You have several choices when it comes to treatment of fibroids (also called leiomyomas). You have to weigh carefully the pros and cons of each method and choose the one best suited to yourself, in consultation with your doctor. Generally, the treatment depends on your age, nearness to menopause, presence of symptoms and your preferences.
Different Fibroids Treatments
Wait And Watch Policy
Most often, fibroids do not cause any symptoms and are discovered incidentally. If so, you can adopt the wait and watch policy. Fibroids are not cancerous and tend to grow slowly. You need to get examined periodically, to check for any rapid growth of the fibroid. However, if they cause any of the symptoms like pain, abnormal uterine bleeding, infertility, massive growth of uterus leading to discomfort, recurrent pregnancy loss, then you need to opt for one of the treatments discussed below.
There are a variety of medications that can control the symptoms and even shrink the fibroids. They are mostly hormonal based.
Levonorgestrel-containing intrauterine devices (IUDs) are very effective in regulating the menses blood flow and alleviating other symptoms, by shrinking the fibroids. Levonorgestrel is a progestin hormone. Side effects are minimal because only low concentrations of levonorgestrel are released locally.
Androgens (male hormones) like danazol are effective in shrinking the fibroids and reducing the symptoms.
Their unfavourable side effects profile limits their use. They can cause headaches, acne, weight gain, deeper voice, hirsutism, anxiety and depression.
Gonadotrophin-releasing hormone (GnRH) analogues cause temporary shrinkage of fibroids. Their mode of action is via decrease of estrogen (a hormone) levels. They are used only for a few months because of their side effects like thinning of bone mass (osteoporosis). Their main use is in shrinking the fibroids before surgery. Combining GnRH analogues with estrogen add-back therapy (estrogen-progestin, progestin alone, and recently tibolone) can overcome the side effects of GnRH analogues and prove effective for long-term therapy.
Nonsteroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives are sometimes used to control the uterine bleeding. Other drugs under consideration are mifepristone, ulipristal and aromatase inhibitors.
Hysterectomy is the surgical removal of uterus. This is a major surgery. It is a permanent solution. But you cannot bear children after this surgery.
Myomectomy is an alternative to hysterectomy. In this, only the fibroids are removed, leaving intact the uterus. This surgery is preferable in those women who want to conceive. It is of three types:
Hysteroscopic myomectomy: In this, an endoscope is inserted into the uterus through vagina, and fibroid tissue is cut using high-frequency electric current.
Laparoscopic myomectomy: A laparoscope is passed into the uterus through a tiny incision in the vicinity of the navel, and the fibroids are removed using surgical instruments. Both hysteroscopic and laparoscopic myomectomies are done only in case of small fibroids.
Laparotomic myomectomy (abdominal myomectomy): In this, the abdomen is opened up (laparotomy) to remove the fibroids from the uterus. It is a very invasive surgery.
Uterine Artery Embolization
This is a radiological intervention technique, whereby the radiologist reduces the blood supply to fibroids by occluding both the uterine arteries, with injection of very tiny particles. This leads to shrinkage of the fibroids.
Since it is a minimally invasive procedure, it has fewer complications compared to other conventional surgeries like hysterectomy. However, massive bleeding, infection and necrosis are some of the side effects that have been reported.
MRI-Guided Focused Ultrasound Surgery (FUS)
This is an outpatient, noninvasive procedure in which MRI is used to focus the ultrasound waves and destroy the fibroid tissue. Its efficacy is still under investigation.
The other newer options are:
Uterine artery ligation: This is a minimally invasive laparoscopic method, in which the uterine arteries are ligated. Thus the blood supply to the fibroids is reduced, resulting in their shrinkage. However, it is not superior to uterine artery embolization in its results.
Radiofrequency ablation: It is the latest minimally invasive procedure for fibroids. Fibroids are shrunk by inserting a needle through the abdomen and delivering a radiofrequency electrical energy into the fibroid, which leads to necrosis of the fibroid tissue. It is an alternative to hysterectomy.