If you have uterine fibroids, you’re not alone.
“More than 70 percent of white women and 80 percent of African-American women have uterine fibroids by age 50,” said Raymond Manohar Anchan, MD, PhD. Dr. Anchan is a reproductive endocrinology and infertility specialist in the Department of Obstetrics and Gynecology. “They are much more common than people realize.”
Uterine fibroids (also known as leiomyomas or myomas) are noncancerous growths that occur on or within your uterus (womb). They can range in size from as small as an apple seed to as large as a watermelon. When fibroids are small or don’t cause symptoms, they can usually be left alone. However, if they grow large or interfere with your quality of life, they need to be treated.
“Unfortunately, it can be difficult for women in the U.S. and even in New England to get excellent high-level care for fibroids,” said Louise Perkins King, MD, JD, an obstetrician-gynecologist in the Department of Obstetrics and Gynecology. But Brigham doctors are working to change that.
“A center of excellence for the treatment of fibroids and complex uterine anomalies is a fundamental step forward for our hospital and academic community. It gives our patients the level of coordinated, efficient, advanced and personalized care that they need and deserve.”Antonio Rosario Gargiulo, MD
A focus on patient-centered care
To give women the best possible fibroid treatment, the Brigham has launched the Center for Fibroids and Complex Uterine Anomalies. The center team provides a full range of fibroid treatments to all women, including those with complicated cases and those who have received poor or incomplete fibroid care in the past.
“The Brigham intends to be completely patient-centered and therefore offers all currently available options for treating uterine fibroids,” Dr. Anchan said. “Many other places may provide only one or two options, which does not amount to a true patient choice.”
“We can do advanced surgery that is typically not available in a general OB/GYN practice,” Dr. King added.
The Center for Fibroids and Complex Uterine Anomalies is led by two gynecologic surgeons, Antonio Rosario Gargiulo, MD, and Mobolaji O. Ajao, MD, MPH. Its specialists work closely with care providers in the Brigham’s new Center for Endometriosis.
“A center of excellence for the treatment of fibroids and complex uterine anomalies is a fundamental step forward for our hospital and academic community,” said Dr. Gargiulo. “It gives our patients the level of coordinated, efficient, advanced and personalized care that they need and deserve.”
“We plan to lead patients by the hand through a diagnostic and therapeutic journey that follows high protocol standards but is always genuinely open-minded and patient-centered,” Dr. Gargiulo added.
Most women with fibroids don’t know they have them. That’s because they may cause no symptoms. But about 1 in 3 women with fibroids develops severe symptoms such as:
- Abnormal uterine bleeding
- Pelvic pressure
- Pain during sex
- A need to urinate more often
Advanced treatment options
There are many ways to treat uterine fibroids. These include a variety of medications and several kinds of procedures that destroy or remove fibroids. However, not all treatments are right for all women, and unbiased expert advice is essential.
“Right now, women really struggle to find providers who offer all of these options,” Dr. King said. “And it can be especially hard for women of color to get high-quality care.” However, the Brigham provides women with a full range of treatment options for fibroids.
“It’s important to present patients with all available options and then work together to find an effective treatment that aligns with their goals,” Dr. Ajao said.
In the past, a standard treatment for fibroids was hysterectomy. This is when a surgeon removes a woman’s uterus. This not only renders a woman unable to get pregnant, but can also result in complications.
Fortunately, newer treatments can make hysterectomy unnecessary. Less invasive treatments give patients the opportunity to keep their uterus if they so desire. “Given the option, our goal is always to take out the fibroids and leave the uterus where it is safe to do so,” Dr. Anchan said.
The type of treatment that is best for each patient depends on many factors. These include:
- Type and number of fibroids you have
- Whether you’ve completed your family
- Your treatment preferences
Nonsurgical treatment for fibroids
The Fibroid Center offers a range of treatment options. These include advanced nonsurgical treatments that may not be available in other places such as:
- Uterine artery embolization: This helps shrink fibroids by cutting off their blood supply.
- Magnetic resonance imaging (MRI)-guided focused ultrasound: This new approach destroys fibroids with sound waves and requires no surgery.
- Radiofrequency ablation: This treatment burns the fibroids in place, which leads to shrinkage.
Minimally invasive fibroid surgery
When surgery is necessary, Brigham doctors aim to perform minimally invasive fibroid surgery. This is done through several tiny incisions (cuts) rather than one larger one.
“We can often perform minimally invasive surgery even if the fibroids are large,” Dr. Anchan said. “As a general rule, when patients are told by surgeons in the community that their fibroids are too big or too many to allow for safe laparoscopic surgery, we can still safely accomplish it.”
One of the main advantages of minimally invasive fibroid surgery is that it leads to a shorter recovery time. Instead of the 4 to 6 weeks of recovery time for open surgery, patients recover from minimally invasive surgery in 3 to 4 weeks.
Other benefits include:
- Fewer complications, even for complex cases
- Less bleeding
- Less chance of infection
- Less pain
- Less need for pain medication
- Less time in the hospital
- Less trauma to your body
- Smaller scars
Robotic-assisted fibroid surgery and hysteroscopy
In some cases, surgeons use robotic assistance to perform fibroid surgery. Robot assistance gives a surgeon greater flexibility, control and precision during a procedure. This can sometimes result in better outcomes and fewer complications, particularly in overweight patients and those with larger tumors.
Our surgeons also offer a treatment known as hysteroscopy. With this treatment, doctors remove fibroids using a thin scope inserted into the uterus through the vagina.
When fibroids affect fertility, reproductive surgeons from the Center for Infertility and Reproductive Surgery, develop the best treatment plan for fertility-preserving fibroid surgery. Our reproductive surgeons are integral members of the Fibroid Center. Working together, they create a treatment plan that can improve your odds of getting pregnant. “We work as a team and take a very personalized approach,” Dr. Anchan said.
Going forward, Brigham doctors will continue to offer patients innovative care for fibroids. “We want to make sure that all patients have access to all treatment options,” Dr. King concluded.