Effectively treating fibroids depends on the size, site, patients age and overall health. The best treatment for fibroids in India is proposed to preserve the fertility of the woman as much as possible. At times, a combination of procedures is recommended to successfully target and remove the fibroids. Some of the approaches to treat uterine fibroids in India are as follows:
Uterine fibroid medications or drugs target hormones that control the menstrual cycle, treating symptoms like excessive menstrual bleeding and pelvic pain. They do not remove fibroids but they may shrink the fibroids. The medicines used in treating fibroids include:
• Gonadotropin-releasing hormone (Gn-RH) agonists
Medicinal drugs called Gn-RH agonists (Lupron, Synarel, others) treat fibroids by blocking estrogen and progesterone production, placing the patient in a temporary postmenopausal state. This causes menstruation to stop, thus shrinking the fibroids and improving anemia.
• Progestin-releasing intrauterine device (IUD)
A progestin-releasing IUD will alleviate serious fibroid-caused bleeding. A progestin-releasing IUD only provides relief of the symptoms and does not shrink or make fibroids vanish.
• Other medications
Oral contraceptives or progestin can help control menstrual bleeding but it does not reduce the size of the fibroid. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are not hormonal medicines, may be effective in alleviating fibroid-related pain, but they do not minimize fibroid-caused bleeding.
• Focused Ultrasound Surgery (FUS)
Focused ultrasound Surgery (FUS) is an MRI-guided non-invasive approach that helps preserve the uterus, with the involvement of no-incision and is performed on an out-patient basis. The procedure involves the patient being under an MRI scanner fitted with high-energy ultrasonic transducer for treatment. The images help the doctor identify the exact location of the uterine fibroids. The ultrasound transducer directs sound waves (sonications) when focused on the fibroid, helps to heat up and destroy fibroid tissue. FUS is a relatively newer treatment approach that is providing long-term effectiveness and safety in treating uterine fibroids.
• Minimally invasive procedure
Some procedures can eliminate uterine fibroids without the actual extensive surgical removal. The laparoscopic or minimally invasive fibroid surgeries are as follows:
• Uterine Fibroid Embolization (UFE)
Embolic agents or small particles are inserted in to the arteries that supply blood to the uterus. This causes obstruction in the flow of blood, thus causing the fibroids to shrink and die. This technique can help to compress fibroids and alleviate the symptoms with pin-point accuracy.
Myolysis is a laparoscopic procedure in which electric current or laser is used to destroy the fibroids and shrink the blood vessels connected to it. Similarly, cryomyolysis is used to freeze the fibroids.
• Laparoscopic or Robotic Myomectomy
Myomectomy is the uterus-sparing surgical removal of fibroids. Laparoscopic myomectomy or robotic myomectomy is done when the fibroids are smaller in size and fewer in number. With the aid of slender instruments which are inserted through small incisions into the abdominal cavity, fibroids present inside the uterus are removed. Laparoscopic or robotic myomectomy provides the patients with shorter recovery time, minimal scars and lesser blood loss as compared to conventional surgery.
• Hysteroscopic Myomectomy
In the case of submucosal fibroid i.e. when the fibroid is inside the uterus, the surgeon by means of using specialized instruments access the fibroids through the cervix and vaginal opening. This procedure, as done through the vaginal opening involves no cut or surgery which ensures shorter recovery time for the patient.
• Endometrial Ablation
With the help particular instruments and the use of heat, microwave energy, hot water of electric current, uterus lining is targeted with stops or reduces menstruation. Endometrial ablation is used to effectively stop unusual bleeding. At the time of hysteroscopy, submucosal fibroids can be extracted for endometrial ablation, although this will not affect fibroids beyond the uterus' interior lining.
• Conventional surgical procedure
• Abdominal myomectomy
Abdominal myomectomy is advised when there are several, large or deeply located fibroids that cannot be treated by another treatment approach. This is a worthy alternative to hysterectomy as it does not remove the uterus but invasively treat the present fibroids.
The surgical removal of the uterus is known as hysterotomy. As this is a major surgery, it is only recommended when it is the only solution to treat fibroids and avoid its re-occurrence.