Uterine Fibroids - Treatment Overview
For infertility and pregnancy problems
If you have fibroids, there is no way of knowing for certain whether they are affecting your fertility. Fibroids are the cause of infertility in only a small number of women. Many women with fibroids have no trouble getting pregnant.4
If a fibroid distorts the wall of the uterus, it can prevent a fertilized egg from implanting in the uterus. This may make an in vitro fertilization less likely to be successful, if the fertilized egg doesn't implant after it is transferred to the uterus.4
Surgical fibroid removal, called myomectomy, is the only fibroid treatment that may improve your chances of having a baby.4 Because fibroids can grow again, it is best to try to become pregnant as soon as possible after a myomectomy.
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 plans.
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 symptoms.
To surgically remove fibroids, myomectomy can often be done through one or more small incisions using 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.