Treatments of Fibroids

If you have fibroids that are not causing you any problems, you don’t need treatment. Your doctor may suggest you keep an eye out for any changes, or s/he may ask you to have regular ultrasounds to check if the fibroids are growing. If your doctor does suggest treatment, it will depend on several factors, including the severity of your symptoms, the size and position of your fibroid(s), your age and whether or not you want to have children in the future. If you are nearing the menopause, for example, when fibroids tend to shrink on their own, you may want to wait and see if your symptoms improve without treatment.

Treating fibroids has traditionally meant undergoing major surgery, but now there are other options to consider (see table below). Talk to your doctor about treatment options. Ask for a full explanation of each approach, including the risks, benefits and success rates. You may also want to talk with women who have had the treatment you are considering. (Women’s Health may be able to put you in touch with a woman who has been in a similar situation.

Drug treatments –
GnRH analoguesA group of drugs, called GnRH analogues, reduce oestrogen levels in your body and, as a result, cause fibroids to shrink. Studies have shown that when taken for six months, GnRH analogues can reduce the size of fibroids by up to 50%. They also stop menstrual bleeding and pelvic pain. But GnRH analogues should not be taken for more than six months in total and there are a number of side effects. These include menopause-like symptoms such as hot flushes, vaginal dryness and bone loss (osteoporosis).

Once you stop taking the drugs, fibroids begin to grow again.Your periods should also return within a few weeks, although some women may no longer ovulate after treatment.
GnRH analogues are most commonly used to reduce the size of fibroids before surgery. In some cases, doctors may recommend them as a temporary treatment for women who are nearing the menopause, when fibroids should begin to shrink naturally.

Surgical and non-surgical procedures

The main treatments for fibroids are:

Myomectomy (removing fibroids individually, leaving the womb intact) Hysterectomy (removing the womb entirely) Uterine artery embolisation (blocking the blood supply to the fibroids)These are discussed in detail below.

There is also a new procedure that is not included in the treatment chart because it is still undergoing trials. The procedure involves inserting four specially designed needles through the abdomen. Magnetic resonance imaging (MRI) is then used to guide the needles directly to the fibroid. The MRI is also used to monitor the effects on normal tissue around the fibroid in order to prevent any damage during the procedure. Once in place, the needles release laser energy into the centre of the fibroid, burning its tissue and halting its growth.

Results so far suggest this procedure is effective in reducing symptoms and fibroid size, is minimally invasive and is without complications. These are, however, only the first set of results. More research and longer follow-up is needed to fully understand the benefits, risks and long-term effects.