Other Alternative Treatment Modalities for Fibroids

Myolysis

Myolysis is the destruction of fibroids (necrosis) by different methods, including coagulation of the tumors with bipolar or unipolar electric electrodes or laser beams. Another technique for destruction of fibroids utilizes a freezing probe (cryomyolysis). The probe is inserted into fibroids through the laparoscope and the electrical, laser, or freezing apparatus is activated, resulting in necrosis of the affected portions inside the fibroid. This is repeated several times, at different locations inside the individual fibroid, until the extent of the necrosis inflicted in a certain fibroid is considered sufficient.

Such techniques, in different versions, have been used since the early nineties. They are time-consuming and are usually limited to the treatment of moderate-sized fibroids. Frequently, the patient is first treated with Lupron injections over several months prior to the procedure in order to reduce fibroid size and vascularity. The procedure is performed through a laparoscope so that no large abdominal incision is required.

Following the procedure, the holes created by the probe on the uterine surface tend to ooze sero-sanguinous fluid. This may lead to infection and pelvic adhesions. The procedure may destroy large portions of the uterine muscle. Consequently, a pregnancy following myolysis is ill-advised. Failure of the myolysis procedure to solve abnormal bleeding, pain, or other clinical problems happens frequently and additional surgery may then be required, usually hysterectomy.

Prevailing views today call for the abandonment of myolysis as a treatment for fibroids.

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Endometrial Ablation

Endometrial ablation destroys the endometrial lining to a varying extent (depending on technique and skill). There are numerous different techniques to achieve endometrial ablation that lead essentially to the same end result. These techniques include hot water balloon, cryo- ablation (freezing the endometrium), laser ablation, roller ball cautery and electric loop resection of the endometrium.

These procedures are quite effective for the treatment of true functional uterine bleeding (bleeding due to hormonal imbalance without the presence of any anatomical abnormality), but in the presence of sub-mucous fibroids, endometrial ablation usually fails (unless effective myomectomy is also performed at the same time). Ablation also fails when the bleeding is caused by deep adenomyosis. Unfortunately, failure to recognize the presence of adenomyosis is a frequent occurance.

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