Surgical management of fibroids includes uterine artery embolization, myomectomy, and hysterectomy. Uterine artery embolization is an outpatient procedure that is done by an invasive radiologist to stop the blood flow to the fibroid. Myomectomy is the removal of the fibroids from the uterus. Hysterectomy is removal of the entire uterus.
Uterine artery embolization involves putting a catheter in an artery and threading it up to the artery that supplies blood to the individual fibroid. That artery is then blocked, stopping the fibroid from receiving blood. This causes the fibroid to degenerate and go away. The advantage to this procedure is that it is an out patient procedure, it does not require hospitalization or general anesthesia. It also preserves the uterus. The disadvantage is that is usually only a temporary fix as usually other fibroids grow up replacing the one that is treated. It also tends to be very painful for 4-6 weeks as the fibroid degenerates. It may be an appropriate procedure in a case with a single dominate fibroid that is causing symptoms.
Myomectomy is removal of the fibroid from the uterus. It is done in the operating room under general anesthesia. It can sometimes be done through a laparoscope but is often done through an open procedure. Myomectomy generally requires hospitalization and has similar recover time to a hysterectomy. The surgery is actually more complicated than a hysterectomy. There is a greater chance of blood loss and complications. Most women that have myomectomies and later become pregnant will require a c-section. The myomectomy can also cause significant scarring of the uterus to the surrounding structures. This can make future surgery more complicated. One of the downsides of myomectomy is that the uterus remains and can grow more fibroids. This surgery is typically used in younger women that still desire more children but have symptomatic fibroids.
Hysterectomy is removal of the uterus from the body. In medical language a complete or total hysterectomy is the removal of the uterus and the cervix. A partial or subtotal hysterectomy is removal of the uterus while leaving the cervix in the body. The ovaries are a completely different issues. Removal of the ovaries is called oophorectomy, removal of the fallopian tubes is called salpingectomy. Removal of the tubes and ovaries is abbreviated BSO. Hysterectomy can be done in a variety of ways. The uterus can be removed through the vagina (vaginal hysterectomy), using a camera with small incisions in the abdomen (laparoscopic hysterectomy), with a combination (laparoscopic assisted vaginal hysterectomy), or through a larger incision in the abdomen (abdominal hysterectomy). Each has its advantages and disadvantages and the type of hysterectomy will depend on many factors.
The advantage of hysterectomy is that it will permanently treat the fibroids, they will not come back. It will also stop the vaginal bleeding. All of the other solutions are potentially temporary and may not work at controlling the vaginal bleeding. The disadvantage is that it is impossible to have children after a hysterectomy and it is a big surgery.