Uterine Fibroid Embolization and Other Minimally Invasive Options

Myomectomy is a surgical procedure requiring hospitalization, done by a gynaecologist through open surgery, laparoscopy or robotically. Uterine artery embolization is an outpatient procedure done by an interventional radiologist together with a gynaecologist, who passes a catheter through the groin artery into the vessel feeding the fibroid and injects small particles to cut off its blood supply, so the fibroid shrinks over time. It is less invasive and generally preferable to myomectomy, but it has limitations: it is not suitable for very large fibroids, for fibroids with any suspicion of malignancy, or where there is an active uterine infection.

Yes, hysterectomy is a good option for a woman over 40 who has completed childbearing and wants to be free of ongoing fibroid symptoms and medication. If she is under 50 and the ovaries are healthy, they are usually left in place; if she is over 50, the ovaries are usually removed as well. If healthy ovaries are removed before the natural age of menopause, hormone replacement therapy is given until the patient reaches the normal menopausal age, to avoid the more severe mood swings, hot flushes, breast pain and anxiety that a sudden surgical menopause can cause compared with a natural one.

There is a genetic predisposition, but no definitive targeted gene therapy exists yet, largely because the exact cause is still not fully known beyond the working assumption that estrogen and progesterone drive growth, based on the fact that fibroids shrink after menopause. On blocking hormones, this is already happening in a milder form: oral contraceptive pills, which many women take from their late teens into their mid-thirties, work by suppressing internal hormone production, and are safe as long as the patient does not smoke and has no family history of stroke or hypertension.

No, Mirena is an intrauterine contraceptive device that releases a small daily dose of progesterone, and it does not treat the fibroid itself. It helps control the symptoms, mainly heavy bleeding, but the only definitive treatments remain removal by myomectomy or hysterectomy, or one of the minimally invasive procedures.

Primolut-N is a progesterone, similar in principle to Mirena, and can be given when a patient cannot tolerate a combined estrogen-progesterone pill. It can be taken twice daily from day five to day 25 of the cycle if the patient wants a withdrawal bleed, which will be much lighter and pain-free than a normal period, or continuously if she prefers not to have periods at all.

It is a minimally invasive outpatient procedure in which an interventional radiologist injects small particles into the blood vessel feeding a fibroid, cutting off its blood supply so it shrinks. It requires no anaesthesia and preserves the uterus.

They are promising but still undergoing clinical trials, and are not yet established enough for routine clinical use.