If you have fibroids that are not causing you any problems, you don’t need treatment. Your doctor may suggest you keep an eye out for any changes, or s/he may ask you to have regular ultrasounds to check if the fibroids are growing. If your doctor does suggest treatment, it will depend on several factors, including the severity of your symptoms, the size and position of your fibroid(s), your age and whether or not you want to have children in the future. If you are nearing the menopause, for example, when fibroids tend to shrink on their own, you may want to wait and see if your symptoms improve without treatment.
Treating fibroids has traditionally meant undergoing major surgery, but now there are other options to consider (see table below). Talk to your doctor about treatment options. Ask for a full explanation of each approach, including the risks, benefits and success rates. You may also want to talk with women who have had the treatment you are considering. (Women’s Health may be able to put you in touch with a woman who has been in a similar situation. Call our Helpline).
A group of drugs, called GnRH analogues, reduce oestrogen levels in your body and, as a result, cause fibroids to shrink. Studies have shown that when taken for six months, GnRH analogues can reduce the size of fibroids by up to 50%. They also stop menstrual bleeding and pelvic pain. But GnRH analogues should not be taken for more than six months in total and there are a number of side effects. These include menopause-like symptoms such as hot flushes, vaginal dryness and bone loss (osteoporosis).
Once you stop taking the drugs, fibroids begin to grow again.Your periods should also return within a few weeks, although some women may no longer ovulate after treatment.
GnRH analogues are most commonly used to reduce the size of fibroids before surgery. In some cases, doctors may recommend them as a temporary treatment for women who are nearing the menopause, when fibroids should begin to shrink naturally.
These are discussed in detail below.
There is also a new procedure that is not included in the treatment chart because it is still undergoing trials. The procedure involves inserting four specially designed needles through the abdomen. Magnetic resonance imaging (MRI) is then used to guide the needles directly to the fibroid. The MRI is also used to monitor the effects on normal tissue around the fibroid in order to prevent any damage during the procedure. Once in place, the needles release laser energy into the centre of the fibroid, burning its tissue and halting its growth. Results so far suggest this procedure is effective in reducing symptoms and fibroid size, is minimally invasive and is without complications. These are, however, only the first set of results. More research and longer follow-up is needed to fully understand the benefits, risks and long-term effects.
Treatment options for fibroids |
Questions |
Abdominal Myomectomy |
What is it? |
Open surgery to remove fibroids (also called laparotomy) |
What types of fibroids does it treat? |
Can remove fibroids in the wall of the womb (intramural) and in the outer layer of the womb (subserous) |
How is it done? |
A 15cm cut is made in the abdomen for the doctor to shell out the fibroids. This is done with a looped wire, knife or laser. Once the fibroids have been removed, the uterus and abdomen are stitched up. The operation requires general anaesthetic and you will be in hospital for a few days. |
What is the recovery period afterwards? |
It will take about a month or more to recover at home. You will probably feel tired and weak and will need to regain your strength by walking and doing specific exercises. Do not lift heavy objects while recovering. |
Will the fibroids come back? |
Some studies show a 10 to 15% chance of fibroid regrowth, while others estimate 30%. In black women, regrowth may be as high as 50%. |
Will I still be able to get pregnant? |
Most women can still become pregnant after a myomectomy, but in some cases scarring in the womb can cause fertility problems. |
What are the advantages of this procedure? |
Advantages: your womb is left intact and you may still be able to have children. |
What are the possible complications and other disadvantages? |
Complications: bleeding that can lead to an emergency hysterectomy. Infection; damage to surrounding organs.
Disadvantages: 20 to 25% of women undergo additional surgery, usually hysterectomy, to stop symptoms. Possible weakening of the womb wall and scarring may cause complications during pregnancy such as rupturing of the womb wall. |
Questions |
Laparoscopic Myomectomy |
What is it? |
Keyhole surgery (through the abdomen) to remove fibroids. |
What types of fibroids does it treat? |
Recommended for fewer than four fibroids and fibroids that are less than 10cm wide. |
How is it done? |
A laparoscope (telescope) is inserted into the womb through a tiny cut in the abdomen. Other small cuts are made in the same area to insert instruments that slice up and remove the fibroids. This is done under general anaesthetic and you will be in hospital for a day or two. It is a difficult, often long, procedure and requires a highly skilled surgeon. |
What is the recovery period afterwards? |
The surgery may take longer but recovery is much quicker than abdominal myomectomy. Recovery at home takes 7 to 14 days. |
Will the fibroids come back? |
This procedure may not remove all fibroids. Any missed fibroids are likely to continue to grow. New fibroids may also develop. |
Will I still be able to get pregnant? |
Laparoscopic myomectomy does not usually interfere with fertility. |
What are the advantages of this procedure? |
Advantages: less invasive than other surgical options; small abdominal scars and little scarring inside the womb. |
What are the possible complications and other disadvantages? |
Complications: unexpected complications may require an abdominal myomectomy or emergency hysterectomy.
Disadvantages: there may be an increased risk of your womb rupturing during pregnancy. |
Questions |
Hysteroscopic Myomectomy |
What is it? |
Removal of small fibroids through the vagina. |
What types of fibroids does it treat? |
Can remove only small submucous fibroids. |
How is it done? |
A small hysteroscope (telescope) is inserted into the womb through the vagina and cervix. A laser or wire loop is then inserted through the hysteroscope to remove the fibroids. You will be given a general or local anaesthetic and will probably be able to go home the same day. |
What is the recovery period afterwards? |
It should take 2 to 7 days to recover at home. |
Will the fibroids come back? |
There is a 20 to 30% chance of fibroids growing back. |
Will I still be able to get pregnant? |
Hysteroscopic myomectomy does not usually interfere with fertility. |
What are the advantages of this procedure? |
Advantages: no incisions; recovery is less than a week; little scarring. You will still have your womb and may be able to have children. |
What are the possible complications and other disadvantages? |
Complications: possible damage to the womb wall.
Disadvantages: symptoms may continue: one study showed that after three years, heavy bleeding had returned in 30% of women who had a hysteroscopic myomectomy. |
Questions |
Uterine Artery Embolisation |
What is it? |
A new procedure that blocks the blood supply to the fibroids. This reduces rather than removes fibroids. |
What types of fibroids does it treat? |
There has not been enough research to determine which types of fibroids respond best to embolisation. |
How is it done? |
The radiologist (doctor) threads a fine tube into the right and left uterine arteries and injects a dye to locate the arteries that are feeding the fibroids. A special substance is then injected to block (embolise) the blood supply. This is done under a local anaesthetic and you will be in hospital for a couple of days. |
What is the recovery period afterwards? |
Recovery at home should take 1 to 2 weeks. |
Will the fibroids come back? |
There is little information about fibroid regrowth after embolisation. |
Will I still be able to get pregnant? |
Some women have become pregnant after embolisation, but it can also lead to ovarian failure. More research is needed. |
What are the advantages of this procedure? |
Advantages: minimally invasive; no incisions or scars; quick recovery period. You will still have your womb and may be able to have children. |
What are the possible complications and other disadvantages? |
Complications: risk of infection that requires a hysterectomy; risk of ovarian failure; radiation exposure.
Disadvantages: may cause ovarian failure. This is a very new procedure and long-term effects are still unkown. |
Questions |
Hysterectomy |
What is it? |
Removal of the uterus (womb). In some cases, the fallopian tubes, cervix and/or ovaries are also removed. |
What types of fibroids does it treat? |
Removes all fibroids. Should only be done if fibroids are very large or cause problems that cannot be treated in other ways. |
How is it done? |
The uterus is removed either through a cut in the abdomen (if fibroids are large) or through the vagina (if fibroids are small). Both are major operations. Abdominal hysterectomy can take one hour or several depending on the size of fibroids. You will be in hospital for 5 to 7 days. Vaginal hysterectomy takes about an hour and you will be in hospital for 2 to 3 days. |
What is the recovery period afterwards? |
Abdominal hysterectomy — Recovery will take 6 to 8 weeks at home.
Vaginal hysterectomy — Recovery should take about five weeks at home.
You will feel tired, but try to walk as much as possible. |
Will the fibroids come back? |
Fibroids will not grow back. |
Will I still be able to get pregnant? |
If you have a hysterectomy you will not be able to have children. |
What are the advantages of this procedure? |
Advantages: all of your fibroids will be gone and will never grow back. |
What are the possible complications and other disadvantages? |
Complications: possible damage to your bladder or bowel; infection; risk of bleeding heavily during or after the operation, which may require a blood transfusion.
Disadvantages: you will no longer have your womb or be able to have children. Can lead to an early menopause. |
