Symptom Levels

• No Symptoms - follow with ultrasound and pelvic exam
• Mild Symptoms - conservative, over-the-counter medications, birth control pills
• Moderate Symptoms - aggressive hormonal therapy (Lupron)
• Severe Symptoms - Hysterectomy, Myomectomy or Uterine Fibroid Embolization.

Lupron for Moderate Symptoms

• Lupron blocks ovarian estrogen production
• Advantages: Not invasive, shrinks fibroids, often improves symptoms
• Disadvantages: Induces premature menopause and associated symptoms. Fibroids usually return to original size after cessation of therapy. Only used for short periods of time because of side effects

Uterine Fibroid Embolization (UFE) for Severe Symptoms

• UFE performed in radiology department
• Conscious sedation by Board Certified Anesthesiologist for your comfort
• Advantages: Procedure performed through a tiny skin nick. Procedure takes about an hour. Recover most of the day in the hospital
• Disadvantages: not appropriate for all patients, small chance of reccurence

Hysterectomy for Severe Symptoms

• Surgical removal of uterus and fibroids, performed through abdominal incision or occasionally vaginally, sometimes with a laparoscope
• Advantages: 100% curative. No risk of regrowth. Well established procedure
• Disadvantages: major surgery with potential surgical complications: infection, hemorrhage, injury to adjacent organs, adhesions, loss of child bearing potential, bowel obstruction. Prolonged recovery.

Myomectomy for Severe Symptoms

• Individual fibroids are resected through an abdominal incision or sometimes with a laparoscope or hysteroscope
• Advantages: Fertility can be preserved, well established procedure, less invasive if laparoscopic or hysteroscopic
• Disadvantages: Same potential surgical complications as hysterectomy. Only part of uterus is treated and recurrence can occur. 15 to 25% need repeat procedure, usually hysterectomy. Not all fibroids amenable to myomectomy. Adhesions can lead to infertility. Prolonged recovery.