Uterine fibroids are common benign tumours that develop in the uterus (womb). Fibroids can be treated both with medications and surgery. Treatment for fibroids depends on various factors such as:
- Your age and general health.
- Severity of symptoms.
- Size and location of the fibroids.
- Whether you are pregnant.
- Your desire to have children in the future.
A woman with fibroids does not need treatment if she has no symptoms, has small tumours, or has gone through menopause. Your doctor may advise regular follow ups to monitor the size and growth of the fibroids and to ensure that there are no indicators of malignancy (cancerous changes).
Treatment for fibroids includes:
Medications: Medications used for the treatment of the symptoms of fibroids include non-steroidal anti-inflammatory drugs (NSAIDs), birth control pills (oral contraceptives) and intrauterine devices (IUDs) that release the hormone progestin and iron supplements to prevent or treat anaemia due to heavy periods.
- Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen may be prescribed to relieve pelvic pain associated with fibroids.
- Oral contraceptive pills: These are commonly given to women with fibroids as they help control heavy periods and pain.
- Gonadotropin releasing hormone (GnRH) agonists: These medications reduce the oestrogen produced by the body by acting on the pituitary gland. Oestrogen stimulates the growth of fibroids. With this therapy, a decrease in oestrogen levels leads to decrease in the size of fibroids by 50% in three months. You may be prescribed this medication prior to surgery to shrink the fibroid. Decrease in the size of fibroids can control heavy periods (thereby improve preoperative blood count) and decrease the amount of blood loss during surgery. However, fibroids tend increase in size once treatment is stopped and long-term use of these medications is limited due to the side effects of low oestrogen such as decreased bone density, osteoporosis, hot flashes, and vaginal dryness.
- RU-486 (mifepristone): This is an anti-hormonal drug which can reduce the size of fibroids by about half. It can also improve other symptoms such as pelvic pain, bladder pressure, and lower back pain. It is given in low doses before surgery in order to reduce the size of fibroids. In some patients, it may also help to avoid surgery by shrinking the fibroids and the symptoms it is causing.
- Danazol: It is an androgenic (male) hormonal drug which reduces bleeding due to fibroids, as it causes menstruation to cease, but it does not decrease the size of fibroids. It can cause several serious side effects such as weight gain, muscle cramps, decreased breast size, acne, hirsutism (inappropriate hair growth), oily skin, mood changes, and depression.
Surgery: There are many surgical procedures used for the treatment of fibroids. Your doctor will discuss the risks and benefits of the various procedures and then recommend a surgery or procedure that is best for you. The surgery and procedures done for fibroids include:
- Hysteroscopic resection of fibroids: Women with fibroids inside the uterine cavity can be treated with hysteroscopic resection. It is usually done as an outpatient procedure. In this procedure, a special instrument with a small camera is inserted through the cervix into the uterus to remove the fibroid tumours.
- Uterine artery embolisation: This procedure involves blocking the artery that supplies blood to the fibroid. This causes it to shrink and die. If you desire to have children in the future discuss this procedure with your healthcare provider.
- Myomectomy: In this surgery only the fibroid is removed and the uterus is preserved. It is often done in women who want to have children, as it helps to preserve fertility. However, you can develop more fibroids after a myomectomy. This surgery can be done through hysteroscopy, laparoscopy, or, less frequently, an open procedure (an incision in the abdomen).
- Hysterectomy: In this procedure the uterus is removed (along with the fibroid). As it is an invasive surgery it is done in women who will not benefit from medications and other surgeries and procedures. However, you cannot conceive after this surgery. It is often done to treat fibroids and is considered as a cure.