I can remember the very first two female patients that walked in my door of my obgyn office over 20 years ago. Both had uteruses that were such giants that I actually got out my fetal monitor to make sure there was not an undiagnosed 5 month pregnancy in there! Needless to say, there were no fetal heart tones to be auscultated in either case. Both women were suffering from gigantic fibroids, heavy bleeding and severe anemia. There were no babies or good news to tell.
What is a fibroid you ask? The first thing to understand is that the uterus is made of layers: the serosa, the myometrium, and the endometrium. The serosa is like the outer “skin” of the uterus. The myometrium is the inner muscle layer. The endometrium is the intracavitary layer where the menstrual flow comes from and the fetuses are nurtured. Sometimes a cell or two of the myometrial layer gets big ideas and starts growing on its own independent of the control of the rest of the myometrium, sometimes resulting in giant balls of mostly, but not always, benign tumor cells. Theses giant balls of cells can sometimes cause diffuse and intense pelvic pain and pressure. More often, they cause heavy bleeding and resultant anemia which can be life threatening.
Back in the day, the options to treat them were not the greatest. The first thing to determine was if the patient desired future fertility. IF they did, the medical option available was lupron, which is a gnrh agonist and hormonal oncologic that can be taken monthly by painful injection for up to 3 months to attempt to shrink fibroids or up to 6 months to treat endometriosis. The idea behind it is to shrink the fibroids or the endometriosis to allow an opportunity for future fertility or pain reduction. The side effects are awful. It is like instant medical menopause with hot flashes, bone loss, arthralgias, etc. And, there is no guaranty it will work. Nowadays we have some pill form options which are somewhat easily tolerated, but still some of the same side effects and still no guaranty that they will work.
The other option for fibroids back in the day was myomectomy. This was usually done with an open large laparotomy incision and the fibroid or fibroids were cut out and an attempt was made to sew the uterus back together. This left the potential for scarring and the potential for uterine rupture during future pregnancy, in addition to the chance that fibroids would grow back. The other option was complete hysterectomy with or without possible pre surgery shrinkage with lupron, which constituted of a large incision laparotomy procedure as well, but at least the fibroids could not grow back.
A slightly less invasive option was a uterine artery embolization procedure. This was usually performed in interventional radiology where catheters are placed into the uterine arteries and particles are injected to block the blood flow, causing the fibroids to necrose and degenerate after the blood supply is cut off. This is a painful process and has a risk of infection and blood clots and risks to future fertility and may lead to premature menopause.
Nowadays we can do so much better than this! We now have the Acessa procedure! The Acessa procedure is an amazing laparoscopic radiofrequency procedure that is minimally invasive. It involves delivering radiofrequency energy with multiple treatments to radioablate the fibroid multiple times to facilitate shrinkage. This is done using a laparoscope with an ultrasound probe inserted into the abdomen and a radiofrequency Acessa probe inserted directly into the fibroid under direct visualization and you can literally watch the fibroid being treated at the exact moment it is being treated. You can do multiple treatments at the same time of multiple fibroids. It will then cause slow regression of the fibroids over time, with maximal effects at 6 months. It tends to be a procedure with relatively little pain, except for the pain from the laparoscopy itself. It does not involve any large incisions or scars. Fertility is also preserved and there is no disruption to the integrity of the uterus so future risk of rupture is minimal. Thus far I have seen it be a win win for patients. Best news yet, we have it readily available right here where I practice in Monroe, Michigan.
Fibroids got ya down? Cmon and see us and look into an Acessa procedure. It could be life changing without the down time or disfigurement.
Dr. Katz