Sometimes it feels like your uterine fibroids control your life.
They control what clothing you wear (to cover up your bloated stomach or avoid leaks from heavy periods); they control what you do (can you manage the party or are you in too much pain?); they control where you go (if there’s no public restroom on the way, you’d better avoid that route).
Fibroids – or their unwanted symptoms – are treatable, and significant treatment advances have been made in the past twenty years alone. The treatment you choose should be based on what aspect of your life uterine fibroids are interfering with, and what options you want to keep open for the future.
Treatments for Fibroid Symptoms
If the primary manifestation of your fibroids is in heavy menstrual bleeding, there are several options to help:
Progestin pills or intrauterine devices (IUDs)
These hormone-based pills and devices (usually used to prevent pregnancy) can also relieve the heavy bleeding.
Tranexamic acid
This non-hormonal medication is taken on days when you are bleeding heavily and reduces the bleeding.
Endometrial ablation
This minimally invasive procedure uses heat, electric current or microwave energy to destroy the lining of your uterus. This option halts menstruation entirely, or reduces the amount of bleeding.
The above options only affect the bleeding, but do not impact the fibroids themselves (although if a fibroid is hanging into the cavity of the uterus, it can likely be removed with a separate myomectomy procedure while doing endometrial ablation). If you are also experiencing pelvic pain or pressure, or incontinence issues as a result of a large fibroid pressing on your bladder, one option is:
Gonadotropin-releasing hormone (Gn-RH) agonists
Gn-RH agonists stop the production of estrogen and progesterone and put you temporarily into a post-menopausal state. Menstruation stops, eliminating the heavy bleeding issues, and with no estrogen and progesterone available, 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 typically for short-term use (3-6 months), because prolonged use can cause bone loss.
Treatments for Fibroid Reduction and Removal
If Gn-RH isn’t a good option for you, or if it did not shrink the fibroids enough to relieve symptoms, other treatments can reduce fibroid size significantly or remove them entirely. They range from non-invasive to traditional surgery. Which you choose will depend on the placement of your fibroids, how permanent a solution you want and whether or not you would like to become pregnant in the future.
Myomectomy
- What is it?
Myomectomy is a surgical procedure to remove the fibroids. Myomectomy can be minimally invasive if done by hysteroscopy (entering the uterus through the vagina and cervix), which works for fibroids within the uterine cavity or by laparoscopy, which works for fewer, smaller fibroids. If fibroids are larger or more numerous, myomectomy is performed in an open abdominal surgical procedure.
- Permanence level?
Myomectomy will take care of the removed fibroids, although it does not guard against the development of future fibroids.
- Pregnancy after?
Pregnancy is possible and often successful after myomectomy, although scarring may on occasion impact fertility.
Uterine artery embolization (UAE)
- What is it?
Small particles are injected into the arteries supplying the fibroid with its blood flow. With the arteries blocked, the fibroids shrink and die.
- Permanence level?
UAE reduces the size of most fibroids supplied by those arteries and drastically improves symptoms in most women, although it does not guard against the development of future fibroids.
- Pregnancy after?
It is possible to become pregnant after uterine artery embolization, although apparent higher rates and risks of complications cause physicians to advise other methods, such as myomectomy. There remains a need for more in-depth studies.
Myolysis
- What is it?
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.
- Permanence level?
Myolysis reduces the size of fibroids, although usually does not destroy them completely, and does not guard against the development of future fibroids.
- Pregnancy after?
While fertility is maintained, and women can become pregnant with normal outcomes, it is not recommended due to increased risk of complications.
MRI-guided focused ultrasound surgery
- What is it?
You lie inside an MRI so your doctor can see the precise location of the fibroids. Then he uses a high-energy ultrasound transducer to focus sound waves directly on the fibroid tissue, heating and destroying them.
- Permanence level?
MRI-guided focused ultrasound surgery is a new technology, and data is still being collected on permanence.
- Pregnancy after?
As above, MRI-guided focused ultrasound surgery is a new technology, and data is still being collected on impact on pregnancy.
Hysterectomy
- What is it?
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 push off the onset of menopause.
- Permanence level?
A hysterectomy is the only permanent solution for all present and future uterine fibroids.
- Pregnancy after?
No – it is impossible to become pregnant after a hysterectomy.
Take charge.
You don’t have to wait for menopause to get your life back from the havoc wreaked by uterine fibroids. Investigate your options and act. Your life is yours – not your fibroids’ – and you can make it look that way.
