If you are a woman experiencing fibroid symptoms, you have many treatment options available, including medical therapies, noninvasive procedures, minimally invasive procedures, and various types of surgeries. Please keep in mind that it is in your best interest to speak to a health care provider as soon as possible about your symptoms, as the earlier you diagnose the fibroids, the more treatment options you will have. Beginning early enables you to choose a treatment based on your own health, lifestyle, professional needs, and family preferences.
Treatment Options Explained
“Watchful waiting” is recommended for women whose fibroids are either not causing any symptoms or have very mild symptoms that do not interfere with their quality of life. Women may consider adopting small lifestyle changes to adapt.
Treatments involve the use of hormones or medications to shrink fibroids and/or control fibroid related bleeding. Various types of medications are often used as first line therapy in patients with abnormal uterine bleeding and include: Progestins and Intrauterine Levonorgestrol, GnRH agonist, androgens, and progesterone receptor modulators. Gonadotropin-releasing agonists (GNRHa) such as Lupron can be used for 3-6 months and inhibit estrogen secretion, producing temporary menopause and shrinking fibroids by 50%. This can be used before surgery and MRgFUS procedures to shrink fibroids and make the procedures faster. Some reports suggest that Lupron also enhances the heating of tissue for faster treatments during MRgFUS. Tranexamic acid reduces bleeding during the menstrual cycle. Women with bulk symptoms may benefit from treatment with Lupron or progesterone receptor modulators to shrink the fibroids. When therapy is discontinued, fibroids often grow back rapidly within four to six months. Women are unable to conceive while on most hormonal therapy and thus most medical treatments of fibroids are contraindicated in women who desire fertility.
Non-Invasive Medical Procedure (No Incision)
Curawave (MR-guided focused ultrasound) is a noninvasive, no-incision technology that uses waves of ultrasound energy to heat and destroy fibroid tissue. MRI images are used to guide treatment and monitor temperature elevation to ensure successful heating and treatment. This outpatient procedure allows for a very quick return to normal activities usually within 1-2 days. A recent nationwide Fibroid Relief survey of nearly 1,000 women found that when women were presented with treatment descriptions, the majority (60%) rated focused ultrasound as their top treatment choice.
Minimally-Invasive Procedures (Requires Catheters)
Uterine Fibroid (or Artery) Embolization (UFE or UAE)
Involves a minimally invasive interventional radiologic technique to block the uterine arteries with small particles to decrease blood supply to the fibroid. This procedure is contraindicated in women who desire future fertility. Risks include radiation, menopause, serious infection, bleeding, and blockage of blood supply to other organs. UFE/UAE causes the fibroids to shrink about 30-50%.
Surgical Procedures (Requires Incision)
This minimally invasive surgical procedure uses radiofrequency ablation to deliver energy (heat) into the fibroid. Two small incisions are made in the anterior abdominal wall. A laparoscopic ultrasound device targets the fibroids and then a separate needle is inserted directly into the fibroid. The fibroid then shrinks in size similar to UAE or MRgFUS.
Myomectomy is an option for women who wish to preserve their uterus or enhance fertility, but carries surgical risks and may require further interventions. This surgery involves cutting the uterine wall to surgically remove the fibroids and then sewing the uterine wall closed. A myomectomy can be performed via a laparotomy (open abdominal incision), laparoscopy (through several small ports in the abdominal wall) or hysteroscopy (through the vagina). Myomectomy requires a highly skilled GYN surgeon to obtain success. Myomectomy controls symptoms in about 80% of cases. There is a 17-20 % fibroid recurrence rate and 10% of women may need a hysterectomy within 5-10 years.
Involves at minimum removing the uterus entirely, and sometimes the cervix, and/or ovaries. This entirely eliminates any possibility of fibroid recurrence. The hysterectomy can be performed via a laparotomy (open abdominal incision), laparoscopy (through several small ports in the abdominal wall) or hysteroscopy (through the vagina). The type of hysterectomy depends on the size of the fibroids, size of the uterus, the woman's medical history, and the skills of her surgeon. Uterine ﬁbroids are the leading cause of hysterectomy in the United States and results in loss of reproductive potential and many possible side effects.