Removal of the fibroids (myomectomy) is usually the treatment of choice for women with fibroids who prefer to maintain the ability to become pregnant.
If a uterine fibroid is subserosal, it may be easily removed laparoscopically. Intramural fibroids may be removed laparoscopically but in some cases, it may be best to make a little larger incision just above the pubic bone and remove the fibroids that way. This procedure, called a laparotomy, is usually performed if there are many fibroids, if the fibroid(s) are deeply imbedded in the uterine wall, if the fibroids are very close to the insertion of the fallopian tube, or if a large fibroid penetrates through the wall into the uterine cavity. We also perform laparotomies for fibroids that are too large to safely remove through the laparoscope.
If a fibroid is removed from within the wall of the uterus, we will usually advise the patient that she will require a cesarean section for subsequent delivery. This is important, as once the uterine wall heals, it is not as strong as it was before the fibroid (and subsequent surgery for fibroid removal) affected it.
Alternative Treatments for Fibroid Removal
Another option for treating fibroids is a procedure called uterine artery embolization (UAE). During this procedure, performed by an interventional radiologist, small coils of material are placed into the blood vessels that feed the fibroids. These coils are delivered through a catheter inserted through the patient’s groin which can be guided directly to the fibroid under XRay observation.
Studies suggest that this procedure is very effective in causing shrinkage of large fibroids as well as a significant reduction in menstrual bleeding, however many women prefer to have their fibroids removed. In addition, there is not much data regarding either the effect of this procedure on subsequent fertility or the safety of labor and delivery in patients who have undergone UAE. As UAE interferes with blood flow to the fibroid – and frequently with blood flow to the surrounding uterine tissue – there is a significant concern that there may be an adverse effect on subsequent fertility and growth of a baby.
Most fertility specialists still do not recommend UAE for women who wish to become pregnant.