Uterine Fibroids

Treatment

MR-guided focused ultrasound waves destroy fibroids.

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If your fibroids are interfering with your everyday activities, you can choose among a number of treatments at Mayo Clinic. Your doctor, who is trained in women's disorders (gynecology), will explain your choices and help you pick the one that's most appropriate for your condition. Some treatments don't involve surgery.

Your gynecologist will work with a team of other specialists, which may include gynecologic surgeons, radiologists and others. The team also works together for any follow-up or re-evaluation that you need.

Treatment options your Mayo Clinic doctor may recommend include:

• Hormone therapy. Your doctor may prescribe drugs to regulate menstruation. Some drugs can stop your periods and shrink your fibroids. Your doctor may prescribe one of them for only a few months before surgery, for example, or to allow time to treat iron deficiency anemia. If you have heavy bleeding, but no other signs or symptoms, your doctor may prescribe oral contraceptives to reduce the amount of menstrual blood you lose.

• Uterine artery embolization. You'll be awake but sedated during this outpatient procedure. A radiologist blocks arteries that supply blood to your fibroids. Blocking the arteries with tiny particles deprives the fibroids of blood, which shrinks the fibroids while leaving your uterus intact and functioning. Although 80 percent of women get prompt symptom relief, some studies suggest that fibroids come back in about 10 percent of women. Depending on your age, uterine artery embolization may not be your ideal choice, as it sometimes brings on menopause.

  Using a local anesthetic to block pain, your doctor makes a small incision in your groin and inserts a thin tube (catheter) into your main leg artery. Then, using radiographic dye and a moving X-ray (fluoroscopy), your doctor carefully guides the catheter through the artery to your uterus. This allows your doctor to watch images (arteriogram) that map the blood supply to your uterus and fibroids. These images show your doctor where to inject tiny plastic spheres that block tiny branches of the arteries supplying your fibroid with blood. You'll stay in the hospital overnight and resume your normal activity in about a week.

  Six months later your fibroids will be about half the size they were, and your uterus may be 40 percent smaller. Because enough unblocked blood vessels remain, your uterus doesn't die. Researchers are still studying the procedure's effect on fertility, so your doctor will warn you not to assume that you'll be able to conceive after the procedure. However, some women have become pregnant after uterine artery embolization.

• Magnetic resonance imaging-guided ultrasound treatment. If you're not interested in having a baby and you have a few large fibroids rather than many small ones, your doctor may suggest MR-guided, focused ultrasound. The MR scanner allows your doctor, without opening your body, to see the fibroid's location and monitor your fibroid's temperature. The focused ultrasound heats your fibroids to destroy them.

  If MR-guided ultrasound treatment is right for you, you won't have an incision and won't be hospitalized. Doctors will give light sedation to prevent discomfort during the treatment, which takes three to four hours. As you're lying on a table that fits into a magnetic resonance scanner, your doctor identifies your tumor on magnetic resonance images and focusing ultrasound waves into your fibroids. Your doctor focuses ultrasound waves on one small spot at a time (about 50 times) until the fibroid is destroyed. Your body gradually sheds the dead tissue within a few months.

  After the procedure, you may need over-the-counter pain medicine, but you should be back to full activity within a day or two. This is a fairly new technology, so the long-term effects aren't yet clear.

• Hysterectomy. Currently, surgery is the only way to remove your uterine fibroids permanently. Your Mayo Clinic doctor may be able to offer vaginal surgery even if your fibroids have enlarged your uterus. If it's possible to remove your uterus through your vagina, you can have a shorter hospital stay. You'll also recover faster than if you need an abdominal incision. Whatever surgery is used, hysterectomy is major surgery that ends your ability to bear a child. If doctors also remove your ovaries, you'll have an early menopause. Even so, if you have fibroid-caused symptoms, you may prefer permanent relief.
• Myomectomy. If you want to eliminate your fibroids but keep your fertility, your Mayo Clinic doctor may recommend surgical removal of your fibroids (myomectomy). Most commonly, your surgeon performs the procedure through an incision in your abdomen, which allows your doctor to remove large or multiple fibroids and reconstruct a strong uterine muscle for you. Depending on the fibroids' size and location, your doctor may be able to remove them through a thin, lighted tubular device (hysteroscope) inserted through your vagina and cervix. Your doctor may use a slender laparoscope inserted through small abdominal incisions to remove fibroids. After a myomectomy you may get new fibroids, or remaining ones can grow. If you want to become pregnant, though, myomectomy is a procedure that may relieve your symptoms while protecting your fertility.

Read more about magnetic resonance imaging (MRI), vaginal hysterectomy, abdominal hysterectomy and myomectomy at MayoClinic.com.