Less conservative procedures such as hysterectomy may be considered for patients who have no success with other treatments and who no longer want to have children. In choosing a treatment for endometriosis, the best approach is to review all treatment options with a physician, and pursue the choice with confidence. These benign fibroid tumors, or myomas, appear to grow in relation to their exposure to estrogen. Symptoms can range from excessive or dysfunctional uterine bleeding, severe pain, anemia of undetermined origin, or pressure-related symptoms from enlarged fibroids. Infertility or recurrent miscarriage have been associated with fibroids that significantly distort the uterus.
Surgical therapy can be conservative or more radical.
For women who do not wish to have the uterus removed, myomectomy is an option available for continued fertility. Myomectomy can be performed either via hysteroscopy or via an abdominal approach. Patients who opt for myomectomy should be aware of potential pregnancy-related complications if they do conceive, including possibility of a necessary cesarean section. Only a fraction of patients with fibroids are candidates for surgical therapy, and for those who are candidates, minimally invasive surgical techniques may be desirable. The physician's goal is always to choose the most efficient and least problematic and painful alternative for patients undergoing treatment for this extremely common gynecologic disorder.