MUSINGS: The Future of Fibroidology

I find myself frequently contemplating what the treatment for fibroids will look like in the future. There continues to be an explosion of both knowledge and technology that has left me with the firm conviction that in just a few years when one says "fibroid" the automatic word association will no longer be "hysterectomy". Who would have predicted, for example, that as advanced operative laparoscopy has finally come into its own, the major indication for its use increasingly would be treated by a non-surgical alternative such as uterine artery embolization (UAE)?

Myolysis and cryomyolysis have instantly been made obsolete by UAE. Who can justify general anesthesia to insert a laparoscope into a woman's abdomen to tediously stab only the myomas that can be seen from the surface of the uterus when all tumors can be treated completely and simultaneously without surgery or major anesthesia? Likewise myomectomy done primarily for palliation or hysterectomy by any method with their 20-40% complication rate both become very unattractive when similar results can be achieved with a less than 5% complication rate. But of course UAE is still not is the answer for all and surgery will continue to be necessary until the next innovations arrive. I wonder what will be next. Will it be the use of gene therapy that will allow genetic alteration of myoma cells so that they can be destroyed by orally administered medication; a technique already demonstrated at the laboratory level? Or will fibroids be eliminated completely by the discovery of an anti myoma vaccine administered to all young girls just prior to menarche? What will a gynecologist do in such a world?

Dr. Hutchin's office phone number is 610.667.4577 and his toll free number for book orders is 877-FIBROID