Which Treatment Is More Effective For Which Myoma?

First, it's important to note that hysterectomy, or the removal of the uterus, should only be considered as a last resort after all other options have been considered. There are two basic options for treating fibroids: myomectomy, which removes only the fibroids, and fibroid embolization, which involves blocking the vessels that feed the fibroids in the uterus, killing and shrinking them in place.

What types of fibroids are the primary options for myomectomy?

In the "What to Know About Fibroids" section, we discussed the types and locations of fibroids. Submucous fibroids, which grow inside the uterus, and subserous fibroids, which grow outside the uterus, can rupture and fall into the uterine cavity or abdominal cavity after embolization, causing discomfort. For fibroids with such a thin stalk, myomectomy should be the first option.

What types of fibroids might benefit from myomectomy or nonsurgical treatments like fibroid embolization?

If there is a single fibroid, both myomectomy and fibroid embolization can be considered, as the surgery is relatively easy. Furthermore, if these fibroids are located on the anterior wall, radiofrequency ablation (RF ablation) can be easily performed. RF ablation involves inserting a needle into the fibroid through the skin, and the fibroid can be treated with heat under local anesthesia. HIFU, a rarely used method for single fibroids, is also an option. HIFU, meaning high...

Finally, if the patient wishes to conceive, myomectomy and embolization treatments carry similar risks in terms of fertility. The choice should be made based on the number and structure of the fibroids.

What types of fibroids are suitable for non-surgical treatments, such as fibroid embolization?

If there are multiple fibroids, or even if they appear to occupy the entire myometrium, fibroid embolization should be the first choice. Because embolization delivers occlusive particles to all fibroids with high vascularity, treatment for all fibroids is possible in a single session. With fibroid embolization, the uterine tissue is preserved because it also receives blood from other sources. After embolization, all fibroids appear as dead tissue, while the uterine tissue is observed as viable tissue on a follow-up MRI.

Very large fibroids, in particular, carry a significant risk for surgery due to their high blood supply. Such cases are likely to require hysterectomy. Our colleagues specifically emphasize this possibility before surgery. Embolization is the first choice for such large and highly vascularized fibroids. It is also possible for a fibroid whose size and blood supply decrease after fibroid embolization to subsequently undergo a myomectomy without risk. These treatments are called combination treatments. (Embolization first, then myomectomy.) When embolization alone is not sufficient for very large fibroids, combined treatment should be considered.