For many years, women were given no other choice besides having a hysterectomy to eliminate fibroids, benign uterine tumors that can cause debilitating symptoms and disrupt sexual health and fertility. But the newly launched Center for Fibroid Care at NYU Langone provides care and treatment options tailored to meet the individual needs of patients, which can also help women avoid this drastic surgery that removes the uterus. Here is a closer look at fibroids and what makes the clinic stand out in its approach to treating this very common but frequently overlooked condition.

The Need for Fibroid Care

Up to 70 percent of women will develop fibroids during their reproductive years. These benign tumors emerge in the smooth muscle cells of the uterus. While they are usually noncancerous, they can be anything but harmless. In some cases, the rubbery nodules can grow as large as a watermelon and cause debilitating symptoms, including heavy, prolonged periods; bladder problems; and severe pelvic pain. They can even disrupt sexual health and fertility. Yet, historically, fibroids have been overlooked by physicians. “Too many women with fibroids are told that they need to live with them, or that they’ll get better after menopause,” says Taraneh Shirazian, MD, associate professor in the Department of Obstetrics and Gynecology at NYU Grossman School of Medicine.

A report published last year in the Journal for Women’s Health found that many women never seek treatment and may not even mention symptoms to their medical provider. Some fear the prospect of a hysterectomy, the surgical removal of the uterus. While an estimated 1 in 3 women have the procedure by age 60—as many as half due to fibroids—there are life-altering downsides. It’s a major surgery that requires weeks of recovery, and recent clinical studies suggest that women who have a hysterectomy before menopause have an increased risk of developing dementia. “Hysterectomy remains a viable medical option, but only for the right patient,” says Dr. Shirazian.

The Draw of the Center

To broaden the range of options for women with fibroids, this year NYU Langone Health has launched the Center for Fibroid Care. Its mission is to provide individualized care by leveraging the skill of surgeons, interventional radiologists, obstetricians, and fertility specialists. Patients begin by completing a survey to assess the impact of fibroids on their lives and to evaluate their treatment goals. This guides the recommended care, which ranges from active surveillance to surgery. “There are many treatment options, including surgeries, but also a suite of medications that not every gynecologist may be familiar with,” says Dana R. Gossett, MD, the Stanley H. Kaplan Professor and Chair of the Department Obstetrics and Gynecology. “The goal is to have one center where women can get all the information and make the best decision for themselves.”

The Approach to Fibroid Treatment

Optimal fibroid treatment depends on the location, size, and number of tumors identified. For women with small, contained growths and mild symptoms, medications may ease pain and serve as a bridge to menopause. However, large and numerous fibroids may require surgery. More than 300 surgical procedures for fibroids are performed annually at NYU Langone hospitals in Manhattan alone, including laparoscopic and robotic myomectomy, minimally invasive procedures that remove fibroids while maintaining fertility. “There’s a trend toward uterine-preserving surgeries, even among women who aren’t planning to have a child,” says Dr. Shirazian. Patients with complex medical histories who are not candidates for surgery may be referred to an interventional radiologist for a nonsurgical procedure called uterine fibroid embolization. A thin tube, called a catheter, is inserted through the leg or wrist and guided by X-ray images to the blood vessels that feed the fibroids. Tiny particles are then injected to block blood flow, causing the fibroids to shrink.

The News About Transcervical Radiofrequency Ablation

A procedure called transcervical radiofrequency ablation, approved by the U.S. Food and Drug Administration in 2018, is quickly gaining popularity among eligible patients. An ultrasound wand is inserted through the vagina to the uterus, where a probe emits precise doses of heat directly into the fibroids, causing them to shrink. There is no incision, and the risk of uterine scarring is minimal. The early outcomes are encouraging. In one study, more than 95 percent of patients experienced significant reduction in menstrual bleeding after 1 year and required no follow-up surgical intervention. Another study, published in the Journal of Gynecologic Surgery, showed that 94 percent of patients who had the procedure were satisfied 3 years later, with 88 percent reporting reduced symptoms. Also, preliminary data show successful pregnancy outcomes in women following the fibroid treatment, including vaginal and cesarean deliveries. “A lot of patients seek us out for the ablation procedure, which lets patients go home the same day from the operating room and has a fast recovery,” says Dr. Gossett.