You have a range of treatment options available if you have symptomatic uterine fibroids. Fibroids themselves are not dangerous, so there is no reason to treat them if they are not causing symptoms. You should be aware of the potential symptoms so you can recognize them if they begin to occur.
We've listed the most common treatment options below, in order from least to most invasive and drastic. Our preferred treatment is Uterine Fibroid Embolization (UFE), because it is minimally invasive, requires only one night of hospital stay, has a very quick recovery, and has been shown to provide complete symptom relief in 85% - 90% of women with symptomatic fibroids. We've performed hundreds of these procedures and our success rate has been 100%.
Please consider all of the following options and give us a call to discuss any questions or concerns you may have about the procedures. You can also set up an appointment to evaluate your symptoms and decide which treatment is best for you. Fibroids very seldom require immediate or emergency treatment, so you have plenty of time to research your options before taking any action.
- Watch and Wait: We recommend that your first course of action should be to simply watch and wait. If your symptoms are mild and tolerable, there is no reason to begin treatment of the fibroids. Fibroids shrink at menopause, so women who are close to the age of menopause can often simply watch and wait until their symptoms disappear with their menses.
- Treat the Symptoms: If your symptoms are not tolerable, you should treat the symptoms. Over-the-counter medications can help with back pain and menstrual cramping. This may not be sufficient if the fibroids are large or in certain locations.
- Uterine Fibroid Embolization (UFE): UFE is a minimally invasive treatment that blocks the blood flow to the fibroids, causing them to shrink. The symptoms are generally caused by the sheer bulk of the fibroids, so shrinking them effectively reduces the symptoms. This procedure is performed by an interventional radiologist and requires one night in the hospital for observation. Patients are usually able to resume work and normal activities within 7-14 days. This is the technique that we recommend if treating the symptoms with OTC mediciation does not provide sufficient relief. Our doctors have performed hundreds of these procedures with 100% patient satisfaction.
- Laparoscopic Uterine Artery Ligation (LUAL): Uterine artery ligation is a very new technique that mimics the effect of UFE by doing laparscopic surgery to tie off the uterine artery, thus depriving the fibroids of their blood supply much as UFE does. The difference between UFE and LUAL is that UFE cuts off the blood supply completely, where LUAL restricts the blood supply, allowing the fibroids to live but not thrive.
- Endometrial Ablation: Ablation involves the removal of the lining of the uterus (endometrium). The primary goal of ablation is to reduce the heavy bleeding associated with fibroids, so it may or may not be appropriate for you, depending on the location of your fibroids. For instance, fibroids that protrude outside of the uterus into the abdominal cavity cannot be treated with ablation. There are many different techniques used to perform the ablation, including lasers, rollerball, and hydrotherm. In all cases, the goal of the procedure is to destroy the lining of the uterus.
- Myomectomy: Myomectomy is a surgical procedure in which the fibroids themselves are removed. This can be done laparoscopically or through traditional surgery. Myomectomy is the only treatment for fibroids that has been proven to preserve fertility, though there have been reports of pregnancy after UFE as well. Studies has shown that fibroids can recur after myomectomy.
- Hysterectomy: Hysterectomy is a surgical procedure in which the uterus itself is removed. This provides complete relief from fibroid symptoms, but is a major surgery with the attendant risk of complications. Hysterectomy can now be performed laparoscopically, which reduces the chance of complication, but removing the uterus has its own side effects. This should be considered only as a last resort.
Hormone therapy is often mentioned as a treatment for fibroids, but it provides only temporary relief from symptoms because the fibroids regrow when the hormones are halted. The hormones cannot be used on a longterm basis because they lead to a loss of bone density. Thus, hormone therapy is primarily used to shrink fibroids to make them easier to remove via surgery. Using gonadotropin releasing hormone (GnRH) agonists causes the body to think it is going through menopause, and thus reduce the amount of estrogen being released.
Problems with a hysterectomy and why you don't want one