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What are Your Alternatives (Myomectomy)?

Clip Number: 36 of 38
Presentation: Myomectomy
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Reviewed By: Arthur Schoenstadt, MD
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Several alternatives exist for treating fibroids. However, these alternatives are not appropriate for every situation, and your doctor may have tried some or all of these already. The alternatives include:
· Observation
· Medication
· Other surgical options.
Fibroids that are small, do not cause symptoms, or occur near menopause often do not require treatment. Watching the growth over a certain time period is one alternative to myomectomy. This involves regular exams to monitor the growth of any fibroids and possibly medication to treat the symptoms you may have.
Another possible option is to treat uterine fibroids with medication. However, individual responses vary greatly, from no response at all to an 80% reduction in the size of the fibroid within the first 3 months. After stopping medication, fibroids gradually grow back to their original size within 6 months. Therefore, medication can be used to shrink fibroids temporarily and to control bleeding to prepare for surgery.
There are several ways to perform a myomectomy. These include: laparotomy, hysteroscopy, and laparoscopy. The method we have been talking about with you is a laparotomy.
A hysteroscopy involves using a small camera placed through the vagina into the uterus to remove the fibrods. This can be used for fibroids that are inside the uterus. But, not all fibroids can be removed this way, such as those deep in the wall of the uterus and approximately 20 out of 100 patients require additional treatment within 5 to10 years after this procedure.
Laparoscopy uses instruments that allow your doctor to view the inside of your abdomen on a video screen. It can also take pictures and videotape the procedure. The laparoscope is inserted through a small incision in your navel. Laparoscopy is used to diagnose fibroids and treat certain types of fibroids. Like hysteroscopy, not all fibroids can be removed this way.
Another surgical alternative is burning the lining of the uterus with a laser to create a scar. This usually does not remove the fibroids, but it can provide a few years of relief from bleeding. For pelvic pressure and infertility problems, this is not the most effective treatment.
Another choice is to have a hysterectomy. This surgery is similar to a myomectomy, although the entire uterus is removed. This will cure the fibroids and essentially eliminate the risk of them growing back. However, once the uterus is removed, you can no longer become pregnant. If you no longer desire to have children, this is usually the best surgical option. If you have any questions about these possible alternatives for your particular situation, you should discuss them with your doctor and decide which one, if any, is appropriate for you.



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