Philosophy of Management

Treatment Methods of Management

 

Philosophy of Management

The management of the uterine fibroids is varied and even controversial. Our experience dictates that the management depends upon the size of the uterus, the symptoms present and the desire of the patient. If the uterus is less than 12 weeks in size and there are no symptoms, then the patient can be followed without any treatment. However, if the uterus is 12 weeks in size or greater, the most important consideration is "what is the desire of the patient." What would be her preference if she were symptomatic now or in the future? If the patient preferred to salvage her uterus, she should have that option and her treatment should be accordingly. The choice would therefore be a myomectomy.  
The most important consideration is the desire of the patient.

Myomectomy was first recorded as being performed in 1884, and became more popular in the 1930’s. However, the procedure was complicated by excessive bleeding and infection followed by the development of adhesions in the pelvis. The resultant adhesion formation also often compromised childbearing function. The blood loss often required blood transfusions.

Today, conventional myomectomy is still associated with excessive bleeding and adhesion formation. Therefore, this procedure had primarily been reserved for the preservation of childbearing capacity.

However, since the introduction of laser methods and the addition of adhesion prevention methods into surgical techniques, myomectomy has become more popular and we can now expand the criteria. Now myomectomy need not be limited only to women who wish to preserve their reproductive capacity. Instead, any woman who prefers to preserve her reproductive organs should have the choice to participate in the decision-making process. Nowhere is choice more important than when a woman faces the possible loss of her reproductive organs.

The Fibroid Center of New Orleans

At The Fibroid Center of New Orleans we have performed more that 1000 myomectomies. Our experience has been that blood loss has been minimized and we have not given a blood transfusion for surgical blood loss. We have minimized the formation of pelvic adhesions which can compromise fertility and/or cause pelvic pain, and we have had many patients who have become pregnant and delivered a baby. However, we have had 15% of patients with recurrent fibroids which required a second myomectomy or hysterectomy. Again, the choice of the procedure was based upon the patient’s desire.

There are other treatment modalities available, but they are temporizing methods at best. These treatments are listed as drug therapy, myolysis and even uterine artery embolization. Because these treatment modalities are relatively recent in medical practice, the long-term result is still unknown. There are several known factors that speak against these treatments as being definitive. The first is that the uterus is a very vascular organ and neoangiogenesis is a physiological mechanism by which the uterus repairs itself (new growth of blood vessels and blood supply). Therefore, over a period of time the uterus and the fibroid tissue would have recovery ability and growth.

Lastly, fibroids are often numerous and multifaceted; therefore, all areas may not respond or may respond differently. The future expectation with drug therapy is that the fibroids may be prevented or treated medically. If clinical trials continue to confirm the efficacy of experimental drugs, long-term medical treatment of fibroids could become a practical option.

Management should be all-encompassing:

  • Pre-operative - would be to prepare the patient physically and emotionally for surgery. An informed patient responds more rapidly.
  • Intra-operative - emphasizing good, meticulous surgical technique and concentrating on adhesion prevention produces the best over-all result.
  • Post-operative - patient is aware of post-operative care and methods to reduce risk of complications.

The information provided here is for general information or educational purposes only. A complete physical exam and consultation is the only way a medical decision can be reached.