There are many possible treatments for fibroids, and what’s best depends on your situation and priorities. But before exploring options, it’s important to make sure that fibroids really are to blame for your symptoms—you don’t want to overlook some other possible reasons for abnormal bleeding, like changes in the lining of the uterus that could be cancerous or precancerous. A thorough workup, including a pelvic sonogram, Pap test, endometrial sampling and hormonal blood work, will help to rule out other problems.
When I’m talking to a patient about fibroid treatments, the first thing I ask is: Do you want to become pregnant in the future? If a patient wants to keep that option open, there are a few approaches that can be helpful, starting with over-the-counter pain relievers. Of course, those won’t make your periods any lighter, but other medical treatments can help with that. For instance, birth control pills that contain either a combination of estrogen and progestin, or just progestin alone, can reduce menstrual bleeding, and an IUD that releases progestin can help as well. When you’re ready to try getting pregnant, you would just stop taking the pills or have the IUD removed. Another option is a non-hormonal medication called tranexamic acid, which makes blood clot more easily—it’s sometimes used by people with hemophilia. It can reduce bleeding by as much as 50%, and you’d only need to take it during your period.
Those approaches can work well if your symptoms aren’t too bad, or if you’re just trying to make it to menopause, when fibroids generally get smaller and become less bothersome. If your symptoms are severe or if you have many years before you reach menopause, though, you may need a more aggressive approach.
If you want to be able to get pregnant later on, it might make sense to have an operation called a myomectomy, in which the fibroids are surgically cut out of the uterus. In addition to helping with symptoms, a myomectomy can make it easier for you to have a healthy pregnancy, though you may need to deliver by cesarean section. Unfortunately, your fibroids may eventually grow back after a myomectomy.
If you are done having children or don’t want them, several other approaches are worth considering. Uterine artery embolization (UAE) involves a catheter to deliver tiny particles into the arteries that feed the fibroids, starving them so they shrink. If you’re having a lot of pain or pressure on your bladder or pelvis from fibroids, UAE can be an awesome solution. We’ve even seen women go on to conceive, but until there’s been more research on that, we can’t definitively recommend UAE if you want to protect your fertility.
You could also have an endometrial ablation, in which we use heat, electrical current or another method to destroy the lining of the uterus. That doesn’t get rid of the fibroids, but it reduces bleeding very effectively.
But in some ways, the simplest and most reliable treatment for fibroids, if childbearing isn’t a consideration, is ovary-preserving hysterectomy. It’s actually less invasive than myomectomy, which can require some pretty radical cutting and stitching, and it guarantees that your fibroids won’t come back. The uterus doesn’t make any hormones, so an ovary-preserving hysterectomy won’t throw you into premature menopause. I always suggest that a woman try other approaches first, since you can always do surgery later if they don’t work. But in the right situation, hysterectomy is a great solution.