After successful treatment for breast cancer, Zamala Cortes, 37, was eager to embark on the next chapter of her life: starting a family. During a routine gynecologic checkup, however, the Staten Island newlywed received a diagnosis of fibroids, non-cancerous tumors of the uterus. Based on the location of the uterine fibroids, “I knew I couldn’t get pregnant no matter how hard we tried,” Cortes says.
For decades, hysterectomy—surgically removing the uterus containing the fibroids and the fallopian tubes—has been the leading fibroid treatment. Nearly 500,000 women in the United States have a hysterectomy each year, with fibroids being the leading reason. Hysterectomy cures fibroids and bleeding permanently, but because pregnancy is no longer possible, it wasn’t right for Cortes.
After meeting with Taraneh Shirazian, MD, a minimally invasive gynecologic surgeon and director of NYU Langone’s Center for Fibroid Care, Cortes learned she had other minimally invasive fibroid treatment options that didn’t involve a hysterectomy, including the one she eventually chose: transcervical fibroid ablation, which uses radiofrequency energy to destroy fibroid tissue, while preserving the uterus.
Doctors at the Center for Fibroid Care develop individual, personalized care. The treatment recommended for you can depend on your needs and goals as well as fibroid size, number, and locations. “Our fibroid treatment toolkit has gotten bigger in terms of what we can offer patients,” Dr. Shirazian says. “Our goal is to use one or more of the tools to help you achieve the best outcome.”
Here’s a look at the latest uterine-sparing fibroid treatment advancements.
Decrease Bleeding with Hormone Therapy
Two new U.S. Food and Drug Administration (FDA)–approved fibroid medications: Oriahnn and Myfembree, have been shown to significantly reduce heavy menstrual bleeding associated with uterine fibroids. The medications drive down hormone levels, but add back a little estrogen, to help women avoid menopausal symptoms such as hot flashes, headaches, and mood changes, says Kelsey Kossl, MD, a minimally invasive gynecologic surgeon at the Center for Fibroid Care, part of obstetrics and gynecology services at NYU Langone.
Starved of estrogen, bleeding may improve. “The medications are well-tolerated, and I’ve had women who have had great responses in terms of stopping bleeding,” Dr. Kossl says. “Reducing bleeding may help improve anemia so subsequent fibroid procedures can be planned safely.”
Starve Fibroids with Uterine Fibroid Embolization
Uterine fibroid embolization is a minimally invasive outpatient procedure performed by an interventional radiologist. It involves inserting tiny medical-grade particles under X-ray guidance through the uterine artery. The particles temporarily decrease blood flow to the uterus and any fibroids. Deprived of oxygen-rich blood, fibroids degenerate and shrink over the next few months to a year.
To make an appointment with one of our fibroid specialists, visit the Center for Fibroid Care.
With uterine fibroid embolization, there’s a risk of premature menopause, especially if you’re age 45 or older. This is a factor to consider if you’re seeking pregnancy.
Remove Fibroids with Myomectomy
One of the most common fibroid procedures, myomectomy is a minimally invasive surgery that removes fibroids through the abdomen with tiny, thumb-size incisions. “Good candidates for myomectomy are women seeking pregnancy who have only 5 to 10 fibroids, and the largest is about 6 centimeters,” Dr. Shirazian says.
After a myomectomy, it’s best to wait a minimum of three to six months before trying to conceive. “We want to make sure any cuts or scars in the uterine wall are well-healed before there’s a pregnancy,” Dr. Kossl says.
Zap Fibroids with Transcervical Ablation
Transcervical fibroid ablation, often performed using the Sonata System, is one of the newest tools in fibroid treatment. Transcervical fibroid ablation uses radiofrequency energy to destroy fibroid tissue, while preserving the uterus. “We use an ultrasound handpiece and enter through the vagina and cervix to deliver targeted energy to the fibroids,” says Catherine W. Chan, MD, a minimally invasive gynecologic surgeon at the Center for Fibroid Care.
Afterward, fibroids degenerate, slowly decreasing in size over months. Results can be long-lasting. In a study in the Journal of Gynecologic Surgery involving 147 women who had Sonata treatment, 94 percent were satisfied with the treatment and 88 percent reported reduced fibroid symptoms after 3 years.
Ablation is the treatment Cortes ultimately chose for her fibroids, which ranged in size from 2 to 10 centimeters. “After the procedure, I felt a little cramping, but that was it. I walked 8 miles the next day,” she says. “But even more importantly, it has given me a lot of hope for starting a family.”