Radiofrequency Ablation vs. Myomectomy: Benefits of Minimally Invasive Fibroid Treatment

 For women experiencing the effects of uterine fibroids, the search for relief can feel overwhelming. But with advances in fibroid treatment, options other than a hysterectomy are available. Myomectomy- removal of fibroid tumors from the uterus while preserving the uterus- has been a long-standing treatment option for patients. Radiofrequency ablation technology has been around for a long time also, but only recently has it been used as a method to treat uterine fibroids. Both myomectomy and radiofrequency ablation offer promising paths forward for symptom relief. While there are also several minimally invasive options, this article will discuss the unique advantages and differences between these two treatment options. Understanding how these treatments work can help you make an informed decision that aligns with your health goals and lifestyle.

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What Causes Fibroids?

Uterine fibroids, also known as leiomyomas, are benign (non-cancerous) growths that develop within the muscle tissue of the uterus. They’re influenced by hormones like estrogen and progesterone and once present, tend to grow over time. Genetics also play a role, meaning that women with a family history of fibroids are more likely to develop them. While many fibroids remain small and don’t cause issues, others can lead to symptoms that interfere with daily life. Fibroids may cause physical discomfort, impact fertility, or result in excessive bleeding. 

Common fibroid symptoms include:

• Heavy or prolonged menstrual bleeding
• Pelvic pressure or bloating
• Frequent urination or difficulty emptying the bladder
• Constipation or difficulty with bowel movements
• Lower back pain or leg pain
• Pain during intercourse
• Abnormal uterine bleeding

When fibroids grow large enough, or multiple fibroids develop, they can cause more serious complications by compression of structures around the uterus.

Treatment: Radiofrequency Ablation vs Myomectomy

When it comes to treating uterine fibroids, both radiofrequency ablation (RFA) and myomectomy are effective options. However, they work in very different ways. 

Radiofrequency Ablation (RFA) 

Radiofrequency ablation is a minimally invasive procedure designed to shrink fibroids. While it can be performed through laparoscopic surgery--instruments and a camera inserted through small incisions in the abdomen--we prefer an incisionless approach through the vagina. Either way, a doctor uses radiofrequency energy to heat and break down the fibroid tissue. Over time, the fibroids shrink, and the body gradually absorbs the remaining tissue. 

Benefits of Radiofrequency Ablation

• Minimally invasive fibroid treatment: With a laparoscopic approach, you will need 10-14 days to recover and will have 3-4 small incisions on your abdomen. With a transvaginal approach there are no incisions and typical recovery is 1 week.
• Short recovery time: Most patients are able to return to normal activities within a few days with transvaginal RFA and 10-14 days with a laparoscopic approach.
• Symptom relief: RFA can reduce symptoms such as heavy bleeding, pelvic pain, and frequent urination. Typical fibroid volume is reduced by 40-50%.
• Reduced postoperative pain: Because the procedure is less invasive, patients tend to experience less discomfort compared to traditional surgery.

Radiofrequency ablation does not completely remove the fibroids; it reduces their size by shrinking them and generally inactivates them so they will not regrow. However, women who have developed multiple fibroids are at risk for new fibroids growing over time. Studies of uterine preserving treatments other than RFA show that about 30% of patients will need additional treatment in the future. Younger patients have a higher risk than those closer to menopause. Additionally, while the procedure is effective in reducing fibroid symptoms, it is not typically recommended for women who wish to preserve their fertility at this time. That being said, there is emerging evidence from Spain that women can have successful and safe pregnancies after transvaginal RFA treatments (Marín Martínez et al., 2024).

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Myomectomy

Myomectomy is a surgical procedure that removes fibroids from the uterus, offering a long-term solution for those dealing with visible symptomatic fibroids. It can be performed in a few different ways, depending on the size and location of the fibroids. Laparoscopic myomectomy, a minimally invasive treatment, involves small incisions and a camera to remove fibroids and is the ideal approach. Hysteroscopic myomectomy involves removing fibroids through the vagina and cervix without external incisions but can only be done for fibroids that are sticking into the uterine cavity. For larger or multiple fibroids, an open surgery (abdominal myomectomy) may be required. 

Benefits of Myomectomy

• Fibroids are completely removed: This provides long-term relief and complete ‘debulking’ of the uterus.
• Ideal for women wanting to preserve fertility: Unlike RFA, in the United States as of 2024, myomectomy is the only recommended treatment for women who want to become pregnant in the future.
• Effective for larger fibroids: Myomectomy can treat larger or more numerous fibroids than RFA.

Myomectomy, while effective, is a more invasive procedure than radiofrequency ablation. Even the minimally invasive forms of myomectomy, like laparoscopic surgery, involve a longer recovery time (14 days). In particular, an abdominal myomectomy can require 4-6 weeks for full recovery, making it a more time-intensive option. Lastly, even with myomectomy, studies show that about 30% of patients will need additional treatment in the future for new fibroids.

Which Treatment Is Right for You?

Choosing between radiofrequency ablation, myomectomy, or other options (medication treatment, uterine artery embolization, high-intensity ultrasound treatment and hysterectomy) often comes down to your individual goals, the severity of your symptoms, and whether you wish to maintain fertility. For women looking for a minimally invasive procedure with a faster recovery time, transvaginal radiofrequency ablation offers a promising option, especially for managing symptoms like abnormal uterine bleeding. On the other hand, if you want to ensure the complete removal of fibroid tissue or are considering future pregnancies, myomectomy might be the better choice until we have more data to confirm the safety of pregnancy after RFA treatment. Your doctor will explain the benefits and potential risks of each treatment and answer any questions you might have during your consultation.

Why Choose The Center For Advanced Gynecology

At The Center For Advanced Gynecology, we specialize in minimally invasive fibroid treatments tailored to your needs. Whether you're considering radiofrequency ablation, myomectomy, or other treatments, our team provides expert care and guidance every step of the way. We understand that treating uterine fibroids is about more than just reducing symptoms—it’s about restoring your quality of life. Our specialists will help you explore the best options for your unique situation, ensuring that you receive the highest standard of care. Don’t let symptomatic fibroids control your life. Contact The Center For Advanced Gynecology today to learn more about your treatment options and find relief from uterine fibroids. Treat fibroids and find relief.

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References 

Marín Martínez ME, Cruz-Melguizo S, Vaquero Argüello G, Engels Calvo V, De la Cruz Conty ML, Pérez Medina T. Transvaginal radiofrequency ablation: a therapeutic option for managing symptomatic uterine fibroids in women with reproductive desires. F S Rep. 2024 Jul 15;5(3):320-327.