Uterine Fibroids

Treatment

MR-guided, focused ultrasound obliterates tumors by focusing high-intensity ultrasound beams on the growths.

Most women with uterine fibroids don't need treatment. Their tumors either don't cause symptoms or the symptoms can be controlled with common medications. But for women truly debilitated by the growths, Mayo offers several treatments, including two nonsurgical options. Mayo physicians have years of experience to help direct patients toward the best choice.

While gynecologists supervise care, gynecologic surgeons, interventional radiologists and other specialists (e.g., urogynecologists and maternal fetal medicine experts) are routinely included on the multidisciplinary team. After initial diagnosis (and treatment, if indicated), women with uterine fibroids are followed and re-evaluated, if necessary.

Hormonal Therapy

Drugs that target hormones which regulate menstruation may be prescribed for long-term control or short-term fibroid relief. By suppressing estrogen and progesterone, gonadontropin-releasing hormone (Gn-RH) agonists (e.g., Lupron or Synarel) virtually halt a woman's periods, and shrink her fibroids. But these drugs are not safe in the long term. Because they trigger the entire spectrum of menopause changes, including loss of bone minerals, the Mayo practice is to prescribe them for just a few months. Most often these medications are used just prior to surgery to shrink the fibroids or to allow time to treat iron deficiency anemia. As for oral contraceptives, since they tend to reduce menstrual bleeding but not fibroid size, they remain an option for women who require treatment for heavy bleeding, but who do not have other symptoms from uterine fibroids.

Uterine artery embolization

Shrinking fibroids by starving them of blood is a newer, nonsurgical therapy offered at Mayo Clinic. Uterine artery embolization relies on the skilled hands of an interventional radiologist to inject micro-particles into the uterine arteries to block the fibroid's blood supply.

The upside of embolization: tumors shrink over several months, giving about eight out of 10 women prompt symptom relief. The downsides: the fibroids may recur, and a few women will begin menopause as a result of the procedure. So, depending on a woman's age, emoblization may or may not be an ideal choice. Read more.

Ultrasound Treatment

MR-guided, focused ultrasound is a new, noninvasive treatment available for select patients. The treatment obliterates tumors by focusing high-intensity ultrasound beams on the growths, raising the temperature enough to destroy them. Read more about MR-guided, focused ultrasound.

Hysterectomy

Surgical removal of the uterus (hysterectomy) is the only permanent solution for uterine fibroids. Mayo surgeons are skilled at abdominal hysterectomies. They may also be able to offer vaginal surgery, even in patients with uterine enlargement due to uterine fibroids. Removing the uterus through the vagina rather than a belly- or bikini-incision has several advantages for patients: shortened hospital stays, lower complication and infection rates and swifter recoveries. But all types of hysterectomy have downsides: hysterectomy is major surgery, it ends a woman's childbearing ability and, if the ovaries are removed, will bring on early menopause. Still, many women who suffer from symptoms of uterine fibroids choose permanent relief.

Myomectomy

Mayo specialists recommend this procedure when a woman wants to eliminate her fibroids, but not lose her fertility. Myomectomies are most commonly performed through an abdominal incision. The advantages of a myomectomy through an abdominal incision include the ability to remove large or multiple fibroids and to reconstruct a strong uterine muscle.

Depending on the size and location of the fibroids, myomectomies may also be done using a hysteroscope inserted through the vagina and cervix or a slender laparoscope threaded through small abdominal incisions. Both minimally invasive tools are equipped with fiber optics to light the uterus as well as cutting and cautery instruments to remove the tumors. These minimally invasive procedures produce excellent outcomes, without large visible scars. But there are downsides to myomectomy: new fibroids can form, and any remaining ones can grow. For women who want to get pregnant, myomectomy is the only established procedure to control symptoms, while protecting the uterus.