Uterine Fibroids - Treatment Overview

Treatment Overview

Most uterine fibroids are harmless, do not cause symptoms, and shrink with menopause. But some fibroids are painful, press on other internal organs, bleed and cause anemia, or cause pregnancy problems. If you have a fibroid problem, there are several treatments to consider. Fibroids can be surgically removed, the blood supply to fibroids can be cut off, the entire uterus can be removed, or medicine can temporarily shrink fibroids. Your choice will depend on whether you have severe symptoms and whether you want to preserve your fertility.

Watchful waiting for minimal fibroid symptoms or when nearing menopause

If you have uterine fibroids but you have few or no symptoms, you do not need treatment. Instead, your health professional will recommend watchful waiting. This means that you will have regular pelvic exams to check on fibroid growth and symptoms. Talk with your health professional about how often you will need a checkup.

If you are nearing menopause, watchful waiting may be an option for you, depending on how tolerable your symptoms are. After menopause, your estrogen and progesterone levels will drop, which causes most fibroids to shrink and symptoms to subside.

For heavy menstrual bleeding or pain

If you have pain or heavy menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also be linked to a simple menstrual cycle problem or other problems. (For more information, see the topic Dysfunctional Uterine Bleeding.) Since the only proven medicine for shrinking fibroids has troublesome side effects and should only be used short-term, consider first trying one or both of the following for menstrual pain or heavy bleeding. Combining the two is most likely to relieve pain and lighten bleeding:⁷

• Nonsteroidal anti-inflammatory drug (NSAID) therapy improves menstrual cramping and reduces bleeding for many women.⁷ But there is no evidence that NSAIDs relieve pain or bleeding specifically caused by fibroids.⁶
• Birth control hormones (pill, patch, or ring) lighten menstrual bleeding and pain while preventing pregnancy.⁸

A progestin shot (Depo-Provera) every 3 months may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may improve fibroids, or may make them grow.^{9, 5} This might be different for each woman.

Iron supplement therapy and an iron-rich diet improve anemia caused by blood loss.

NSAID use during conception or early pregnancy may cause miscarriage.¹⁰ If you are trying to get pregnant, talk to your health professional about whether you can use NSAID therapy.

For infertility and pregnancy problems

If you have fibroids, there is no way of knowing for certain whether they are affecting your fertility. Fibroids are the cause of infertility only 2% to 3% of the time. Many women with fibroids have no trouble getting pregnant. Other women with fibroids have fertility problems because of some other reason.⁵

Experts have yet to learn exactly how much of a part fibroids play in pregnancy problems and miscarriage.⁵ If it distorts the wall of the uterus, a fibroid can prevent a fertilized egg from implanting in the uterus. This may make an in vitro fertilization less likely to be successful, if the fertilized egg doesn't implant after it is transferred to the uterus.¹¹

Surgical fibroid removal, called myomectomy, is the only fibroid treatment that may improve your chances of having a baby.⁵ Because fibroids can grow again, it is best to try to become pregnant as soon as possible after a myomectomy.

Some studies suggest that myomectomy may also lower the risk of miscarriages among women with fibroids. But there are not yet good enough studies to know for sure.⁵

For severe fibroid symptoms

If you have fibroid-related pain, heavy bleeding, or a large fibroid that is pressing on other organs, you can consider shrinking the fibroid, removing the fibroid (myomectomy) , or removing the entire uterus (hysterectomy). After all treatments except hysterectomy, fibroids may grow back. Only myomectomy is recommended for women who have future childbearing plans.

To shrink a fibroid for a short time, hormone therapy with a gonadotropin-releasing hormone analogue (GnRH-a) puts the body in a state like menopause. This shrinks both the uterus and the fibroids. Fibroids grow back after GnRH-a therapy. GnRH-a therapy can help to:

• Shrink a fibroid before it is surgically removed. This lowers your risk of heavy blood loss and scar tissue from the surgery.
• Provide short-term relief as a "bridge therapy" if you are nearing menopause. (Fibroids naturally shrink after menopause.)

GnRH-a therapy should be used for only a few months because it can weaken the bones. It also may cause unpleasant menopausal symptoms.

To surgically remove fibroids, myomectomy can often be done through one or more small incisions using laparoscopy or through the vagina (hysteroscopy). Sometimes, a larger abdominal incision is needed. Myomectomy preserves the uterus, and makes pregnancy possible for some women.^{5, 11}

To shrink or destroy fibroids without surgery, uterine fibroid embolization (UFE) (also called uterine artery embolization) stops the blood supply to the fibroid. The fibroid then shrinks and may break down. UFE preserves the uterus, but pregnancy is not common after treatment. UFE is not usually recommended for women who plan to become pregnant.¹²

To surgically remove the entire uterus, hysterectomy is available to women with long-lasting or severe symptoms who have no future pregnancy plans. Hysterectomy has both positive and negative long-term effects. For more information, see the topic Hysterectomy.

Should I use GnRH-a therapy to treat uterine fibroids?

Should I have surgery to treat uterine fibroids?

Should I have uterine fibroid embolization for uterine fibroids?

What To Think About

Fibroids can grow back after a myomectomy or after uterine fibroid embolization (UFE).

Compared to myomectomy, UFE is quicker and has a shorter recovery time.

The risk of complications (like severe pain or infection) is about the same after surgery or UFE.¹³

• With surgery (hysterectomy or myomectomy), most complications happen in the first days, in the hospital.
• With UFE, most complications happen in the following weeks or months, at home.

UFE is not always a definitive, final treatment option. In one study, nearly 1 in 5 women who had UFE later had a repeat UFE or a hysterectomy within 3½ years.¹³

There are several new ways of removing fibroids or killing fibroid tissue using extreme cold (cryomyolysis), laser (myolysis), or high-frequency focused ultrasound (ExAblate). But they are still new enough that risks and long-term benefits are not yet fully known.¹⁴ If your doctor offers one of these procedures, ask how many of the procedures he or she has done, how successful they have been, and what kinds of problems can result. These treatments are not recommended for women who are trying to become pregnant.⁵