Home > Medical Reference > Patient Education

Services at Maryland General

A complete list of inpatient and outpatient healthcare services at MGH.

Uterine fibroids and hysterectomy - Treatment

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of uterine fibroids

Alternative Names

Hysterectomy and uterine fibroids; Leiomyoma; Myoma

Treatment:

Not all women require treatment for uterine fibroids. A woman� ' s age and the severity of her symptoms are important factors in considering treatment options.

The three treatment options are:

Watchful Waiting. A woman may choose to delay having any treatment, particularly if she is close to reaching menopause. Periodic pelvic exams and ultrasounds can help track the progression of her fibroid condition.
Drug Therapy. Hormonal treatments such as oral contraceptives or a progestin-releasing IUD can help reduce heavy bleeding and pain. Gonadotropin releasing hormones (GnRH) stop ovulation, and thus the production of estrogen, and can reduce fibroid size.
Surgery. There are many surgical options ranging from less invasive to very invasive. They include removal of the fibroid (myomectomy), removal of the endometrial lining (endometrial ablation), shrinking the blood supply to the fibroid (uterine artery embolization), and removal of the uterus (hysterectomy).

Women should discuss each option with their doctor. Deciding on a particular surgical procedure depends on the location, size, and number of fibroids. Certain procedures affect a woman's fertility and are recommended only for women who are past childbearing age or who do not want to become pregnant. In terms of surgical options, myomectomy is generally the only commonly performed procedure that preserves fertility.

Resources

www.asrm.com -- American Society for Reproductive Medicine
www.acog.org -- American College of Obstetricians and Gynecologists
www.sirweb.org -- Society of Interventional Radiology
www.nuff.org -- National Uterine Fibroids Foundation
www.rsna.org -- Radiological Society of North America
www.radiologyinfo.org -- Radiology info from the American College of Radiology and the Radiological Society of North America
www.womenshealth.gov -- National Women's Health Information Center
www.nichd.nih.gov -- National Institute of Child Health and Human Development

References

American College of Obstetricians and Gynecologists. ACOG practice bulletin. Alternatives to hysterectomy in the management of leiomyomas. Obstet Gynecol. 2008 Aug;112(2 Pt 1):387-400.

Edwards RD, Moss JG, Lumsden MA, Wu O, Murray LS, Twaddle S, et al. Uterine-artery embolization versus surgery for symptomatic uterine fibroids. N Engl J Med. 2007 Jan 25;356(4):360-70.

Evans P, Brunsell S. Uterine fibroid tumors: diagnosis and treatment. Am Fam Physician. 2007 May 15;75(10):1503-8.

Gabriel-Cox K, Jacobson GF, Armstrong MA, Hung YY, Learman LA. Predictors of hysterectomy after uterine artery embolization for leiomyoma. Am J Obstet Gynecol. 2007 Jun;196(6):588.e1-6.

Griffiths A, D'Angelo A, Amso N. Surgical treatment of fibroids for subfertility. Cochrane Database Syst Rev. 2006 Jul 19;3:CD003857.

Hehenkamp WJ, Volkers NA, Donderwinkel PF, de Blok S, Birnie E, Ankum WM, et al. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids (EMMY trial): peri- and postprocedural results from a randomized controlled trial. Am J Obstet Gynecol. 2005 Nov;193(5):1618-29.

Jacoby VL, Grady D, Sawaya GF. Oophorectomy as a risk factor for coronary heart disease. Am J Obstet Gynecol. 2009 Feb;200(2):140.e1-9. Epub 2008 Nov 18.

Kaunitz AM. Progestin-releasing intrauterine systems and leiomyoma. Contraception. 2007 Jun;75(6 Suppl):S130-3. Epub 2007 Mar 9.

Kaunitz AM, Meredith S, Inki P, Kubba A, Sanchez-Ramos L. Levonorgestrel-releasing intrauterine system and endometrial ablation in heavy menstrual bleeding: a systematic review and meta-analysis. Obstet Gynecol. 2009 May;113(5):1104-16.

Lethaby A, Ivanova V, Johnson NP. Total versus subtotal hysterectomy for benign gynaecological conditions. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004993.

Olive DL, Lindheim SR, Pritts EA. Conservative surgical management of uterine myomas. Obstet Gynecol Clin North Am. 2006 Mar;33(1):115-24.

Parker WH, Broder MS, Chang E, Feskanich D, Farquhar C, Liu Z, et al. Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study. Obstet Gynecol. 2009 May;113(5):1027-37.

Rackow BW, Arici A. Options for medical treatment of myomas. Obstet Gynecol Clin North Am. 2006 Mar;33(1):97-113.

Smart OC, Hindley JT, Regan L, Gedroyc WG. Gonadotrophin-releasing hormone and magnetic-resonance-guided ultrasound surgery for uterine leiomyomata. Obstet Gynecol. 2006 Jul;108(1):49-54.

Van Voorhis B. A 41-year-old woman with menorrhagia, anemia, and fibroids: review of treatment of uterine fibroids. JAMA. 2009 Jan 7;301(1):82-93. Epub 2008 Dec 2.

Viswanathan M, Hartmann K, McKoy N, Stuart G, Rankins N, Thieda P, et al. Management of uterine fibroids: an update of the evidence. Evid Rep Technol Assess (Full Rep). 2007 Jul;(154):1-122.

Volkers NA, Hehenkamp WJ, Birnie E, Ankum WM, Reekers JA. Uterine artery embolization versus hysterectomy in the treatment of symptomatic uterine fibroids: 2 years' outcome from the randomized EMMY trial. Am J Obstet Gynecol. 2007 Jun;196(6):519.e1-11.

Reviewed last on: 8/5/2009
Reviewed by Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Physician Directory
seperater

Physician Specialties
seperater

Medical Glossary
seperater

Guide for Patients
seperater

Guide for Visitors
seperater

· · · · · · ·

© 2008 Maryland General Hospital, All Rights Reserved · 827 Linden Avenue, Baltimore, MD 21201 · 410-225-8000
Commitment to Compliance · Privacy Policy · Terms and Conditions of Use · Disclaimer · JCAHO Public Notice