Uterine fibroids, or leiomyomas, are non-cancerous tumors that grow inside the uterine wall. As scary as that sounds, fibroids are actually very common.
Despite millions of women living with undetectable fibroids, when they grow big — or even if there are a lot of little tumors — they can cause problems, like pain and bleeding. That’s when it’s time to talk to a healthcare professional to get some help.
Medical treatments for fibroids
Uterine fibroids get a lot of attention, both because of the large number of women affected by them, and due to the large number of hysterectomies people undergo to treat the symptoms they cause.
Your health care provider may suggest medical treatments to reduce the symptoms of fibroids or to stop the growth of fibroids. These treatments are less invasive than surgery. However, if the medical treatments are not helpful, then surgery is often recommended. Certain medical treatments to reduce fibroid size and blood loss may be used to help the surgery succeed.
Common medical treatments for fibroids include:
Pain medication. Over-the-counter or prescription medication is often used for mild or occasional pain from fibroids.
Birth control pills or other types of hormonal birth control. These medications control heavy bleeding and painful periods. However, this therapy can sometimes cause fibroids to grow larger.
Progestin-releasing intrauterine device (IUD). The IUD, also called intrauterine contraception (IUC), reduces heavy and painful bleeding but does not treat the fibroids themselves. It is not recommended for women whose fibroids result in an extremely large uterine cavity.
Gonadotropin-releasing hormone agonists (GnRHa). These medications block the body from making the hormones that cause women to ovulate and have their periods. The medications also reduce the size of fibroids. Because this treatment can cause side effects that mimic the symptoms of menopause (such as hot flashes, night sweats, and vaginal dryness) and bone loss (which weakens the bones), it is not meant for long-term use. Most of the time, these medications are used for a short time to reduce the size of fibroids prior to surgery, or to treat anemia. If you need to take this treatment for a long time, the doctor may prescribe medication to put back the hormones that were blocked.
Antihormonal agents. These drugs, which include mifepristone, can slow or stop the growth, but the FDA has not approved their use for this purpose.
Medical treatments may give only temporary relief from the symptoms of fibroids. Once you stop the treatment, they often grow back and symptoms return.
Medications are generally safe, but they can have side effects, some of which may be serious. Be sure to talk to your health care provider about the possible side effects of any medical treatment you consider.
If you have moderate or severe symptoms of fibroids, surgery may be the best treatment for you.
Surgical treatment can be a major procedure or a minor one. The type of surgery depends on the size, location, and number of fibroids present, and your desire to bear children in the future.
Sometimes, there are a variety of surgical options from which to choose. Talk to your health care provider about the different types of surgical treatments and about the possible risks, side effects, and recovery time of each procedure.
Endometrial ablation destroys the lining of the uterus. It is used to treat small fibroids inside the uterus. Two common ways of doing an ablation are with a heated balloon, and with a tool that uses microwave energy to destroy the uterine lining and fibroids.
Pregnancy is unlikely after this procedure, but it can happen. Women who get pregnant after endometrial ablation are at higher risk for miscarriage and other problems. If you are going to have this treatment, talk to your health care provider about the risks of getting pregnant after the procedure. You might want to use birth control to prevent pregnancy until after you go through menopause.
This procedure removes only the fibroids, and leaves the healthy areas of the uterus intact, and can preserve your ability to get pregnant.
Myomectomy can be performed in one of three ways. The method you need will depend on the location and size of your fibroids.
Hysteroscopy: For this procedure, the surgeon inserts a long, thin telescope with a light through the vagina and cervix (the opening of the uterus). The doctor then uses electricity or a mechanical device to cut or destroy the fibroids. The doctor will inject a fluid into the uterus to make it easier to see before trying to remove the tumors.
Laparotomy: The surgeon removes the fibroids through a cut in the abdomen.
Laparoscopy: The surgeon uses a long, thin telescope to see inside the pelvic area, and then removes the fibroids using another tool. This procedure usually involves two small cuts in the abdomen.
Studies show that myomectomy can relieve fibroid-related symptoms in 80% to 90% percent of patients. The original fibroids do not regrow after surgery, but new ones may develop.
Hysterectomy is the only sure way to cure uterine fibroids completely. Health care providers usually recommend this option if your fibroids are large, you have very heavy bleeding, and you are near or past menopause.
During a hysterectomy, the whole uterus or just part of it is removed. The types of hysterectomy include:
Subtotal, or partial, hysterectomy. In this procedure, only the upper part of the uterus is removed.
Total hysterectomy. The entire uterus and the cervix are removed. Sometimes the ovaries and fallopian tubes are also removed. This procedure is called a total hysterectomy with bilateral salpingo-oophorectomy.
Radical hysterectomy. This procedure removes the uterus, the tissue on both sides of the cervix, and the upper part of the vagina.
There are several approaches to doing a hysterectomy:
Abdominal hysterectomy. The surgeon removes the uterus through a cut in the abdomen. This incision may be similar to what is done during a cesarean section. Full recovery time from an abdominal hysterectomy is one to two months. Removal of the ovaries is not required for treatment of fibroid symptoms. Similarly, some women may desire to preserve the cervix, if there is no history of abnormal pap smears.
Vaginal hysterectomy. Instead of making a cut into the abdomen, the surgeon removes the uterus through the vagina. This method is less invasive than an abdominal hysterectomy, so recovery time is usually shorter. Vaginal hysterectomy may not be an option if your fibroids are very large.
Laparoscopic hysterectomy. Minimally invasive approaches may include laparoscopic hysterectomy, laparoscopic-assisted vaginal hysterectomy, or robotic-assisted laparoscopic hysterectomy. Not all cases of uterine fibroids can be treated with such approaches, but these methods may result in reduced postoperative recovery time.
Robotic hysterectomy. Robotic hysterectomy is becoming more common. The surgeon sits at a console near the patient and guides a robotic arm to perform laparoscopic surgery. Like laparoscopic myomectomies, this technique requires only small incisions in the uterus and abdomen. As a result, recovery can be shorter than with more invasive procedures. More research is needed to understand how (and how well) these procedures work and to compare the outcomes with those of other established surgical treatments.
If you have not gone through menopause and are considering a hysterectomy for your fibroids, talk to your health care provider about keeping your ovaries. The ovaries make hormones that help maintain bone density and sexual health even if the uterus is removed. If your body can continue to make these hormones on its own, you might not need hormone replacement after the hysterectomy.
Having a hysterectomy means that you will no longer be able to get pregnant, so you will probably want to talk to your partner or spouse before deciding to have a hysterectomy. The process cannot be reversed, so be certain about your choice before having the surgery.
Radiological treatments for fibroids
Radiologic treatments (also called radiation therapy or radiotherapy) use ionizing radiation, similar to what you are exposed to when you get an X-ray, to treat fibroids.
Such treatments might be indicated if you want a minimally invasive option that avoids surgery and typically involves a short hospital stay. Before undergoing any treatment for uterine fibroids, you should discuss your options with your health care provider.
Uterine Artery Embolization (UAE)
Magnetic Resonance Imaging (MRI)-Guided Ultrasound
Uterine artery embolization, or UAE, is also called uterine fibroid embolization (UFE). This procedure cuts off the blood supply to the fibroids, causing them to shrink and be reabsorbed by your body.
In this procedure, the doctor makes a small cut in the groin area and inserts a tube (called a catheter) into the large blood vessel there. The doctor slides the tube until it reaches the arteries that supply blood to the uterus and then injects tiny particles through the tube into the arteries. The particles block blood flow to the fibroids. Blocking the blood flow eventually shrinks the fibroids and may relieve symptoms.
Recovery from UAE takes less time than does recovery from a hysterectomy. Some research has shown that UAE successfully treats them, but that about one-third of women who have UAE need treatment again within five years.
Because this procedure stops blood flow to parts of the uterus, it can affect how the uterus functions. It can also affect future ovarian function if the inserted particles drift into other areas of the pelvis such as the ovarian artery. Its effect on pregnancy is not clear, but an increased risk of miscarriage has been reported. For this reason, most health care providers do not recommend UAE for women who want to have children.
This treatment destroys fibroids using high-intensity ultrasound. The health care provider uses an MRI scanner to see the fibroids, then directs ultrasound waves through the skin to destroy the fibroids. This option is usually recommended for women who have only a few large fibroids.
Scientists are still studying the long-term effects of this procedure. Current research shows that up to 25% of women who have MRI-guided ultrasound need a second procedure after one year. Because MRI-guided ultrasound is new, your health care provider may not offer it or your health insurance company may not pay for it. It may also affect ovarian function.
Emotional support for living with fibroids
Emotional support may be just as important as medical treatment for dealing with the chronic symptoms and potential reproductive problems associated with fibroids. Many women find that joining a support group and talking to other women who have fibroids helps them come to terms with their condition.
Hospitals and health clinics may offer support groups for women and families affected by fibroids. Your health care provider may be able to refer you to a support group. You may also find it helpful to work with a “professional listener,” such as a social worker, a psychologist, a psychiatrist or another mental health professional.