Fibroids - Women's Health
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How are fibroids treated?
Most women with fibroids do not have any symptoms. For women who do have symptoms, there are treatments that can help. Talk with your doctor about the best way to treat your fibroids. She or he will consider many things before helping you choose a treatment. Some of these things include:
• whether or not you are having symptoms from the fibroids
• if you might want to become pregnant in the future
• the size of the fibroids
• the location of the fibroids
• your age and how close to menopause you might be
If you have fibroids but do not have any symptoms, you may not need treatment. Your doctor will check during your regular exams to see if they have grown.
Medications
If you have fibroids and have mild symptoms, your doctor may suggest taking medication. Over-the-counter drugs such as ibuprofen or acetaminophen can be used for mild pain. If you have heavy bleeding during your period, taking an iron supplement can keep you from getting anemia or correct it if you already are anemic.
Several drugs commonly used for birth control can be prescribed to help control symptoms of fibroids. Low-dose hormonal birth control pills do not make fibroids grow and can help control heavy bleeding. The same is true of progesterone-like hormonal injections e.g. Depo-Provera. An IUD (intrauterine device) called Mirena contains a small amount of progesterone-like hormonal medication, which can be used to control heavy bleeding as well as for birth control in case the cavity of the womb is not too much distorted by large fibroids.
Other drugs used to treat fibroids are "gonadotropin releasing hormone agonists" (GnRHa). These drugs, given by injection, nasal spray, or implanted, can shrink your fibroids. Sometimes they are used before surgery to make fibroids easier to remove. Side effects of GnRHas can include hot flashes, depression, not being able to sleep, decreased sex drive, and joint pains. Most women tolerate GnRHas quite well. Most women do not get a period when taking GnRHas. It also allows women with anemia to recover to a normal blood count. GnRHas can cause bone thinning, so their use is generally limited to six months or less. These drugs also are very expensive, and some insurance companies will cover only some or none of the cost. GnRHas offer temporary relief from the symptoms of fibroids; once you stop taking the drugs, the fibroids often grow back quickly.
Overall, the medical therapies may often not be a permanent solution to the problems caused by fibroids especially if they are big in size.
Surgery
If you have fibroids with moderate or severe symptoms, surgery may be the best way to treat them. Here are the options:
• Myomectomy
surgery to remove fibroids without taking out the healthy tissue of the uterus. It is best for women who wish to have children after treatment for their fibroids or who wish to keep their uterus for other reasons. You can become pregnant after myomectomy. But if your fibroids were imbedded deeply in the uterus, you might need a cesarean section to deliver. Myomectomy can be performed in many ways. It can be major surgery (involving cutting into the abdomen) or performed with laparoscopy or hysteroscopy ( passing a telescope via tummy or neck of the womb ). The type of surgery that can be done depends on the type, size, and location of the fibroids. After myomectomy, sometimes new fibroids can grow and cause trouble later.
• Hysterectomy
surgery to remove the uterus. This surgery is the only sure way to cure uterine fibroids. Fibroids are the most common reason that hysterectomy is performed. This surgery is used when a woman's fibroids are large, if she has heavy bleeding, is either near or past menopause, or does not want children. If the fibroids are large, a woman may need a hysterectomy that involves cutting into the abdomen to remove the uterus. If the fibroids are smaller, the doctor may be able to reach the uterus through the vagina, instead of making a cut in the abdomen. In some cases hysterectomy can be performed through the laparoscope. Removal of the ovaries and the cervix (neck of the womb) at the time of hysterectomy is usually optional. Women whose ovaries are not removed do not go into menopause at the time of hysterectomy. Hysterectomy is a major surgery. Although hysterectomy is usually quite safe, it does carry a significant risk of complications. Recovery from hysterectomy usually takes several weeks.
• Myolysis
A needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
• Uterine Fibroid Embolization (UFE) or Uterine Artery Embolization (UAE)
- A thin tube is thread into the blood vessels that supply blood to the fibroid. Then, tiny plastic or gel particles are injected into the blood vessels. This blocks the blood supply to the fibroid, causing it to shrink. UFE can be an outpatient or inpatient procedure. Many women are in the hospital for as little as 24-36 hours; they are then advised to rest for 1-2 weeks. Complications, including early menopause, are uncommon but can occur. Studies suggest that symptoms improve in 60-90 per cent of women, but not enough is known about long-term benefits.Not all fibroids can be treated with UFE. The best candidates for UFE are women who:
• have fibroids that are causing heavy bleeding
• have fibroids that are causing pain or pressing on the bladder or rectum
• don't want to have a hysterectomy
• don't want to have children in the future.
Are other treatments being developed for uterine fibroids?
Yes. Researchers are looking into other ways to treat uterine fibroids. The following methods are not yet standard treatments; so your doctor may not offer them or health insurance may not cover them.
• MRI-guided ultrasound surgery shrinks fibroids using a high-intensity ultrasound beam. The MRI scanner helps the doctor locate the fibroid, and the ultrasound sends out very hot sound waves to destroy the fibroid.
• Some health care providers use lasers to remove a fibroid or to cut off the blood supply to the fibroid, making it shrink.
• Mifepristone, and other anti-hormonal drugs being developed, could provide symptom relief without bone-thinning side effects. These are promising treatments, but none are yet available or formally approved.
If you have any queries regarding topic raised within this article please do not hesistate to contact the Women's Health Clinic via the email form at the bottom of the page or by calling our London clinic on 020 8947 9877.
