Surgical therapy comes down to three options: endometrial ablation, myomectomy, and hysterectomy.
The lining of the uterus (the endometrium) is destroyed with endometrial ablation. This is used to remove small leiomyomas within the uterus. The procedure can be performed via freezing, laser, electric current, instrumentation, or boiling water. Often a heated balloon is used. At other times a device is employed that uses microwave energy to destroy the lining.
Endometrial ablation makes pregnancy unlikely, but not impossible. When pregnancy does occur, the pregnancy carries a higher risk of miscarriage and other complications.
Most women recover quickly from this outpatient procedure. About half of patients will no longer bleed during their periods. About 30% will experience much lighter bleeding. Although complications can occur, they are unusual with most methods of endometrial ablation.
For women who wish to become pregnant, myomectomy is the most promising surgical option. Myomectomy removes leiomyomas while leaving healthy womb tissue intact.
This surgery can be performed in a variety of ways, and may be classified as major surgery depending on the extensiveness of the procedure and the placement of the leiomyomas. For this reason complications vary depending on the details of a given procedure.
One drawback to myomectomy care is that although the existing leiomyomas will be destroyed, new leiomyomas may develop develop later on.
The only certain and permanent treatment for uterine fibroids is hysterectomy. About 200,000 hysterectomies are performed every year in the US for treatment of leiomyoma. Hysterectomy involves the removal of part or all of the womb, and sometimes the ovaries and fallopian tubes as well.
A patient will be infertile following hysterectomy surgery. It is a major surgery, though health risks are among the lowest of all major surgeries. Nonetheless serious complications can occur, including blood clots, injury to the urinary tract and bowels, severe infection and, rarely, death.
Recovery time for hysterectomy is typically several weeks.