Myolysis

In myolysis, surgical instruments are inserted through a tiny, laparoscopic incision in the abdomen and a high frequency electrical current is administered to the fibroid. The electrical current causes the blood vessels to vaso-constrict (become very small or close down) and this basically cuts off the blood flow to the fibroids. The fibroids remain in place and are not surgically removed. Without a blood supply, the fibroids eventually die and shrink just as they do with uterine artery embolization.

Cryomyolysis is a similar procedure that "freezes to death" the fibroids. Liquid nitrogen at minus 180 degrees Celsius is applied through a cryoprobe while the doctor monitors the freezing process using ultrasound.

Both procedures take about one hour and the patient is observed in the recovery room for approximately another three hours and then discharged to go home. Total recovery from this procedure takes about one week.

A few words of caution about the drug Lupron

There are many potential side effects to this drug which was originally developed and FDA-approved for the treatment of advanced prostate cancer in men. These days, however, Lupron is widely used by gynecologists to treat women for a variety of routine gynecological problems.

According to a special report series published by the Boston Herald in August 1999 (email me if you'd like to read this report), some specialists are now saying that the long-term effects of Lupron can be dangerous and harmful, and that not enough studies have been done to adequately demonstrate that it is safe and effective.

As with any other potential treatment option available for your uterine fibroids, it is important to weigh the risks and benefits of potential outcome for each option against your own specific condition, belief system, and overall need for resolution to your situation. Lupron has helped many women. It has also hurt many women. Only you can weigh what potential benefit you might receive/not receive from its use and what risks you are willing to take/not take in the pursuit of treating your uterine fibroids.

Oh, did I mention that the prescriptive use of GnRH agonists (like Lupron) is generally required for 3-6 months pre-procedure? In order to maximize the potential shrinkage that results from this procedure, the patient is requested to undergo GnRH therapy as a precursor. Hopefully, the fibroids shrink somewhere in the 50% range and this makes the procedure easier to perform as well as gives the patient a better "starting point" to experience shrinkage of their fibroids from with the myolysis/cryomyolysis procedure. The use of Lupron, however, is controversial.

Neither myolysis nor cryomyolysis can be performed on very large fibroids (anything over 10 cm pre-administration of GnRH agonists is considered "very large") nor can they be performed if there are more than 4 fibroids each with a volume of up to 5 cm. Also, anything less than 3 cm in size is, well, too small.

In other words:

Fibroids that are too large complicate the procedure and make the shrinkage less than ideal in the long run -- bulk-related symptoms may not be resolved when the size of the fibroid at the time of the procedure is still very large; too many fibroids may make the amount of time it takes to perform the procedure impossible; and, too small of fibroids (less than 3 cm) are simply too small to perform this procedure on. (Kind of sounds like I'm telling you the story of The Three Bears, doesn't it? Fibroids can be classified as Papa Bear, Mama Bear, or Baby Bear. Only in this case the fibroids that are "just right" can only be assessed by Goldilocks, err, I mean, your gynecologist. The "ideal size" is probably Mama Bear -- but only if there are not too many of them.)

History of Myolysis

Myolysis is a procedure that has been around since the late 1980s in Europe and was first used as an alternative to myomectomy for women interested in preserving fertility. It fell out of favor in Europe, however, because follow-up showed that it was not a good alternative afterall. Pregnancy rates were low and fibrous pelvic adhesions were common.

In the United States, not too many doctors perform myolysis. It's the "baby" of Dr. Herbert Goldfarb as he introduced it to the U.S. gynecological community sometime around 1994. However, it has not been widely accepted by gynecologists and, according to Dr. Goldfarb's website, only around 800 patients have undergone this procedure.

There really isn't a whole lot of information on the internet about this procedure because only doctors who are thoroughly experienced laparoscopical operators should attempt this procedure. Both skill AND special equipment are required to perform this procedure and this may well account for the low number of patients that have actually undergone this procedure. To find out who has actually been trained in your area so that you can learn more, send email directly to Dr. Goldfarb.

Fertility

There appears to be conflicting information -- on the internet and among some gynecologists -- on the issue of fertility after myolysis. Some doctors say that myolysis is a good alternative to hysterectomy -- especially for women who want to retain their ability to have children.

Others, such as Dr. William Parker, author of A Gynecologist's Second Opinion : The Questions and Answers You Need to Take Charge of Your Health, believes it is not a good alternative for women wishing to preserve their fertility. He indicates that neither myolysis nor cryomyolysis is recommended for women who still want to give birth to children and cites two major problems with the procedure:

Scar tissue has been known to form around the uterus after myolysis.
The strength of the uterine wall after myolysis is unknown.

Because of the potential risk of the uterus tearing during labor, it's important that women not attempt to get pregnant after myolysis or cryomyolysis, according to Dr. Parker.

In a recent interview with Dr. Herbert Goldfarb, he most emphatically agreed with Dr. Parker's assessment. In fact, he indicated that he has always been diligent about not offering this procedure to women who intend to become pregnant in the future. The risk of uterine rupture is simply too great. Nonetheless, some gynecologists offering this procedure have not shown due diligence in this regard and several women have experienced uterine rupture with pregnancy as a result.

Link	Site Name/Author	What You'll Find
hgoldfarb.com/clinics.htm	Dr. Herbert Goldfarb	Laparoscopic Coagulation of Myoma (Myolysis) Reprinted from: Obstetrics and Gynecology Clinics of North America VOLUME 22, NUMBER 4, DECEMBER 1995
www.fibroidcorner.com/ treatments/myolysis.ihtml	RL Worthington-Kirsch, MD	Short, easy to understand description of both myolysis and cryomyolysis.
www.hgoldfarb.com/	Dr. Herbert Goldfarb	Professional home page of Dr. Goldfarb.
www.wral-tv.com/features/ healthteam/1997 /1203-hyst-alternatives/	WRAL5 Online	12/3/97 Some Women Finding Alternative to Hysterectomy
www.ccon.com/hers/	HERS Foundation	Contact HERS directly or send for more information on myolysis.
www.gynsecondopinion.com/ FibroidTreatment.shtml	Dr. William Parker	Website for A Gynecologist's Second Opinion : The Questions and Answers You Need to Take Charge of Your Health.
www.allhealth.edu/ womenshealth/EDU/ CONSUMER/fibroid.html	Allegheny General Hospital Pittsburg, Pennsylvania	New technique freezes, shrinks fibroid tumors.