Gynecology

Fibroids

Signs and Symptoms
Diagnosis
Treatment

Treatment

Treatment options for fibroids can range from no treatment at all to surgery. Unless fibroids are causing excessive bleeding, discomfort or bladder problems, treatment usually isn't necessary.

Women with fibroids should be evaluated periodically by their health care provider to review symptoms, follow the fibroid size and conduct abdominal and pelvic examinations to assess uterine size.

The following are treatment options for fibroids:

Medical Therapy

Medical treatments currently available for fibroids may improve certain symptoms, but do not make fibroids go away. Medical treatment may be recommended for women with heavy bleeding caused by fibroids before they decide to have a surgical procedure. Women with pressure symptoms caused by large fibroids will not benefit from any medicines currently available. Several promising new drugs that will treat the fibroids themselves and not just the symptoms are currently being developed and tested in clinical trials.

Oral Contraceptive Pills and Progestational Agents (Provera, medroxyprogesterone acetate)

Women with heavy menstrual periods and fibroids are often prescribed hormonal medications to try to reduce bleeding and regulate their menstrual cycle. The medications will not cause fibroids to shrink nor will it cause them to grow at a faster rate. If the medication has not improved your bleeding after three months, consult your doctor. Women over the age of 35 who smoke should not use oral contraceptive pills.

GnRH Agonists (Lupron)

GnRH agonists are a class of medications that temporarily shrinks fibroids and stops heavy bleeding by blocking production of the female hormone, estrogen. Lupron is the most well known of these drugs. Although Lupron can improve fibroid symptoms, it causes unpleasant, menopausal symptoms such as hot flashes and with long-term use, leads to bone loss.

Lupron is recommended only for very specific cases. For example, a woman with very heavy bleeding and serious anemia will likely need a blood transfusion at the time of fibroid surgery. However, if she takes Lupron for two to three months before surgery to make her periods temporarily stop, along with an iron supplement, her anemia will improve and she may not need a blood transfusion. In rare instances, Lupron may be recommended to women with very large fibroids -- greater than 10-12 centimeters -- prior to fibroid surgery. It is important to note that Lupron should not be used solely for the purpose of shrinking fibroids unless surgery is planned because fibroids will re-grow to their original size and symptoms will return as soon as a woman stops taking Lupron.

Intrauterine Devices (IUD)

Although intrauterine devices (IUD) are typically used to prevent pregnancy, they have non-contraceptive benefits as well. An IUD that releases a small amount of hormone into the uterine cavity has been shown to decrease bleeding caused by fibroids. An IUD can be inserted during a routine office appointment. Ask you doctor for more information about this treatment option.

Myomectomy

This procedure involves removing the fibroids while preserving the uterus. For women with problematic fibroids who want to have children, myomectomy is the best treatment option. The procedure can be performed several different ways depending on the size, number and location of the fibroids. For example, fibroids located within the uterine cavity can be removed using a hysteroscope, called a hysteroscopic myomectomy. Some fibroids can be removed via several small incisions through which a viewing instrument called a laparoscope and several miniature surgical instruments are used. A laparoscopic myomectomy involves removing fibroids located on the outer aspect of the uterus. Most myomectomies are performed by making an incision across the lower abdomen during an abdominal myomectomy. This allows for the removal of all types and sizes of fibroids and for the reconstruction of the uterus to its former size and contour.

Myomectomy is very effective treatment, but fibroids can re-grow. The younger a woman is at the time of myomectomy and the more fibroids she had, the more likely she is to develop fibroids in the future. Women nearing menopause are the least likely to have problems from recurring fibroids.

Hysterectomy

Hysterectomy is a major surgical procedure in which the uterus is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow. A woman can no longer become pregnant after a hysterectomy.

There are several different surgical approaches. A vaginal hysterectomy involves removing the uterus through an incision in the vagina. An abdominal hysterectomy is performed through an incision on the lower abdomen. A laparoscopic hysterectomy is accomplished through four tiny incisions on the abdomen. The type of hysterectomy will depend on the size of the uterus and several other factors.

The ovaries are not necessarily removed during a hysterectomy. Women should discuss the pros and cons of ovarian removal with their physicians.

Uterine artery embolization (UAE)

This relatively new treatment is an alternative to open surgery for fibroids. Embolization is a technique that blocks the blood flow to the fibroids, causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.

UAE is performed in a radiology suite rather than an operating room. A substance is released into the blood vessels leading to the fibroids, blocking the blood flow. Women receive pain medicine but are not completely asleep. After the procedure, patients experience pain for one to three days but are able to return to work and full activities in one week. Ninety percent of women report improvement in both pelvic pressure and heavy bleeding. However, UAE has been performed for only five years, so there is little information about long-term results. Since the procedure is still quite new, we discourage its use for women who have not completed childbearing.

See Fibroid FAQs and UCSF Comprehensive Fibroid Center.