Uterine Fibroids: Treatment Options, Surgery, New Methods

What are the treatments for fibroids?

If a woman is having heavy bleeding which could cause a low blood count or is experiencing severe cramping, painful periods, infertility, or bladder or bowel problems, she will need treatment. If you have uterine fibroids that need treatment, a gynecologist may recommend medicine to help relieve your symptoms or surgery if these are ineffective.

Before deciding on a treatment, it is important to talk with your health care provider to get more information. Ask your health care provider:

• How many fibroids do I have and will they grow bigger?
• Where are they located and will they cause problems?
• Do I need treatment if I am not having any problems?
• What are my choices for treatment?
• Can I try other options such as medications or hormone therapy before I try surgery?
• What are the treatment options other than hysterectomy?
• What are the risks and benefits of these treatment options?

If you need more information before deciding on a treatment, you can ask your health care provider to refer you to another doctor for a second opinion to be sure you are making the best decision.

Treatments Options for Uterine Fibroids

Medications

For occasional mild to moderate pain or discomfort, over-the-counter medication such as ibuprofen or acetaminophen can be taken. Over the counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, if used during early pregnancy, may cause miscarriage.

For symptoms of heavy bleeding, which can cause anemia, taking an iron supplement and an iron-rich diet can help to prevent anemia or treat anemia. More serious symptoms may require stronger drugs available by prescription from your health care provider.

Hormone Therapy

Birth control pills (oral contraceptives) can be used to treat the bleeding symptoms of fibroids. Low-dose birth control pills or progesterone-like injections (such as Depo-Provera) do not make fibroids grow and can help control heavy bleeding.

An intrauterine device (IUD) that contains a small amount of progesterone-like medication (such as a Mirena IUD) can also control fibroid symptoms and provide birth control.

Gonadotropin-releasing hormone agonists (GnRHa)

Some fibroids are treated with GnRHa, a hormone that reduces the amount of estrogen to shrink the fibroids and control symptoms. Sometimes GnRHa is used before surgery to make fibroids easier to remove. Most women can take GnRHa without any problems, but using GnRHa causes menopause-like side effects such as:

• Hot flashes
• Depression or mood swings
• Decreased sexual interest
• Insomnia (not being able to sleep)
• Headaches
• Bone thinning
• Joint pain

The side effects go away when the GnRHa is stopped, and once you stop taking the drugs the fibroids often grow back quickly. Most women don’t get a period when taking GnRHa. This can relieve the symptoms of heavy bleeding and improve the low blood count (anemia) which can happen with heavy bleeding. Since GnRHa can cause bone thinning, it is generally used for six months or less.

Surgery for Uterine Fibroids

There are three surgical treatments for fibroids:

• Myomectomy – cutting fibroids from the uterus,
• Endometrial Ablation – removing or destroying the lining of the uterus, or
• Hysterectomy – removing the entire uterus (womb).

The surgical method used depends on the size, location, and several fibroids.

Myomectomy

Myomectomy is removing fibroids without taking out the uterus, which makes pregnancy possible for some women. A woman who has had a myomectomy can have problems with the placenta or can make a cesarean delivery more likely if she becomes pregnant. Fibroids may also develop again, even after a myomectomy.

Myomectomy can be done by:

• Laparoscopy – making one or more small cuts in the abdomen and inserting a lighted viewing instrument to remove the fibroids through the small cuts,
• Hysteroscopy – using a lighted viewing instrument going through the vagina and into the uterus to remove the fibroids, or
• Laparotomy – major surgery is done by making a larger cut into the abdomen and the uterus.

The type of operation done for the myomectomy depends on the size and location of the fibroids.

Endometrial Ablation

Endometrial Ablation is when the lining of the uterus is removed or destroyed by using a laser, wire loops, freezing, or other methods to control very heavy bleeding. This procedure is usually considered minor surgery and can be done on an outpatient basis. A woman having this procedure will be unable to have children. Complications can occur but are not common.

Hysterectomy

A hysterectomy is an operation to remove the uterus (womb). The only absolute cure for uterine fibroids is a hysterectomy. This procedure results in permanent infertility; a woman will be unable to have children. A hysterectomy is a major surgery. All of the possible risks of surgery listed above are the same for hysterectomy.

• Hysterectomy

Embolization

Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE) – is a non-surgical procedure that blocks blood flow to fibroids in the uterus. Embolization is done with local anesthesia, and there are no incisions or cuts in the skin.

A thin flexible tube is threaded into the blood vessels that supply blood to the fibroid; a solution is then injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. Fibroids treated with embolization shrink by half or more. Normal uterine tissue usually remains unharmed, because it is supplied by other arteries.

Pregnancy is possible after embolization, but the risks to pregnancy after embolization are not fully known. Embolization is a procedure for women who do not want to have children in the future.

Women who are considered the best candidates for embolization are women who:

• Have fibroids that are causing heavy bleeding
• Have fibroids that are causing pain or pressing on the bladder or rectum
• Don’t want to have a hysterectomy
• Don’t want to have children in the future

Complications of embolization are not common but can occur. They are:

• Infection – the most serious, potentially life-threatening complication of embolization. See your doctor immediately if you have a high fever and feel ill or notice pus in your vaginal discharge. In rare cases, an emergency hysterectomy is needed to treat an infected uterus.
• Loss of menstrual periods
• Premature menopause
• Scar tissue formation

It is important to note though that all women are different and treatment may vary. Only your health care provider can provide you with the best options to treat uterine fibroids.

Are new treatments for uterine fibroids being developed?

There are several new ways of destroying fibroid tissue or removing fibroids. These methods are not yet standard treatments so your health care provider may not offer them and your health insurance may not pay for them.

If your doctor offers one of these procedures, ask:

• How many of the procedures he or she has done,
• How successful they have been,
• What kinds of problems can result, and
• Whether your insurance covers the procedure.

Myolysis

Myolysis is the destruction of muscle tissue. Myolysis is generally recommended for smaller fibroids. It is not recommended for women who hope to have children. These treatments can cause serious pregnancy complications, such as uterine scarring and infection; these can be dangerous to both mother and fetus.

• Laser (myolysis) – is usually done by laparoscopy. A laser is used to remove the fibroid or clot the blood supply to the fibroid, causing the fibroid to shrink and eventually die.
• Cold (cryomyolysis) – is usually done by laparoscopy. Liquid nitrogen is used to freeze the fibroid.
• Electric current – Myoma coagulation (myolysis) – is usually done by laparoscopy. An electrical needle is passed directly into the fibroid delivering high-temperature energy to destroy both the fibroid and the blood vessels feeding it.
• High-frequency focused ultrasound – Using a high-intensity ultrasound beam, the Magnetic Resonance Imaging(MRI) scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy it.

New Medications

New anti-hormonal drugs and other medications are being studied for the treatment of fibroids, but none are yet available or Federal Drug Administration (FDA)-approved for us in the US.

It is important you talk with your health care provider to fully understand your options for uterine fibroids that are causing you problems. If your health care provider is recommending a hysterectomy, be sure to ask why other options are not right for you. Remember, you can ask for a second opinion to be sure the treatment option is right for you.