Uterine fibroids are benign (non-cancerous) tumors that grow within the muscular tissue of the uterus. About 10-30% of women of childbearing age have fibroids, but not all fibroids require intervention; most patients are often asymptomatic and do not need treatment. In some patients, their symptoms may be so severe, such as anemia, heavy menstrual flow, frequent urination, and constipation, that they require treatment.
The advantages and disadvantages of several common treatment modalities are listed below.
Treatment
How it is treated
Advantages
Disadvantages
Hysterectomy
Surgical removal of the uterus
Hysterectomy, fibroids do not recur
Loss of fertility and possible risk of early menopause.
Recovery time is 4-6 weeks.
Open hysterectomy for fibroids
Surgical procedure with dissection of the lower abdomen to remove the fibroids
Preserves the uterus and cervix, allows pregnancy and allows for pathological diagnosis
Highly traumatic, recovery time usually 2-4 weeks, relatively high probability of complications
Laparoscopic myomectomy
Removal of one or more fibroids by laparoscopic or endoscopic techniques
Less traumatic, preserves the uterus and cervix, and allows pregnancy Pathological diagnosis can be obtained
Not suitable for larger, multiple or deep fibroids Recovery time is 1-4 weeks. Other complications may occur.
Uterine artery embolization/UAE
Polyvinyl alcohol is injected into the uterine artery with a catheter to prevent blood flow to the myoma, causing ischemic necrosis of the myoma
Minimally invasive, local anesthesia, short hospital stay of 3-5 days, faster recovery, and low complication rate.
Risks include premature amenorrhea, ectopic embolization, post-embolization treatment syndrome such as hyperthermia and pain for 3-5 days after the procedure. Pathologic diagnosis cannot be obtained.
Magnetic resonance-guided focused ultrasound
Non-invasive treatment, using magnetic resonance guidance to focus ultrasound on leiomyoma to kill leiomyoma tissue
No or only 1 day of hospitalization is required, and normal activities can be resumed quickly with very low complication rate. Minimal recovery time and protection of the uterus and cervix.
Pathological diagnosis cannot be obtained.
Hormonal drug therapy
GnRHa and other drug treatments cause myoma contraction
Conservative treatment method without surgery
Treatment is only effective for 6-12 months and may lead to menopause.
Methodologically, MRI-guided focused ultrasound is a relatively new technique that combines two widely recognized medical technologies – magnetic resonance imaging and focused ultrasound. Focused ultrasound has been used by scholars as early as 1942. Early applications of this technology were not very effective due to the lack of effective means of localization and temperature monitoring. Magnetic resonance imaging (MRI) has good soft tissue resolution and can effectively discriminate and localize target tissues while monitoring the acoustic beam pathway to the target tissue and surrounding sensitive tissues, such as intestinal gas, bone and nerves, which can interfere with the focused ultrasound beam or be vulnerable to its damage. Magnetic resonance (MRI) is also currently the only technique that produces reliable, reproducible and accurate real-time temperature monitoring maps, so the entire tissue thermal ablation process can be effectively monitored. The combination of these two technologies has produced the most sophisticated image-guided and controlled treatment system available: the Magnetic Resonance Guided Focused Ultrasound System (MRgFUS).
From an invasive point of view, the recovery period for MR-guided focused ultrasound treatment of uterine fibroids is the shortest, completely non-invasive treatment, with same-day treatment and next-day work availability. Open surgery is more invasive and has a longer recovery period. Patients still need to choose the right treatment according to their condition.