Uterine fibroids, or leiomyomas, are benign tumors that develop in or around the uterus. These common tumors can vary in size and number, affecting many women during their reproductive years. An estimated 50 percent of women have uterine fibroids before the age of 50 with 80% of black women and 70% of white women developing at least one fibroid at some point in their life.
Uterine fibroids can be asymptomatic, but they can also provoke symptoms like heavy menstrual bleeding, pelvic pain, frequent urination, and reproductive issues. When women present with such lifestyle-limiting symptoms, they routinely benefit from exploring their treatment options.
The first step in addressing uterine fibroids is achieving an appropriate diagnosis, which begins with a pelvic examination that helps detect irregularities in the shape of the uterus. Imaging tests like ultrasound and magnetic resonance imaging (MRI) help determine fibroid presence and size. The recommended treatment plan depends on the diagnosis.
Monitoring the presence and growth of fibroids over time is the first option to consider for women who aren’t experiencing any known symptoms. However, many women with fibroids who think they have no symptoms are often surprised by how many symptoms they endorse after consulting a Fibroid Specialist. Regular follow-up visits and imaging tests support the detection of changes in the size of fibroids or their associated symptoms. This strategy is often one considered by women approaching menopause, as fibroids tend to shrink naturally due to decreased hormone levels.
One side of effect of waiting for large fibroids to regress after menopause is a process of degeneration that results in calcification of the regressed fibroids. When this occurs, these large fibroids often harden in a process that almost cements at the given size. In the case of women who are concerned about a protruding abdomen due to their fibroids, this appearance and feel may worsen in the case of such women with such calcified fibroids. This is one reason for women to consider seeking treatment interventions before menopause.
Women experiencing symptoms have several medication options available to manage fibroids. One option is gonadotropin-releasing hormone (GnRH), which induces a temporary menopausal state, reducing estrogen levels and shrinking fibroids. However, these medicines have side effects like hot flashes and bone loss over time. As such, they represent a short-term strategy to shrink fibroids before surgery. Alternatively, GnRH antagonists block the production of hormones that stimulate fibroid growth, reducing symptoms without shrinking fibroids. These can be taken for up to 2 years.
A progestin-releasing intrauterine device (IUD) can also provide relief by reducing heavy menstrual bleeding, although it does not shrink fibroids. Another option for reducing heavy menstrual periods is tranexamic acid, marketed as Lysteda or Cyklokapron, which is taken on heavy bleeding days. Finally, birth control pills can regulate menstrual cycles and manage symptoms, but they do not reduce the size of fibroids.
An innovative, non-invasive treatment option, MRI-guided focused ultrasound surgery (FUS), uses high-intensity ultrasound waves to heat and destroy fibroid tissue while leaving surrounding healthy tissue intact. FUS is still new and has limited data about effectiveness, but it offers the advantage of a quick recovery and minimal risk of complications, although with a notably higher reintervention rate than other procedures like uterine artery embolization and myomectomy.
Minimally invasive procedures are also highly effective for treating fibroids. Uterine artery embolization is a notable example. The procedure involves injecting tiny particles (embolic agents) into the arteries supplying the fibroids, cutting off their blood supply, resulting in their shrinkage and absorption.
Radiofrequency ablation utilizes heat to destroy fibroid tissue through a laparoscopic, transvaginal, or transcervical approach. The procedure offers significant symptom relief and has a short recovery period. The laparoscopic approach requires two small cuts in the abdomen, but leaves uterine tissue intact. All procedures involve locating the fibroids with ultrasound and inserting small needles into the fibroid to heat up and destroy the tissue. Fibroids gradually shrink over the following weeks.
Another minimally invasive surgery, a myomectomy can be performed with different approaches, depending on the fibroid’s size and location. Laparoscopic or robotic myomectomy removes fibroids through small incisions in the abdomen, while hysteroscopic myomectomy removes them via the vagina and cervix. The latter method is used for submucosal fibroids, which are inside the uterus.
An endometrial ablation destroys the uterus lining using heat, microwave energy, electric current, or cold temperature. The procedure is effective for controlling heavy bleeding, but is only recommended for women who do not wish to have children.
While minimally invasive procedures can successfully remove fibroids, they do not prevent reoccurrence. The only permanent solution is to remove the uterus through a hysterectomy. This invasive surgery leaves patients unable to bear children. A hysterectomy often includes ovary removal, which triggers menopause. Patients may consider hormone replacement therapy to limit menopause side effects. In some cases, keeping the ovaries is possible.
Finally, an abdominal myomectomy is an invasive surgery requiring a large incision in the abdomen. This procedure may be necessary for large or numerous fibroids. While this approach preserves the uterus, the scarring can reduce the chance of getting pregnant.
Choosing the most appropriate treatment for uterine fibroids requires careful consideration of symptom severity, fibroid size, location, and desire to maintain fertility. Consulting with a specialist health care provider is crucial in selecting the best treatment strategy.
