Choosing the Best Fibroid Treatment Option for You
By Alicia Armeli

Choices

Being diagnosed with uterine fibroids may be overwhelming. But fortunately, you have options—and lots of them. From pharmaceutical treatments to surgery, and less-invasive options in between, a woman has much to choose from.

NON-INVASIVE TREATMENT OPTIONS 

Pharmaceutical Treatment 

Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, can reduce menstrual flow by 25-30 percent and lessen cramping.1 Hormonal birth control options2,3 like the pill, patch, vaginal ring, injections, and intrauterine devices have also been found to reduce bleeding—but not fibroid size. Iron supplementation1 may be needed to combat anemia that can result from heavy periods. Although some of these options are available over-the-counter, use and duration of therapy should be discussed with your doctor first.

GnRH-a Therapy 

GnRH-a, or Gonadotropin-releasing hormone analogue therapy, may be used to shrink fibroids and reduce menstrual bleeding. Fibroid symptoms may cease when starting therapy but will return once treatment stops.

GnRH-a therapy preserves the uterus but has been linked to causing menopausal-like symptoms, such as hot flashes, decreased sex drive, spotting, fatigue, depression, and bone loss.4 For this reason, it’s commonly used as a short-term option to shrink fibroids before their surgical removal.2

MR-Guided Focused Ultrasound (MRgFUS) 

Also known as high intensity focused ultrasound or HIFU, this procedure uses ultrasound waves to penetrate the abdominal wall and heat fibroid tissue causing it to shrink by up to 54 percent one year after the procedure, according to research.5

This uterus and fertility-sparing option can take several hours to complete but is associated with less than one week of recovery time and minimal discomfort.

The success of MRgFUS depends on fibroid location since it’s most effective at treating small fibroids located near the uterine surface. A risk of fibroid recurrence exists and more than one procedure may be needed.

LESS-INVASIVE TREATMENTS 

Uterine Fibroid Embolization (UFE) Performed by an interventional radiologist, UFE is a minimally-invasive, non-surgical option that shrinks fibroids.

The physician makes a small incision in the upper thigh or wrist to access the arteries providing blood to the fibroids. Tiny spheres called embolics are injected into the arteries, blocking the blood flow, causing the fibroids to shrink and die. After the procedure, cramping and flu-like symptoms may occur, but can be treated and typically subside after 12 hours.6 Women can return to normal activity, on average, within 11 days. UFE has a 90 percent cure rate of symptoms7 and is effective treating fibroids of all sizes, but risk of recurrence does exist, in some cases warranting further rounds of treatment.

Endometrial Ablation 

Endometrial ablation destroys the lining of the uterus with the goal of reducing heavy menstrual bleeding. By inserting tools into the uterus through the vagina, ablation methods include radiofrequency, freezing, heated fluid, microwave energy, and electrosurgery.8 Since the lining is targeted, this option effectively treats submucosal fibroids that measure less than one inch in diameter. Since endometrial ablation doesn’t reduce fibroid size, it doesn’t treat symptoms related to fibroid bulk such as pain, pressure, or urinary incontinence.

Abnormal bleeding can recur and additional procedures may be needed. Although uterus-sparing, women who wish to become pregnant should avoid this procedure.

Radiofrequency Ablation 

Performed laparoscopically and as an outpatient procedure, radiofrequency ablation works by inserting a needle-probe into the middle of each fibroid. Heat is delivered through the probe, destroying and shrinking fibroid tissue.

Recovery time is minimal with women reportedly returning to work in less than a week. The procedure may take several hours and there’s a risk of fibroid recurrence. However, studies indicate a high rate of patient satisfaction, significant reductions in symptom severity, and an increase in quality of life.9

SURGICAL TREATMENTS 

Myomectomy 

Myomectomy, or the surgical removal of fibroids, has been considered the go-to treatment for women wanting to alleviate symptoms while still maintaining their fertility. Surgical methods include hysteroscopic, laparoscopic (including robotic), and abdominal. Risks include those associated with surgery, including extensive blood loss and scar tissue. Recovery time can last up to six weeks and fibroids may recur, requiring more surgery over time.

Hysterectomy

A hysterectomy surgically removes the entire uterus and is an option for women who no longer wish to conceive. Doing so leads to permanent symptom relief but other side effects such as pelvic and back pain, sexual dysfunction, and incontinence. Side effects may intensify with ovary removal.

As seen with myomectomy, additional risks include those linked with surgery and general anesthesia. Different types of hysterectomy are available and differ depending on whether other structures surrounding the uterus are also removed. Recovery time averages between two and six weeks.

And what if you don’t have symptoms? The best option may be to simply monitor your fibroids under the supervision of your doctor.

In the end, the best decision a woman can make regarding her fibroid treatment is one she’s made with confidence and a well-informed mind.

 

REFERENCES

1. The Centre for Menstrual Cycle and Ovulation Research. (2013). Very Heavy Menstrual Flow. Retrieved January 8, 2015, from http://www.cemcor.ubc.ca/resources/very-heavy-menstrual-flow

2. Khan, A. T., Shehmar, M., & Gupta, J. (2014). Uterine fibroids: current perspectives. International Journal of Women’s Health, 6: 95-114. doi: 10.2147/IJWH.S51083

3. Zapata, L. B., Whiteman, M. K., Tepper, N. K., Jamieson, D. J., Marchbanks, P. A., & Curtis, K. M. (2010). Intrauterine device use among women with uterine fibroids: a systematic review. Contraception, 82(1): 41-55. doi: 10.1016/j.contraception.2010.02.011

4. Magon, N. (2011). Gonadotropin releasing hormone agonists: expanding vistas. Indian Journal of Endocrinology ad Metabolism, 15(4): 261-267. doi: 10.4103/2230-8210.85575

5. Bohlmann, M. K., Hoellen, F., Hunold, P., & David, M. (2014). High-intensity focused ultrasound ablation of uterine fibroids-potential impact on fertility and pregnancy outcome. Geburtshilfe Frauenheilkd, 74(2): 139-145.doi: 10.1055/s-0033-1360311

6. Spencer, E. B., Stratil, P., & Mizones, H. (2013). Clinical and periprocedural pain management for uterine artery embolization. Seminars in Interventional Radiology, 30(4): 354-363. doi: 10.1055/s-0033-1359729

7. McLucas, B., Voorhees Iii, W. D., & Elliott, S. (2015). Fertility after uterine artery embolization: a review. Minimally Invasive Therapy & Allied Technologies, 2: 1-7.

8. The American College of Obstetricians and Gynecologists. (2013). Endometrial Ablation. Retrieved January 8, 2015, from https://www.acog.org/-/media/For-Patients/faq134.pdf?dmc=1&ts=20160114T2053317542 

9. Chudnoff, S. G., Berman, J. M., Levine, D. J., Harris, M., Guido, R. S., & Banks, E. (2013). Outpatient procedure for the treatment and relief of symptomatic uterine myomas. Obstetrics & Gynecology, 121(5): 1075-1082. doi: 10.1097/AOG.0b013e31828b796