Q: How are fibroids treated?

A: Fibroids that do not cause symptoms, are small, or occur in a woman who is nearing menopause often do not require treatment. There are many treatment options for fibroids. Treatment will depend upon the specific symptoms, uterine size and location of the fibroids.

• Medications
  • Birth control pills and other types of hormonal birth control methods are used to control heavy bleeding and painful periods. A drawback is that this treatment may cause the fibroids to increase slightly in size.
  • Gonadotropin-releasing hormone (GnRH) agonists stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. GnRH agonists have many side effects, including bone loss, osteoporosis, vaginal dryness, and night sweats. For these reasons, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size.
• Intrauterine Devices
  • Progestin-releasing intrauterine device. This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves.
• Surgery
  • Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. If a woman does become pregnant after a myomectomy, the baby may need to be delivered by cesarean birth. Sometimes, though, a myomectomy causes internal scarring that can lead to infertility.
  • Hysteroscopic myomectomy can be used to remove fibroids that protrude into the uterine cavity. This procedure requires no external incisions. Hysteroscopy is a procedure that allows direct visualization of the inside of the uterine cavity. A resectoscope is inserted through the hysteroscope. The resectoscope is used to excise the fibroids with electricity. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. In most cases, an overnight stay in the hospital is not necessary.
  • Endometrial ablation destroys the lining of the uterus. It is used to treat women who have heavy menstrual periods. This treatment also is used to treat women with small (less than 3 centimeters) fibroids. Risks of endometrial ablation include bleeding and infection. The device used to destroy the lining of the uterus may pass through the uterine wall or bowel, although this rarely happens. Most women are not able to get pregnant after they have this procedure.
  • Uterine artery embolization (UAE) is performed by a specially trained radiologist. In this procedure, the blood vessels to the uterus are blocked, stopping the blood flow that allows fibroids to grow. A small incision (cut) is made in your groin area. A tube called a catheter is passed through the large artery there until it reaches the small arteries that supply the uterus with blood. Tiny particles (about the size of grains of sand) are injected through the catheter into these arteries. The particles cut off the blood flow to the fibroid and cause it to shrink. The procedure works even if you have more than one fibroid. Sometimes after UAE, the particles that are put into the fibroids to cut off their blood supply have traveled to the ovaries. In a few women, the ovaries then stop working for a short time or permanently.
  • Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. For this procedure, the uterus may be removed through an incision (cut) in the abdomen, with laparoscopic assistance, with robotic surgery or through the vagina. The method used depends on the size of the fibroids. This will usually require at least an overnight stay in the hospital.