How are uterine fibroids treated?

There are a number of ways to treat uterine fibroids.  The most common symptoms seen with fibroids are pelvic pressure, pelvic pain, and heavy menstrual flow.  I will prescribe oral contraceptive pills to help decrease the menstrual flow, and this usually helps patients cope with their fibroids.  If patients fibroids are causing severe pain, nonsteroidal antiinflammatory medications and sometimes narcotics are necessary to help with this problem.  If conservative measures do not work for the treatment of uterine fibroids, often times we will discuss surgical options.  If a patient is wanting to maintain future fertility, a myomectomy is the surgical procedure that is most commonly performed.  A myomectomy can be performed with a "bikini incision" or laparoscopically.  I often tell patients that if the fibroids are really large that it is not very amenable to a laparoscopic approach and we will have to perform an abdominal procedure.  If this is the case, there is a possibility that there could be need for uterine reconstruction after the fibroid is removed as well as the possible need for a cesarean section if the patient becomes pregnant. 

 

Fibroids are the most common reason for women in the United States to undergo a hysterectomy, and I explain to patients that often times it is easier to perform a hysterectomy than it is to remove a fibroid due to the fact that a hysterectomy can be performed in a minimally invasive way and often times large fibroids have to be removed through an abdominal incision.  Lastly, there are some newer treatments for fibroids such as uterine artery embolization, MRI-guided ultrasound surgery, as well as the use of lasers to decrease blood flow.  

 

There are hormonal treatments for fibroids, and these are used to help decrease estrogen levels and will help the fibroids shrink. 

 

Watch as Obstetrician and gynecologist Dr. Evelyn Minaya discusses how uterine fibroids are treated.

Medications may be used to shrink the fibroids. Many women with fibroids are told they need a hysterectomy, surgery to remove the uterus, and about a third to a half of the 600,000 hysterectomies performed each year in the US are for fibroids. For many patients, though, a less invasive uterine sparing alternative called uterine fibroid embolization (UFE) is an option.

During uterine fibroid embolization (UFE), a medical specialist called an interventional radiologist cuts off the blood supply to fibroids, so that they gradually shrink. Doctors begin the procedure by inserting a tiny tube called a catheter into an artery at the top of the leg. They guide the catheter into the uterine artery, map the arteries feeding the fibroids with an arteriogram (an x-ray in which a dye is injected into the arteries), then inject microspheres the size of grains of sand through the catheter and into the fibroids to block their blood supply. The fibroids begin to shrink, and many women experience rapid relief from their symptoms. The procedure takes about an hour and the recovery time is significantly less than traditional surgery. Unlike in hysterectomy, the uterus and ovaries are spared. Studies show that most women who undergo UFE experience either significant or complete resolution of their symptoms over time, and fibroids rarely return.

If a woman has fibroids but does not have symptoms, no treatment is necessary. For mild symptoms, lifestyle modifications may be all that is necessary. For example estrogen (which stimulates fibroid growth and why fibroids can grow during pregnancy and typically not an issue once the woman is in menopause) is stored in body fat. Xenoestrogens are estrogen-like compounds, which are pervasive in our food supply, particularly meat and dairy. By exercising (lowering body fat) and eating right (ex. more fish and less meat and poultry), it is not only good for your heart health, lowering your risk for type 2 diabetes, hypertension, and stroke, it is also good for your "fibroid health". Certain natural products can also be used (exs. Vitex, DIM) that can help with the milder symptoms. Nonsteroidal anti-inflammatory medications (ex. ibuprofen) and oral contraceptive pills (OCP) are also used as well. However, while the OCPs can improve the bleeding symptoms in women, the effect is usually short-lived, as the fibroids will often grow under this additional estrogen and progesterone stimulation.

For more significant symptoms, there are surgical and nonsurgical choices available. The 2 main surgical choices are hysterectomy (for women who have completed child bearing) and myomectomy (for women who are still interested in future fertility). Hysterectomy is termed "partial" if it is just removing the uterus, and "total" if the ovaries are removed in addition to the uterus. Myomectomy is the surgical attempt of removing as much of the fibroid burden surgically as is feasible without compromising the integrity of the uterus. There are also different types of surgical removal: Open (i.e. traditional surgical incision), laparoscopic, and robotic. The main nonsurgical choices are uterine fibroid embolization (UFE) and MRI guided focused ultrasound (MRgFUS).