertility options significantly. It heightens the risk of miscarriage because the fibroids remain in place post-procedure. Moreover, there’s a possibility that the plastic particles employed in embolization might drift towards the ovarian blood supply, potentially disrupting normal ovarian function. Given that ovaries produce eggs crucial for pregnancy, any harm inflicted on them could profoundly impede the chances of conception.
Radiofrequency Ablation
OBGYNs offer alternative non-surgical methods for fibroid treatment, such as radiofrequency ablation (Accessa, Sonata), although neither is FDA-approved.
These procedures involve inserting needles into the fibroids to heat them and attempt to eradicate them. Similar to embolization, the fibroids remain in place, and symptoms persist. Neither of these procedures is recommended for patients seeking pregnancy. Another option, MRI-guided ultrasound for fibroids, requires multiple treatments over an extended period but is less successful than other methods, particularly for patients desiring fertility.
Medical Options
Medical options are also available for fibroid treatment.
These medications aim to reduce fibroid size by lowering estrogen production from the ovaries, often necessitating at least six months to take effect. Examples include Orilissa, Orihann, MyFemBree, and Lupron. Since estrogen promotes fibroid growth, reducing its production can trigger menopausal symptoms like hot flashes, night sweats, depression, anxiety, painful intercourse, sexual dysfunction, bone loss, and others, which younger patients typically find challenging to endure long-term. Consequently, many discontinue the medication without resolving the fibroids or their symptoms.
