Radiofrequency ablation: A new paradigm for treatment of fibroids
Dr Guido is Professor of Obstetrics, Gynecology, and Reproductive Sciences and director of the Fibroid Treatment Center, Magee-Womens Hospital, University of Pittsburgh Medical Center.
Dr Stuparich is a fellow in minimally invasive gynecology at Magee-Womens Hospital, University of Pittsburgh.
Uterine fibroids (leiomyoma) are very common among women of reproductive age. The lifetime prevalence is between 70% and 80%, with black women having a higher risk.1 The majority of women who have fibroids are asymptomatic, but some women can experience heavy menstrual bleeding, dysmenorrhea, pelvic pressure, increased urinary frequency, and painful intercourse.
Fibroids are the primary indication for hysterectomy in the United States, accounting for 40% of all hysterectomies performed annually between 1990 and 1997.2 Symptoms associated with uterine fibroids can be quantified using the well-validated Uterine Fibroid Symptom and Quality of Life QoL) questionnaire (UFS-QoL).3 The questionnaire is used to quantify symptom severity as well as measure six domains of health-related QoL. A higher symptom score is indicative of more significant symptoms. The severity of symptoms in women undergoing surgical intervention for fibroids was on average 64.8 (±20) as compared to 15.3 (±14.5) for a control group of women undergoing routine gynecologic care.4
Treatment of fibroids has evolved rapidly over the last decade. The traditional therapy for symptomatic fibroids has been hysterectomy for women who no longer desire to maintain their fertility, and laparotomy and myomectomy for those who want to maintain their uteruses.
With the advent of less-invasive surgical techniques, myomectomy can be performed via hysteroscopy and laparoscopically. The size and location of fibroids are critical in determining which method of myomectomy is appropriate. Laparoscopic approaches have been shown to have reproductive outcomes similar to that for open procedures, with shorter time for recovery.5