Uterine Fibroids

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 or manage symptoms. 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 don't need treatment. Instead, your doctor will recommend watchful waiting. This means that you will have pelvic exams to check on fibroid growth and symptoms. Talk with your doctor 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 Abnormal Uterine Bleeding. The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods, but they do not shrink fibroids:

• Nonsteroidal anti-inflammatory drug (NSAID) therapy improves menstrual cramping and reduces bleeding for many women.
• Birth control hormones (pill, patch, or ring) lighten menstrual bleeding and pain while preventing pregnancy.
• An intrauterine device (IUD) that releases small amounts of the hormone progesterone into the uterus may reduce heavy menstrual bleeding.
• A progestin shot (Depo-Provera) every 3 months may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may shrink fibroids or may make them grow.^{footnote 2} This might be different for each woman.
• Iron supplements, available without a prescription, are an important part of correcting anemia caused by fibroid blood loss.

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 in only a small number of women. Most women with fibroids have no trouble getting pregnant.

If a fibroid distorts the wall of the uterus, it 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.^{footnote 3}

Surgical fibroid removal, called myomectomy, may improve your chances of having a baby.^{footnote 3} Because fibroids can grow again, it is best to try to become pregnant as soon as possible after a myomectomy.

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. Myomectomy or treatment with medicine is recommended for women who have 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 has ended. 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 is used for only a few months, because it can weaken the bones. It also may cause unpleasant menopausal symptoms.

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.^{footnote 2}

Another treatment used to destroy fibroids without surgery is MRI-guided focused ultrasound. This treatment uses high-intensity ultrasound waves to break down the fibroids. Studies show that this treatment is safe and works well at relieving symptoms. But more studies are needed to find out if it works over time.^{footnote 2} This treatment may not be available everywhere.

Endometrial ablation is a treatment that destroys the lining of the uterus. It may use a laser beam, heat, electricity, freezing, or microwaves. As the lining of the uterus heals, it will scar. This scarring reduces or prevents bleeding.

To surgically remove fibroids, myomectomy can often be done through one or more small incisions using laparoscopy or through the vagina (hysteroscopy). Some surgeries can be done using robotic tools. Sometimes, a larger abdominal incision is needed depending on where the fibroid is located in the uterus. Myomectomy preserves the uterus, and it makes pregnancy possible for some women.

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.