Fibroid treatment, explained
Years ago, removing your entire uterus was the only way to take care of uterine fibroids. Nowadays, there are many options for uterine fibroid treatment. If you have fibroids, take some time to decide on the best uterine fibroid treatment for you.
The benign, non-cancerous overgrowths of the muscle cells in the uterus aren’t malignant, so there’s no need to panic, says Janice Newsome, MD, associate division director of interventional radiology and image-guided medicine at Emory University Hospital in Atlanta.
Your options are based on your uterine fibroid symptoms. Not everyone with fibroids has symptoms, and whether or not you do usually depends on how big the fibroids are, how many there are, and where they’re located. Signs of uterine fibroids include heavy bleeding, pelvic pressure, having to urinate a lot, back pain, and constipation or diarrhea.
When deciding on a fibroid treatment option, you and your doctor will also take into consideration “the desire for future fertility,” says Jenny M. Jaque, MD, chief of obstetrics and gynecology at the University of Southern California’s Keck School of Medicine. Unlike hysterectomies, many other uterine fibroid treatments allow you to still get pregnant later on.
If you have uterine fibroids but don’t have any symptoms or only minor symptoms, doing nothing–while staying alert for any changes–is an option.
“If the fibroids are not causing any problems, and they’re not dramatically enlarged, they can be watched,” says Mitchell S. Kramer, MD, chairman of obstetrics and gynecology at Northwell Health’s Huntington Hospital in Huntington, New York. “You do not necessarily need to intervene.”
This is often the strategy when a woman is nearing menopause or post-menopause. Estrogen causes fibroids to grow; often, as estrogen naturally diminishes, so do fibroids.
Watchful waiting is also an option if you want to get pregnant and the fibroid doesn’t look like it’s going to interfere with pregnancy. “From a pregnancy point of view, some fibroids are very problematic, some aren’t,” says Dr. Kramer.
Specialists can help you decide if this option is a safe and effective one for you.
Diet and lifestyle changes
“Because we actually don’t understand what causes fibroids to form, it’s difficult to say what you should do to prevent them,” says Dr. Newsome. We do know that fibroids are sensitive to hormones, especially estrogen, and that lifestyle modifications that affect hormone production may alleviate some symptoms.
In fact, diet and exercise may be the two main things you can do at home to treat uterine fibroids.
Estrogen affects fibroids, and fat cells produce estrogen, says Dr. Newsome. Shedding some excess body fat could therefore improve fibroid symptoms, she says. While there are no large studies on diet or foods that can shrink fibroids, there is some anecdotal evidence, she adds, that women who follow a plant-based diet have improved fibroid symptoms.
Exercise may also help ease some uterine fibroid symptoms, but there are no known ways to get rid of fibroids naturally, says Dr. Newsome.
If watchful waiting and lifestyle changes aren’t options for you, doctors may move on to hormonal medications to control symptoms and even shrink the fibroids.
Several of these medications, like leuprolide (Lupron), are gonadotropin-releasing hormone (GnRH) agonists. They work by blocking hormone production. This causes the fibroids to shrink, which relieves uterine fibroid symptoms like heavy bleeding, pelvic pain, or needing to urinate all the time. Reducing bleeding is especially important to lower a woman’s risk of anemia.
But halting hormone production means you may also end up with menopausal symptoms like hot flashes. Some doctors prescribe “add back” medications–low doses of hormones–to counter that effect without decreasing how well the GnRH agonist works.
GnRH agonists, available in pill, nasal spray, and injection forms, are typically used for a short period of time. They can be helpful in reducing the size of a fibroid before surgery, for example. Fibroids will grow back after these medications are stopped.
Hormonal contraceptives are another option to treat uterine fibroid symptoms. They won’t necessarily reduce the size of uterine fibroids, but they may regulate periods or reduce heavy bleeding. This could be the pill or a progestin-releasing IUD, as long as the location of the fibroids doesn’t interfere with inserting one safely, says Dr. Jaque.
Androgens, so-called male hormones, like danazol (a synthetic drug that mimics testosterone), can stop periods and shrink fibroids. However, this treatment might also result in weight gain, a lower voice, and unwanted hair.
Non-hormonal options include tranexamic acid (Lysteda), which can lighten bleeding if it’s taken on the days when your period is heavy.
And while they won’t do anything to reduce fibroid size, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve fibroid pain. “For the most part, medical therapy tends to be more of a temporizing measure,” says Dr. Kramer.
MRI-guided focused ultrasound
In this non-surgical procedure, doctors use a magnetic resonance imaging (MRI) system to locate your uterine fibroids then zap them with high-frequency ultrasound. “It’s considered to be a permanent procedure to eliminate or decrease the size of the fibroids,” Dr. Kramer says.
The actual procedure is painless and noninvasive. It’s performed inside an MRI machine, and you can usually go home the same day.
So far, MRI-guided focused ultrasound to treat uterine fibroids looks safe but is still relatively new. Researchers are still collecting long-term data, but it seems safe to use if you still want to get pregnant.
Uterine artery embolization
Also called uterine fibroid embolization, this procedure deprives fibroids of their lifeblood–literally. “Embolization can block off blood supply to the fibroids,” explains Dr. Newsome. “The fibroids shrink and die.”
Your doctor will inject tiny particles into the arteries that supply blood to the fibroids. The particles set up a roadblock for any blood trying to get to the uterine fibroid. Uterine artery embolization can be done as either an inpatient or outpatient procedure.
Embolization is generally an option for women whose uterine fibroids are causing heavy bleeding or pain or whose fibroids are pushing on the bladder or rectum, but it’s not for you if you plan to get pregnant. “There are studies being done now to assess whether or not it’s safe to have this procedure and get pregnant,” says Dr. Kramer. It’s thought to weaken the walls of the uterus, he says, putting you at risk for complications during pregnancy.
Endometrial ablation is a type of minor surgery that doesn’t just destroy a fibroid, it destroys the entire lining of the uterus (called the endometrium). This usually takes care of heavy bleeding, but it only works on some uterine fibroids. “Endometrial ablation doesn’t treat all fibroids, just ones that are towards the inside portion of the uterus,” says Dr. Newsome.
Endometrial ablation is usually done on an outpatient basis, even right in your doctor’s office. An instrument is inserted through the vagina and into the uterus, where it uses heat, electric currents, or microwave energy to destroy the fibroids and uterine tissue. It’s unlikely for women to be able to get pregnant after endometrial ablation.
Unlike endometrial ablation, myomectomy is an option for women who still want to get pregnant and can be used to take care of intracavitary fibroids, or those that go into the uterine cavity. “Myomectomy is surgery to remove the fibroids from the uterus, and it keeps the uterus intact,” says Dr. Kramer.
There are several different ways to perform a myomectomy: hysteroscopic, laparoscopic, abdominal, or robotic. Some involve inserting an instrument through the vagina and cervix into the uterus to destroy or remove the fibroids. Others involve making small incisions in the uterine and abdominal walls to do the job. The procedures are minimally invasive and are considered permanent.
“The fibroids do not grow back,” says Dr. Kramer. However, in some cases, it’s not the end of fibroids entirely. “Theoretically, there could be very small ones that will grow over time that weren’t detected at the time of the surgery,” he explains.
Sometimes myomectomy is accompanied by morcellation, a procedure that breaks fibroids into smaller pieces before removing them. The FDA recommends against this practice, especially for women who are near or in menopause, in case there is an undiagnosed cancerous tumor present. If a cancerous tumor is broken into little pieces, it could spread.
A hysterectomy, or surgery to remove the uterus, used to be the only treatment for uterine fibroids. Fibroids are still the most common reason for a hysterectomy, and the procedure remains the only way to be 100% sure the fibroids won’t come back.
Today, it’s typically reserved for women with very large uterine fibroids and very heavy bleeding who are nearing or post-menopause.
However, it may be the preferred treatment method in some patients. “If a woman has a family history of ovarian cancer or endometrial cancer, maybe they’re not the best person to have a uterine-sparing procedure,” says Dr. Newsome.
Doctors may opt to remove just the uterus, part of the uterus, or also the ovaries and fallopian tubes. Removing the uterus means you won’t be able to have children. Taking out the ovaries means you will go into menopause.
There are different ways to perform a hysterectomy: Doctors can insert an instrument and pull the uterus out through the vagina, make small incisions in the abdomen, or make major cuts into the abdomen, much like a Cesarean section. This is considered major surgery and can have serious complications.