After being diagnosed with fibroids or uterine fibroids, treatment is discussed with the patient. There is a long list of treatment options, with a specific treatment plan individualized including one or more treatments for each patient. Fibroid treatments may involve waiting, medications or surgery.
The Wait and Watch Approach
Just because a woman is diagnosed with fibroids does not mean aggressive treatment is necessary. Many fibroids are too small to cause fertility problems or serious symptoms. In these cases, doctors typically schedule regular ultrasounds to measure and count fibroids. The most common fibroids are slow-growing or non-growing, causing no problems with fertility or pain. After menopause, fibroids shrink or disappear due to reduced estrogen and progesterone levels.
Doctors use medications to control the level of hormones in the body to shrink fibroids or improve symptoms of fibroids. The medication approaches most commonly used fall on opposite ends of the spectrum.
- GnRH: Gonadotropin Releasing Hormone (GnRH) stops production of progesterone and estrogen, leaving the patient in a temporary state of menopause. Without the hormones needed for growth, the fibroids shrink and often disappear. Women suffering from heavy or prolonged bleeding see improvement as menstruation stops while taking GnRH.
- Birth Control: Low-dose birth control, often progesterone based, is sometimes used to control menstrual bleeding and shorten bleeding times. The low dose does not pose the threat of supporting fibroid growth.
Surgical treatment of fibroids ranges from non-invasive to highly invasive. Doctors tend to choose less invasive means of treatment, including medications, prior to suggesting surgery of any kind.
- Non-Invasive: A relatively new approach to treating fibroids combines MRI and ultrasound technology. The MRI is used to focus an ultrasound-based heating device. When the fibroid is located, the ultrasound focuses heat on the fibroid to shrink the growth. Sound waves are used to produce heat.
- Minimally-Invasive: Minimally-invasive procedures tend to focus on stopping blood flow to the fibroids with embolization or myolysis. Embolization blocks blood flow using medications injected into uterine arteries and myolysis shrinks blood vessels with lasers or an electrical current.
Laparoscopic and hysteroscopic procedures aim to remove fibroids through a small incision or cervical entry, respectively. Laparoscopy can be used to remove fibroids growing outside the uterus while hysteroscopy is reserved for fibroids growing within the uterus. Ablation, a procedure to remove the lining of the uterus, may also be used.
- Invasive: Often a last resort, invasive fibroid treatments involve major surgery, including abdominal surgery to remove large or deep fibroids. Hysterectomy, the removal of the uterus, is the only definitive cure for fibroids that prevents regrowth.
Treating fibroids does not necessarily mean you have to have major surgery, but that could be an option for women with severe pain, bleeding and anemia caused by loss of blood. Each patient is given a list of treatment options and suggestions after fibroids are diagnosed.