You might not need a procedure for your uterine fibroids. But it depends in part on how bad your symptoms are.
Many women have uterine fibroids but don’t have symptoms. Those probably don’t need any treatment.
Medications can help if your symptoms are mild. Doctors usually save procedures for women whose fibroids cause moderate or severe symptoms, like pain or heavy bleeding.
If you do need a procedure, there are a few different options that you and your doctor can talk about. Most of these techniques can be done by laparoscopy, which means your doctor makes small cuts instead of one big one to enter the abdomen or reach the surgical site. You have less pain and a shorter recovery time.
In this procedure, your doctor destroys the smooth muscle composing the fibroid so it shrinks and dies through freezing, heating, or radiofrequency energy.
It’s best for small fibroids. There’s a chance that it can cause scarring or infection in the uterus, which could affect your fertility. So if you might want to get pregnant at some point, tell your doctor so you can weigh the risks and benefits.
Uterine Artery Embolization
If your fibroids cause issues like heavy bleeding or pain, your doctor might recommend this to shrink the fibroids and ease some of your symptoms.
Your doctor won’t have to make any cuts. Instead, they’ll insert a thin tube, called a catheter, into your uterine artery. Then they’ll inject a substance that cuts off the blood supply to the fibroids. This technique will shrink or kill them off and allow your uterus to decrease in overall size.
You might need a sedative for the procedure, so you’re awake but sleepy. You’ll probably feel some pressure when your doctor inserts the catheter, but you shouldn’t feel pain.
You’ll stay overnight at the hospital and be able to go home the next day. Many women have cramping after the procedure, so your doctor may give you some medicine to ease any discomfort.
Occasionally, fibroids grow back or for new ones to develop after uterine fibroid embolization. But there are risks, including damage to the blood vessel. You and your doctor should talk about whether this is the right procedure for you, especially if you plan to get pregnant in the future.
This procedure doesn’t involve any cuts to skin or abdomen, but is done through your vagina. It can be done many different ways, such as with a laser, heated liquid, electric current, freezing, and more.
You should only consider it if you don’t want to get pregnant in the future. Depending on the procedure, you may be able to have it right in your doctor’s office. Recovery is usually quick, and you might have a lighter period or no periods at all after surgery. You'll need to use contraceptives or have a tubal ligation to prevent pregnancy. Endometrial ablation would cause future pregnancies to end in likely miscarriage.
If you think you might want to get pregnant in the future, your doctor might suggest a myomectomy. This surgery removes the fibroids but leaves healthy tissue of your uterus.
Depending how many fibroids you have, how big they are, and where they’re located, your doctor has three choices for how to do the myomectomy:
- Abdominal. This operation is needed if your fibroids are really large, you have a lot of them, or they’re located deep inside the uterus. You’ll get general anesthesia so you won’t be awake during the procedure. The surgeon will make a cut in your lower abdomen to remove the fibroids. They’ll then sew your uterine muscle back together.
You might need to stay in the hospital for 2 nights and recovery can take between 4 to 6 weeks. If you do get pregnant in the future, your doctor might want to schedule a C-section. This can help you avoid laboring and decrease the risk of the uterus opening during labor due to your history of myomectomy. Other complications, such as infection, are rare, but your doctor should talk with you about them.
- Hysteroscopic. If your fibroids are inside the lining of your uterus, your doctor may be able to remove them with this procedure. They will use an instrument called a hysteroscope, which is like a telescope that lets your doctor see the fibroids. It is fitted with a wire loop called a resectoscope, an instrument that lets your doctor remove the fibroids with high-frequency electrical current, which cuts them loose.
You may get general anesthesia for this procedure. You’ll probably be able to go home after a few hours of recovery. Complications are rare, but whether or not it works for you will depend on the type of fibroids you have, how big they are, and how many you have.
- Laparoscopic. During this procedure, your surgeon makes small cuts in your abdomen that let them use tools to remove the fibroids.
This surgery removes your uterus. It may be the best option if your fibroids are large, you have very heavy periods, or if you know you don’t want children in the future.
The kind of hysterectomy you get depends on the size of your fibroids. If they’re small, your doctor might be able to do the surgery through your vagina. But if they’re large, they might need to cut open your abdomen.
In other cases, your doctor might be able to use a laparoscope. Some women have their cervix and ovaries removed during hysterectomy. Others keep their ovaries. If yours have to be removed, you’ll go through menopause. Talk about this with your doctor in advance so you know what to expect.
Hysterectomy is a major surgery. You’ll need at least a few weeks to recover. But recovery can take up to 6 to 8 weeks if your surgery is done through a larger incision in your belly.