For severe fibroid symptoms
If you have
fibroid-related pain, heavy bleeding, or a large
fibroid that is pressing on other organs, you can consider shrinking the
fibroid, removing the fibroid (myomectomy), or removing the entire uterus
(hysterectomy). After all treatments except hysterectomy, fibroids may grow
back. Only myomectomy is recommended for women who have childbearing
To shrink a fibroid for a short time, hormone therapy with a
gonadotropin-releasing hormone analogue (GnRH-a) puts
the body in a state like
menopause. This shrinks both the uterus and the
fibroids. Fibroids grow back after GnRH-a therapy has ended. GnRH-a therapy can help to:
- Shrink a fibroid before it is surgically removed. This lowers
your risk of heavy blood loss and scar tissue from the surgery.
- Provide short-term relief as a "bridge therapy" if you are nearing
menopause. (Fibroids naturally shrink after menopause.)
GnRH-a therapy should be used for only a few months,
because it can weaken the bones. It also may cause unpleasant menopausal
To surgically remove fibroids,
myomectomy can often be done through one or more small
laparoscopy or through the vagina (hysteroscopy). Some surgeries can be done using robotic tools. Sometimes, a larger abdominal incision
is needed depending on where the fibroid is located in the uterus.
Myomectomy preserves the uterus,
and it makes pregnancy possible for some women.
To surgically remove the entire uterus,
hysterectomy is available to women with long-lasting
or severe symptoms who have no future pregnancy plans. Hysterectomy has both
positive and negative long-term effects. For more information, see the topic
To shrink or destroy fibroids without surgery,
uterine fibroid embolization (UFE) (also called
uterine artery embolization) stops the blood supply to the fibroid. The fibroid
then shrinks and may break down. UFE preserves the uterus, but pregnancy is not
common after treatment. UFE is not usually recommended for women who plan to
Another treatment used to destroy
fibroids without surgery is MRI-guided focused ultrasound. This treatment uses
high-intensity ultrasound waves to break down the fibroids. Studies show that
this treatment is safe and works well at relieving symptoms. But more studies
are needed to find out if it works over time.3 This
treatment may not be available everywhere.
There are several other ways of
removing fibroids or killing fibroid tissue using extreme cold (cryomyolysis), or laser (myolysis). But
they are still new enough that risks and long-term benefits are not yet fully
known. If your doctor offers one of these
procedures, ask how many of the procedures he or she has done, how successful
they have been, and what kinds of problems can result. These treatments are not
recommended for women who are trying to become pregnant.4 And these
treatments may not be available everywhere.
- Uterine Fibroids: Should I Use GnRH-A Therapy?
- Uterine Fibroids: Should I Have Surgery?
- Uterine Fibroids: Should I Have Uterine Fibroid Embolization?