Treatment Options

Treatment depends on the severity of symptoms, the patient's age, whether or not she is pregnant, the desire for future pregnancies, her general health, and characteristics of the fibroids. Some of the more common treatments are described below. Talk to your doctor about the treatment option that is right for you.

Some women may just require monitoring of the fibroids by pelvic exams or ultrasounds every so often. Painful menstrual cramps may be treated with nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen sodium. Iron supplementation may be given to prevent anemia in women with heavy periods.

In some cases, hormonal therapy involving drugs such as injectable Depo Leuprolide is prescribed to temporarily shrink fibroids. This medication stops the production of the hormones estrogen and progesterone which are required to maintain the fibroids. Leuprolide creates a state in the body that is very similar to menopause. Side effects include hot flashes, vaginal dryness, and mild loss of bone density. These side effects resolve after the drug is discontinued. Hormone treatment may last several months. Fibroids will begin to grow as soon as treatment stops. In some cases, hormone therapy is used for a short period of time before surgery or when the woman is expected to reach menopause soon.

Additionally, birth control pills (oral contraceptives) may be used to help decrease menstrual blood flow.

A myomectomy is a surgical procedure to remove fibroids. It is frequently the treatment of choice for women who want to have children, because it usually can preserve fertility. Another advantage of a myomectomy is that it often decreases the pain or excessive bleeding that many women with uterine fibroids have. A laparoscopic myomectomy involves a surgical removal of the fibroids while leaving the uterus intact. This procedure is conducted when the fibroids are located within the wall of the uterus and are best treated through the abdominal approach. In this procedure, a laparoscope and other instruments are inserted through the abdominal wall. The hysteroscopic myomectomy procedure may be performed in order to remove those fibroids growing inside the uterine cavity. In this procedure, a hysteroscope and other instruments are inserted through the cervix into the uterine cavity to remove the fibroids.

Uterine artery embolization is a procedure performed by interventional radiologists. A catheter is placed into one of the blood vessels in the groin and directed through the body into the two main arteries that provide blood flow into the uterus. Small permanent beads are injected into the uterine arteries which greatly reduce the blood supply to the entire uterus. This has been shown to reduce the size of the fibroids by cutting off their blood supply.

High Frequency Ultrasound (Hi-Fu or MRI-GU) is another procedure performed by radiologists. It uses MRI imaging and monitoring and high energy ultrasound which heats the tissue that is targeted. Hi-Fu has been shown to produce damage to a limited number of fibroids of moderate to small size and in certain locations.
Radiofrequency ablation has been used for many years to treat other medical conditions, and has been shown to be very effective in treating certain types of cancer.  The treatment of uterine fibroids through Radiofrequency ablation is an experimental procedure that aims to destroy the fibroids by applying RF energy through a small needle that is inserted through the abdomen and into each fibroid.  Ultrasound inside the abdomen (intra-abdominal ultrasound) and laparoscopy are used for visualization and guidance of the needle into the fibroids.  After the fibroid is destroyed, the needle is withdrawn, and the destroyed tissue is slowly reabsorbed. 

In some cases, a hysterectomy may be the best option. A hysterectomy completely removes all fibroids by removing the uterus. Though this has been done for many years as a treatment for heavy bleeding or discomfort due to fibroids, patients are often turning to alternatives that preserve the uterus.

Contacting Your Health Care Provider

There are many treatment options available to women with fibroids. You will need to call your health care provider if gradual changes in your menstrual pattern occur (heavier flow, increased cramping, bleeding between periods), or if fullness or heaviness develops in your lower abdomen. There may be associated pressure or discomfort and occasionally interference with normal urinary function. Your health care provider can discuss the risks and benefits of the various treatment options available to you.

References

L Speroff, M Fitz. Clinical Gynecologic Endocrinology and Infertility. 7th ed. Lippincott Williams & Wilkins; 2004.

Casini ML, Rossi F, Agostini R, Unfer V. Effects of the position of fibroids on fertility. Gynecol Endocrinol. 2006 Feb;22(2):106-9.