In our last blog post, we discussed some basic facts about uterine fibroids. In this blog post, we will discuss your treatment options.
Here are some things to consider when determining your best treatment options:
- Size and location of the fibroids: See image 1 below
- Submucosal fibroids poke into the uterine cavity
- Intramural fibroids grow in the uterine wall
- Subserosal fibroids grow on the outer wall of the uterus
- Severity of symptoms
- Your age and if you are close to menopause
- If you are planning on becoming pregnant
- If you want to have babies, there are several treatment options. Discuss the different options with your doctor before jumping to a hysterectomy! (A hysterectomy is when your uterus is surgically removed.)
Image 1: Fibroids in different locations Image 2: Uterus with multiple fibroids
What are my Treatment Options?
1. Do Nothing
You can do nothing. Many women with uterine fibroids experience no signs or symptoms, or only mildly annoying signs and symptoms that they can safely live with. If that’s the case for you, watchful waiting could be the best option. Your doctor can help you decide if this is an appropriate option for you.
2. Take Medication. Some potential options include the following:
- Hormonal medication. To decrease the amount of bleeding you are experiencing, hormonal medications like birth control pills, oral progestins, or progesterone-releasing intrauterine devices (IUDs) might be prescribed. These medications will help control your symptoms, but they will not shrink your fibroids.
- Tranexamic acid. This is a nonhormonal medication that is taken to ease heavy menstrual periods. It’s taken only on heavy bleeding days.
- Gonadotropin releasing hormone agonist (ex: Lupron). In some instances, a doctor will treat your fibroids or prepare for surgery with a “gonadotropin releasing hormone agonist” (GnRHa) medication. Be aware that GnRHas can cause side effects (like really bad hot flashes), so be sure to ask your doctor to explain the potential side effects. Also, GnRHas are typically not used for more than three to six months because symptoms return when the medication is stopped and long-term use can cause bone loss.
- Over the counter medications. Your doctor may recommend something like Ibuprofen to control pain or iron supplements to prevent anemia from heavy bleeding.
- I don’t recommend alternative medicine. Some websites and consumer health books promote alternative treatments, such as black cohosh. However, there’s currently no scientific evidence to support the effectiveness of these techniques.
Heating pads can also help discomfort, with or without medication.
If you have severe symptoms from your uterine fibroids, you may want to treat them with surgery. There are several different surgical options, depending on the size/ location of your fibroids and your reproductive plans. Here are some of your options (*If you want children in the future, ask your doctor which option is best for you.):
- Myomectomy—This surgery removes the fibroid(s). If you’re planning on having children, this is a good option because it removes the fibroids without removing healthy tissue from the uterus. It can be performed robotically, laparoscopically or hysteroscopically, or it may require a larger abdominal incision. While you can become pregnant after a myomectomy, you might need a C-section to safely deliver your baby. Also, following a myomectomy, fibroids may return.
- Endometrial Ablation—This procedure, which destroys the lining of the uterus, can be done using several techniques. Endometrial ablation is usually an outpatient procedure, meaning you do not have to stay in the hospital overnight. This procedure can sometimes help with heavy bleeding caused by small uterine fibroids (less than 3 centimeters). In some instances, your doctor will perform a myomectomy (removal the fibroid) prior to your endometrial ablation. An endometrial ablation is not a desirable option if you want children in the future.
- Myolysis—In this laparoscopic procedure, radiofrequency energy, an electric current or laser destroys the fibroids and shrinks the blood vessels that feed them. A similar procedure called cryomyolysis freezes the fibroids.
- Hysterectomy—This major surgery completely removes the fibroids and the uterus, and fibroids will not return. A hysterectomy may be a good option for women who do not want children or who are close to menopause. The surgery can sometimes be performed vaginally (no abdominal incisions), laproscopically (usually 3-4 small abdominal incisions), or robotically (small incisions, like laparoscopy but your surgeon uses a machine called a “robot”). However, women with larger fibroids will sometimes need a larger abdominal incision (either through a bikini cut similar to a c-section scar, or through a vertical incision going from the pubic bone toward the belly button); this is called an “abdominal hysterectomy.” If your ovaries are removed during the surgery, you will go into menopause, but if you keep your ovaries during the hysterectomy, you won’t go into menopause immediately following the surgery. Be aware that this is a major surgery, so your recovery will be more extensive and your risk of complications will be higher than with outpatient procedures.
When you have large fibroids, your doctor may discuss something called “morcellation”—a process that breaks fibroids into smaller pieces. By allowing your doctor remove the fibroid in smaller pieces, morcellation sometimes avoids larger abdominal incisions. Prior to agreeing to morcellation, ask your doctor to discuss the potential risks and benefits.
4. Interventional Radiology Procedures
- Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization (UAE)—This procedure targets the blood vessels that supply blood to the fibroid. Your doctor will inject tiny particles into the blood vessels to block blood supply, causing the fibroid to shrink. Complications may occur if the blood supply to your ovaries or other organs is compromised. Additionally, although it is sometimes done as an outpatient procedure, women can have quite a bit of discomfort after this procedure.
- MRI-guided focused ultrasound surgery (FUS)—This is a newer, non-invasive technique that preserves your uterus, doesn’t require any incisions and can be done as an outpatient procedure. With the help of magnetic resonance imaging, ultrasound waves are directed at the fibroids through the skin. The ultrasound waves destroy the fibroids. Since this is newer technology, researchers are learning more about the long-term safety and effectiveness. But so far data collected show that FUS for uterine fibroids is safe and effective.
If you have, or suspect you might have, uterine fibroids, it’s time to make an appointment with your doctor to check out treatment options. As always, we women have to make the best decision for ourselves. But you can’t do that without consulting your doctor! So make an appointment. Knowledge is power. #DrNita