Treating Fibroids

You have options. Don’t delay treatment if you are symptomatic. Find the right provider. Be your own advocate.

Why is treatment important for me?

Treatment is important because it may alleviate your symptoms. The sooner you can get effective treatment, the better outcomes you may be able to achieve. In some cases, fibroid symptoms worsen over time. It is better to address symptoms early and avoid having to make treatment decisions quickly if you are not feeling well.

How do I select the treatment option that is best for me?

Like many women, you have heard from your care provider that you have fibroids. Depending upon how heavy your menstrual periods are or how much pain you are feeling, you may have different goals for therapy. Fortunately, you have many options to treat your symptoms, and it is important for you to consider all of your options before making the best decision for you.

For most of these options, you can try one and switch to another, so when in doubt, choose the option that is best for you. Before your doctor’s visit, make a list of your symptoms, and rank them in order of importance. Each patients goals for treatment are very personal. Your physician should address each concern.

Treatment considerations may be different if you’re recently diagnosed, near menopause, or if you wish to become pregnant soon. There are many potential options, and each have their benefits and drawbacks. Understanding YOUR medical and surgical management options will help you select the best option(s) to achieve your treatment goals.

Therapies directed at your symptoms

Watchful Waiting

If you know you have fibroids, but your symptoms are manageable at home without involving medicine or surgery, it is reasonable to check in with your care provider regularly and otherwise continue to manage your symptoms as you have been doing. It is possible that your symptoms will get worse over time, so regular re-assessment is important to be sure that your fibroids are not disrupting your life.
Birth Control Pills

Birth control pills are often prescribed for women who have heavy periods in order to decrease the amount of bleeding associated with their periods. While this therapy does decrease normal menstrual bleeding, unfortunately it does not treat the fibroids, and symptoms may start to worsen over time despite using birth control pills. This therapy does not treat the fibroids, so they may continue to grow, and any pain or pressure that you feel will not be treated either.
Other Hormonal Therapies

Hormone-releasing IUDs, pills that only contain progesterone-like compounds, implants, and other hormonal methods will have a similar effect on bleeding, but do not treat the fibroid directly. As a result, while menstrual bleeding may improve initially, your fibroids also may worsen over time. Also, pain and pressure will not be treated.
Tranexamic Acid

This medicine regulates the way that blood clots, and can lower the amount of blood that is lost from the normal menstrual period and from fibroids. It does not treat the fibroid directly, however, and will not address pain and pressure.
Endometrial Ablation

This out-patient surgery essentially destroys the part of the womb that is involved with menstruation. The procedure is quick and requires a few visits, but it can be expensive and does not cure the fibroids. As a result, additional treatment in the future may be required. Also, if you plan on having children in the future, this is not an option to consider, since it destroys the tissue required for pregnancy.

Therapies that treat fibroids

GnRH Analogues

There are two types of medicines that block the impact of hormones on fibroids: gonadotrophin-releasing hormone (GnRH) agonists and antagonists. In the United States, currently only GnRH-agonists and antagonists are available for fibroid treatment. These therapies may decrease fibroid size and heavy menstrual bleeding. Currently, the approved treatment timeframe for a GnRH agonist is 3-6 months which is used prior to fibroid surgery. The approved treatment timeframe for a GnRH antagonist is up to 2 years. Consult with your health care provider to determine which medical therapy is best for you.
Selective Progesterone Receptor Modulators

Progesterone receptor modulators are drugs that bind to the progesterone receptor modifying the uterine tissue response to progesterone. By modifying the response of the uterine muscle (called myometrium) these drugs help decrease fibroid size and heavy menstrual bleeding.
Uterine Artery Embolization

Under X-ray guidance, a small tube is placed near the fibroid, and small beads are released into the nearby blood vessels to block blood flow to the fibroids. This causes the fibroids to shrink, and improves symptoms. However, surrounding tissue may be impacted, and as a result this option may not be best for women who want to have children in the future.²
MRI-Guided High Frequency Ultrasound

This therapy uses a focused ultrasound to heat up the fibroids an MRI machine to monitor the spread of the heat so that surrounding tissues (such as blood vessels, nerves, and normal uterine tissue) are protected. No incisions are needed. Specialized equipment and training are required, however, and may not be available locally. Finally, this therapy may not be covered by insurance, so be sure to check before proceeding with this option.
Radiofrequency Ablation

A probe is placed into the fibroid either during a surgical procedure or using local anesthesia and going through the normal skin. The tip of the probe is then heated up to destroy normal myometrial tissue. While the tip is monitored, potential damage to surrounding tissues may be difficult to detect and prevent.
Myomectomy

The surgical procedure where the fibroids are removed from the uterus, leaving the uterus inside of you. It may be performed inside the uterus (called a hysteroscopic myomectomy), or through the abdomen as a laparoscopic surgery, a robotic surgery, or a laparotomy (where a larger incision is used to make the uterus more accessible. Robotic surgery has certain benefits to the surgeon, but typically the quality of the surgery is not better than either a laparoscopic surgery or surgery by laparotomy.
Hysterectomy

This is the surgical removal of the uterus, with all fibroids. While curative, it also eliminates the possibility of future child-bearing, and may result in other long-term side-effects such as inability to hold urine when coughing or sneezing, and potentially bulging of tissues out of the vagina. Given the wide array of alternatives, hysterectomy should be the last option once all other options are either not right for you or have failed.

References

* Understanding racial disparities for women with uterine fibroids – Erica Marsh, M.D., M.S.C.I

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By age 50, nearly two-thirds of women experience uterine fibroids¹

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