What treatment options are available for uterine fibroids?

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Whether it’s discomfort from chronic pain, lifestyle limitations due to heavy bleeding, weakness, fertility issues or all-around misery, “What are my options for treating uterine fibroids?” is one of the first things most women ask upon receiving a diagnosis. Women talking to each other about fibroids can yield a great deal of advice, but let’s put some order to the chaos.

Treatments break down into three categories:

  • Medication
  • Mini invasive procedure
  • Surgery

Additionally, with close monitoring of competent medical staff, a fourth option is often to take the monitor-and-wait approach. Not all fibroids grow to the point of making their hosts uncomfortable and some women choose to put up with symptoms in order to avoid treatment.

Medical treatment

This category includes discomfort relief pills such as acetaminophen, ibuprofen and other painkillers. Heating pads, iron supplements and a careful diet can all help in quelling the discomfort created by symptoms of uterine fibroids.

Medications include a number of subcategories, so let’s take these one at a time. This is the field in which there has been the most advancement in recent years, resulting in a number of current options. For women still wishing to carry a pregnancy, fibroids and fertility can (but doesn’t always) become an issue. As some treatments also affect fertility, make sure you know all the ins and outs involved in any choices you make.

Hormones

Some women choose to take hormone-based birth control that can bring some welcome relief from very heavy menstrual periods. Others choose to take progestogen injections, generally administered once each 13 weeks. An intrauterine device (IUD) is also part of this family and unlike an injection, it is inserted (by a professional) into the uterus.

Ulipristal Acetate (Esmya)

This option isn’t frequently used because it carries monthly liver enzymes monitoring. Due to these constraints, ulipristal acetate is only used to treat more severe cases and those in which other options aren’t relevant.  It is however very effective and can also helps to shrink fibroids in a sustained way.

Gonadotropin Releasing Hormone Analogues (GnRHas) / GnRH  Agonists

This family of medications is also hormonal and is administered by injection. It affects the pituitary gland, stopping production of estrogen. Even though this may sound similar to birth control pills, this is NOT an effective form of contraception. They have been proven to shrink fibroids in many women, which can provide immense relief from symptoms, however, they may cause side effects that mimic menopause. As with any medication, use must be monitored periodically by your gynecologist and/or GP to ensure safety and effectiveness.

Gn-RH Antagonists – Add-back therapy
Add-back therapy, using low doses of hormones combined with GnRH Antagonists, has been shown effective to control fibroid symptoms while avoiding many potential side effects seen in the past from similar methods, such as heavy bleeding and hot flashes. Use of GnRH antagonists is easily reversible and patients report quick relief of fibroid symptoms. Patients should take note that this method of controlling symptoms from uterine fibroids does cause temporary infertility, for the duration she takes this medication. Additionally, patients with a history of liver problems should be sure to mention this to their doctor.

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Mini invasive and surgery options are often a quicker fix for women frustrated with the extent to which fibroids have affected their quality of life. Still, many women prefer to try options that appear less extreme before reaching this point. Even within the area of invasive procedures, there is still a list of options from which to choose. It is up to your doctor to present all applicable options and help each patient make an informed decision as per her own particular situation, needs and priorities.

Endometrial Ablation

This procedure removes the lining of the womb by either laser energy, a heated wire loop or through the use of hot fluid inside a balloon. While ablation requires anesthetic, it is a relatively quick procedure with quick recovery time. Ablation does affect fertility but isn’t a 100% effective method of birth control. Still, women wishing to bear children are advised against this procedure, as risk of miscarriage and other serious problems is markedly increased.

Uterine artery embolization

UAE aims to shrink a fibroid by cutting off its blood supply. While not classified as a surgery, UAE will still require some hospitalization. Polyvinyl alcohol is injected into the arteries feeding the fibroid(s) and this can cause some nausea, vomiting and pain.

Myomectomy

This surgical procedure aims to remove the fibroids only, leaving the womb — and therefore preserve the patient’s fertility.  However, as with any surgery, there are risks involved. Additionally, other fibroids can regrow. Therefore, while surgical, myomectomy is only a temporary solution for some women. As of today, we have yet to discover a way to test ahead of time to see who will redevelop fibroids and who won’t.

Hysterectomy

Not all that long ago, this option, now considered the most extreme of all options, was the only option available to women in need of relief of the symptoms of uterine fibroids. Hysterectomy is the complete removal of the uterus and this procedure can also include the removal of the ovaries and fallopian tubes. While being the only surefire way of knowing that the fibroids won’t return, this option completely negates any possibility of ever becoming pregnant and also puts the patient into a premature state of menopause (when the ovaries are removed), potentially necessitating the use of Hormone Replacement Therapy (HRT) to avoid osteoporosis and other menopause-related symptoms.

The abundance of options in treating uterine fibroids is a luxury in comparison to the options available even a decade ago, and research is adding and improving upon what we have today. Appreciate that and in consultation with your women’s health specialist, choose the right path for you.