What Are My Treatment Options?

What treatment options are available to women with uterine fibroids?

“Watchful waiting” is suitable for women whose fibroid symptoms are mild, who are not family-complete, or who are nearing menopause. Women may consider adopting lifestyle changes recommended by their physicians to alleviate discomfort.

Hormonal therapy encompasses anti-inflammatory drugs, birth control pills, and hormone therapy. A recent development in hormone therapy is the administration of synthetic GnRH agonists (gonadotropin releasing hormone agonists), which reduce the amount of estrogen produced by the body. Lower estrogen levels cause the fibroids and the uterus to shrink, relieving symptoms. GnRH agonists also stop menstrual periods, speeding a woman’s recovery from anemia. However,if therapy is discontinued, fibroids grow back within 4 to 6 months. Women are unable to conceive while on most hormonal therapy.

Focused Ultrasound is a non-invasive outpatient procedure that requires no incisions. Focused Ultrasound uses focused high-intensity ultrasound waves to heat and destroy the fibroids, guided by magnetic resonance imaging (MRI). The 3-dimensional MRI view permits a clinician to focus and deliver ultrasound energy to areas of individual fibroids. Tissue temperature and ablation are monitored in real-time during the procedure. The procedure may treat only four to six fibroids at a time. Research is ongoing to determine women’s reproductive potential following Focused Ultrasound. Anecdotally, there have been successful pregnancies carried to term following treatment (the treatment is approved for use in the U.K. for women seeking to retain their fertility).

Uterine fibroid embolization (UFE) is an alternative to surgery. Previously performed to stop postpartum hemorrhaging, it has been used increasingly to treat uterine fibroids since the mid-1990s. A clinician inserts a small catheter through the femoral artery in the groin, and guides the catheter to arteries that supply the uterus, using X-ray imaging. Small plastic particles are injected through the catheter into blood vessels that supply the fibroid. The particles block blood flow to the fibroid, causing it to shrink which relieves the symptoms typically within 2 - 3 months. UFE can be considered for women who are not family complete but in consultation with an experienced interventional radiologist.

A Myomectomy surgically removes fibroids from the uterine wall. Although fibroids in the uterine cavity can be removed through the vagina and cervix, fibroids within the uterine walls or on the outer surface require an incision. A hysteroscopic myomectomy removes one or more fibroids (mostly within the uterine cavity) using a hysteroscope through the cervix. A laparoscopic myomectomy removes fibroids (typically up to 6 cm in size depending on location) on the outside of the uterus via a small incision in the abdominal wall. An abdominal myomectomy requires incisions in the abdomen and in the uterus to access the fibroid. With myomectomy, reproductive potential is spared - it is generally safe to conceive after adequate healing time. Cesearean section may be required for delivery.

Hysterectomy is still the most common treatment for women with uterine fibroids. Of the half-million hysterectomies performed in the United States each year, one-third are for the treatment of fibroids. The uterus is entirely removed in a hysterectomy, eliminating any possibility of fibroid recurrence. The surgeon may use an abdominal or a vaginal approach, and may retain the ovaries. Hysterectomy is a frequent choice of women whose fibroids are large, or who experience heavy bleeding. However, the procedure should be chosen only by women who are family-complete.