What are the new treatment modalities for uterine fibroids to avoid total abdominal hysterectomy?
There are several new treatment modalities for treatment of uterine fibroids. These methods include medical therapy with Ulipristal acetate, GnRh analogues. These medicines reduce the size of fibroid and decrease the associated bleeding. Reduction in fibroid size can change the route of surgery and reduces operative time, intraoperative blood loss.
Other methods include Uterine artery embolization, high frequency focussed ultrasound therapy, hysteroscopic removal of submucous fibroid, Laparoscopic myomectomy in which uterus is preserved and only fibroid is removed.
More and more recent advances are occuring in the field of conservative treatment of fibroids where the uterus is preserved.
Latest one is MRg FUS
MRI guided focussed ultasound
It is a non invasive procedure which requires 2-3 sittings depending upon the size and location of fibroid and gradual follow up shows even 80-90% reduction of the fibroids
Uterine artery embolisation and MRI Focused ultrasound ablation are the two options instead of proceeding for hysterectomy.
Depending on the type of uterine fibroids, Uterine artery embolisation, laparoscopic (in medium sizes and non-cancerous ) and hysteroscopy can be used.
I wish to say that, except the patient had completed child birth or there is significant risk of death from haemorrhage, or there is a concurrent pathology that is inimical to the patient, like a carcinoma, then, the uterus should be preserved and various outlined methods of either reducing the size of the fibroids( with the use of GnRH analogues or Ulipristal acetate) or laparoscopic removal should be employed.
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