Choosing the right Uterine Fibroids treatment

Sometimes uterine fibroids are a minor inconvenience. A heavy period. Some stomach pain here and there. But sometimes fibroids can interfere with the enjoyment of and the ability to handle everyday life and activities. Work. Leisure. Spending time with friends and family. It’s all overshadowed by the pain or discomfort that the fibroids cause. It’s usually at that point that you may start looking into treatments, so that you can get your life back. There are many different treatment options available, however: how do you choose the right one for you? Available treatment options range from medications, surgery and non-surgical procedures. Depending on your stage in life, you might prefer one treatment over another.

Questions to Ask

Before you even investigate uterine fibroid treatment options, you’ll want to ask (and answer!) the following questions:

• How do my symptoms manifest?
• How bad are my symptoms?
• How permanent do I want my solution to be?
• Do I want the option of getting pregnant in the future?
• How much time can I take off from work/other life commitments?

Finding Answers – Medications

Once you’ve answered those questions for yourself, it’s time to look into treatment options. The first level of treatment is often medication. Progestin pills or intrauterine devices (IUDs) These hormone-based pills and devices (usually used to prevent pregnancy) can also be used  to control the heavy menstrual bleeding caused by fibroids. These may be a good option to try if:

• the primary symptom of your fibroids is heavy menstrual bleeding
• you want to avoid a medical procedure and the recovery time it entails
• you’re not interested in getting pregnant now or for the length of time you’re taking the medication (once you stop taking the medication, you will be fertile again, but your menstrual bleeding will become heavier again)

Tranexamic acid This non-hormonal medication is taken on days when you are bleeding heavily; the medication reduces the bleeding. This may be a good option to try if:

• the primary symptom of your fibroids is heavy menstrual bleeding
• you want to avoid a medical procedure and the recovery time it entails
• you are interested in getting pregnant now or in the near future (note: if you do get pregnant, you should likely stop taking tranexamic acid. Consult your doctor.)

Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists Gn-RH agonists stop the production of estrogen and progesterone by causing an initial increased release of hormones known as the flare-up effect. After several days of continuous administration, this is followed by a dramatic drop in the circulating concentrations of hormones which puts you temporarily into a reversible menopausal-like state. Menstruation stops, eliminating the heavy bleeding issues, and fibroids tend to shrink (just as they do in a real post- menopause situation). A shrunken fibroid can mean significant relief of pressure. Gn-RH agonists are only for short-term use (3-6 months) due to their effects on bones. These may be a good option to try if:

• the primary symptom of your fibroids is heavy menstrual bleeding, pelvic pain and/or pressure, or incontinence from fibroids pushing on your bladder
• you are about to have a surgery to remove UF
• you’re not interested in getting pregnant now or for the length of time you’re taking the medication (once you stop taking the medication, you will be fertile again but your symptoms might reappear and the fibroids may start to regrow).

Gn-RH antagonists associated with add-back therapy Gn-RH antagonists alone induce a blockage of GnRH receptors resulting in a fast, dose dependent reduction in estradiol and progesterone levels, which is quickly reversible. Unlike Gn-RH agonists, the effect is immediate without any initial flare up of symptoms after initiation. When add-back therapy (low dosed hormones) is taken with the antagonists, it results in excellent control of fibroid-related symptoms and minimizes any potential menopausal-like side effects such as hot flushes: heavy menstrual bleeding, pain and bulk symptoms are reduced while the overall quality of life is improved. These may be a good option to try if:

• the primary symptom of your fibroids is heavy menstrual bleeding, pelvic pain and/or pressure, or incontinence from fibroids pushing on your bladder
• you want to avoid a medical procedure and the recovery time it entails
• you’re not interested in getting pregnant now or for the length of time you’re taking the medication (once you stop taking the medication, you will be fertile again but your symptoms might reappear and the fibroids may start to regrow)

SPRMs (selective progesterone receptor modulators): This medication affects the way the body processes one of the hormones that encourages fibroid growth, and causes existing fibroids to shrink. The use of this type of medication requires regular liver monitoring. These may be a good option to try if:

• the primary symptom of your fibroids is heavy menstrual bleeding, pelvic pain and/or pressure, or incontinence from fibroids pushing on your bladder
• you want to avoid a medical procedure and the recovery time it entails
• you’re not interested in getting pregnant now or for the length of time you’re taking the medication. (Once you stop taking the medication, you will be fertile again and your menstrual bleeding will take time to be heavier again and the fibroids might not regrow).

Finding Answers – Non surgical Procedures If medications don’t answer your needs or produce the desired outcome, you may want to consider the following procedures: Endometrial ablation This minimally invasive procedure uses heat, electric current or microwave energy to destroy the lining of your uterus. This option reduces the amount of menstrual bleeding or halts menstruation entirely. The procedure is usually outpatient and takes about 45 minutes under local or spinal anaesthesia. Post-procedure side effects include cramping and bloody discharge for a few days. Total recovery takes from a few days to 2 weeks. This may be a good option to try if:

• the primary symptom of your fibroids is heavy menstrual bleeding
• you want an outpatient procedure with shorter recovery time
• you’re not interested in getting pregnant at any point in the future

Uterine artery embolization (UAE) UAE is a procedure involving the injection of small particles into the arteries which supply the fibroid with blood flow. With the arteries blocked, the fibroids shrink and may die. UAE is usually an outpatient procedure, with full recovery taking 8 to 14 days. This may be a good option to try if:

• your fibroids symptoms have not responded to medication
• you want a minimally invasive procedure
• it’s acceptable to you to shrink the fibroids, not remove them entirely
• you want an outpatient procedure with moderate recovery time
• you’re not interested in getting pregnant in the near future

Myolysis Myolysis a minimally invasive procedure in which radiofrequency energy, a laser, or an electric current is used to destroy fibroids and the blood vessels that feed them. Myolysis is usually performed under general anaesthesia as an outpatient procedure, and full recovery takes about a week. This may be a good option to try if:

• your fibroids symptoms have not responded to medication
• you want a minimally invasive procedure
• you want an outpatient procedure with moderate recovery time
• you’re not interested in getting pregnant in the near future (while it is possible to become pregnant, apparent higher rates and risks of complications cause physicians to advise other methods if you wish to conceive, such as myomectomy)

MRI-guided focused ultrasound surgery With this non invasive surgery, you lie inside an MRI so your doctor can see the precise location of the fibroids. Then the doctor uses a high-energy ultrasound transducer to focus sound waves directly on the fibroid tissue, heating and destroying them. Ultrasound surgery is usually an outpatient procedure and total recovery time takes 3-4 days. This may be a good option to try if:

• your fibroids symptoms have not responded to medication
• you want a non invasive procedure
• you want an outpatient procedure with short recovery time
• you’re not interested in getting pregnant in the near future (data is still being collected on the safety of pregnancy after ultrasound surgery)

Finding Answers – Surgery

Hysterectomy This major surgical procedure is the complete removal of the uterus. If the ovaries are removed as well, it will bring on menopause. Most women can choose to keep their ovaries – or undergo hormone replacement therapy – to control the onset of menopause. Hysterectomy requires a hospital stay of 2-3 days and a complete recovery period of 6-8 weeks with restricted activity. This may be a good option to try if:

• your fibroids symptoms have not responded to medication and/or other procedures
• you want to permanently remove the fibroids
• you want to permanently prevent any fibroid growth in the future
• you’re not interested in getting pregnant again (with the removal of the uterus, it is impossible to conceive)
• you are able to commit to a lengthy recovery process

Choose wisely

There are many options out there for women who are dealing with uterine fibroids. Know what is important to you, and be informed about your options. Speak to your doctor and express your thoughts and preferences. Choose the option that is right for you – and you have a good chance at living the life you want and deserve.