Choosing the best treatment for uterine fibroids

The best treatment for uterine fibroids is the option that addresses all your symptoms and improves your quality of life.

There are many treatments for uterine fibroids. And although there isn't a "best" option, there is a best treatment for you — one that addresses all your symptoms and improves your quality of life.

To successfully treat fibroids, it's important to discuss all your symptoms with your doctor. For fibroids that don't cause bothering symptoms, having a yearly pelvic exam will keep track of the location and size of fibroids and whether they are increasing in number.

Most symptoms caused by uterine fibroids are divided into two categories: heavy menstrual bleeding and "bulk" symptoms, like pelvic pain or pressure and frequent urination. Once your symptoms are accounted for, other factors that determine which treatment is best for you include your age, if you want to have children, and the size and location of the fibroids.

Medications and hormones

If your main concern is heavy menstrual bleeding, the first line of treatment might be with a medication or hormone, including:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Birth control pills
  • Hormonal IUDs
  • Hormone injections
  • Nonhormonal oral medications

Nonhormonal medications reduce heavy bleeding by helping blood clot. Hormonal birth control options work by thinning the endometrium — the lining of the uterus that's shed during your period. Some medications and hormones may also reduce the size of fibroids.

Treatment options for uterine fibroids

If medications don't reduce your heavy bleeding — or you have symptoms that medications can't address — there are treatments that can help you find relief.

Endometrial ablation. This treatment is performed with a specialized instrument that destroys the lining of the uterus. Endometrial ablation does not shrink the fibroid(s), but it can help decrease heavy menstrual bleeding caused by them. Some women stop having periods after this procedure.

Pregnancy is not recommended and may not be possible after endometrial ablation. However, you will need to use birth control because women who do get pregnant after ablation are more likely to have an abnormal pregnancy.

Magnetic resonance-guided focused ultrasound. This treatment takes place in an MRI machine. Multiple waves of ultrasound energy go through the abdomen and destroy the fibroids — without harming your body or other tissues. Fibroids begin to shrink over the next few weeks, and heavy menstrual bleeding is reduced. This procedure will not affect your ability to have children.

Uterine artery embolization (UAE). During this procedure, a doctor uses a slender, flexible tube to inject small particles (about the size of grains of sand) into blood vessels that feed the fibroids. This cuts off the blood supply to fibroids, causing them to shrink and die. Although it is possible to become pregnant after UAE, it may not be ideal. If you don't want to become pregnant, you'll need to use some form of birth control.

Laparoscopic radiofrequency ablation. Radiofrequency energy destroys fibroids and shrinks the blood vessels that feed them. Your doctor makes two small incisions in your abdomen and inserts a tiny camera to locate the fibroids. Once located, your doctor inserts a thin device that heats up and destroys the fibroids. During the next three to 12 months, the fibroids shrink, improving your symptoms. Although it is possible to become pregnant after treatment, it's not usually recommended.

Minimally invasive myomectomy. During a myomectomy, a surgeon removes the fibroids and leaves your uterus in place. Most women who have myomectomy can have children afterwards. There are two types of myomectomy that are minimally invasive:

  • Laparoscopic or robotic myomectomy. During this procedure, a doctor removes fibroids by inserting slender instruments through small cuts in your abdomen. Robotic myomectomy is a laparoscopic myomectomy that is aided with a surgical robot.
  • Hysteroscopic myomectomy. If the fibroids are inside your uterine cavity (or womb), a doctor can insert slender instruments through your vagina and cervix into the uterus to remove the fibroids.

Abdominal myomectomy. If you have multiple fibroids, ones that are very large or deeply located, your doctor may perform an abdominal myomectomy. The fibroids are removed from the uterus through a cut made on the lower abdomen, called a "bikini cut." Many women who are told that hysterectomy is their only option can have an abdominal myomectomy instead — and still be able to have children. Recovery may take three to six weeks.

Hysterectomy. This surgery — the removal of the uterus — is the only proven permanent solution for uterine fibroids that will also end your ability to have children. Most women who have their uterus removed can choose to keep their ovaries to avoid going into menopause. When a hysterectomy is performed as a minimally invasive procedure, most women return to office work in one to two weeks.

May 27, 2021 See more In-depth