Even though uterine fibroids are extremely common, what to do about them isn't exactly straightforward. Many factors go into the decision to treat these benign muscle tissue growths, from when and how to try removing or shrinking them to whether they even need to be treated in the first place.
"We think about 50% of women have them, but about 50% of those women aren't symptomatic," says G. Thomas Ruiz, MD, ob-gyn lead at MemorialCare Orange Coast Medical Center in Fountain Valley, California. "That's what makes fibroids so fascinating—you can do an exam on a patient and it may feel like the uterus is large, but the patient is asymptomatic."
Now, if you have uterine fibroids, you might not think they're "fascinating," but Dr. Ruiz's point still stands: there is a tremendous amount of variation in the experiences of women with fibroids. And because the growths aren't cancerous, per the Mayo Clinic, there's plenty of variation in how they're treated, too.
Here's what you need to know about the treatment of uterine fibroids, including medication and surgical options.
RELATED: What Causes Uterine Fibroids? 5 Risk Factors to Know, According to Experts
If I have uterine fibroids, should I treat them?
Before you begin discussing treatment options with your doctor, you'll have to decide whether or not you want to treat them at all. According to Lisa Hansard, MD, board-certified reproductive endocrinologist at Texas Fertility Center, doing nothing about your uterine fibroids is "100%" an option in some cases.
If your uterine fibroids aren't causing symptoms, for example, Dr. Hansard and other experts say you may not want or need to treat them. But according to the Cleveland Clinic, fibroids can cause pain, cramping, abnormal bleeding, and heavier or longer periods, among other symptoms, so treating them can improve your quality of life.
The other point of consideration is your fertility, or your plans to become pregnant in the future.
"Uterine fibroids may or may not affect fertility, depending on their location," says Dr. Ruiz. "If they're submucosal, or growing into the uterine cavity, they can affect the embryo's ability to implant."
After conception has occurred, fibroids can still interfere with pregnancy (and, later, your baby's birth), says Dr. Ruiz, by predisposing you to preterm labor and abnormal bleeding during delivery, as well as increasing the likelihood of having a baby with a breech presentation.
Essentially, if you happen to find out you have a uterine fibroid—say, during a routine ob-gyn exam—but you're asymptomatic and not planning to become pregnant in the near future, you and your doctor may choose not to treat it. If you do decide to treat, though, there are several possible options.
RELATED: What Are Uterine Fibroids—And What Can You Do If You Have Pain and Bleeding?
Medicines for treating uterine fibroids
There aren't any medications that can "cure" uterine fibroids or make them disappear completely, Rose Chang-Jackson, MD, ob-gyn at Austin Regional Clinic in Austin, Texas, tells Health. But there are medications that can alleviate some of your worst fibroid-related symptoms and, in some cases, slow down the growth of fibroids or even shrink the growths during the course of treatment.
Over-the-counter medicines
The Cleveland Clinic states that common pain relievers, like acetaminophen and NSAIDs such as ibuprofen, can be used to treat pain associated with fibroids.
Iron supplements
These are sometimes recommended if you bleed heavily enough during your period for anemia to be a concern, according to the Cleveland Clinic.
Hormonal birth control
Per Dr. Chang-Jackson, some forms of birth control can reduce symptoms like pain and bleeding.
"Birth control is first-line for symptom management, but only some types work, like the combination pill and progesterone-only IUDs," she advises. "Other types of birth control, like the estrogen-only pill, the implant, and injections, are not proven to help with symptoms."
Gonadotropin-releasing hormone (GnRH) agonists
These medicines reduce estrogen levels, putting you into a menopause-like state, which can cause your fibroids to shrink, reports the Cochrane Database of Systematic Reviews.
However, this isn't a long-term solution; per University of Michigan Health, GnRH agonists are used to make fibroids smaller before a surgical procedure or keep them from causing symptoms until menopause (at which point they will probably stop causing symptoms on their own).
Blood loss therapy
One treatment, tranexamic acid, is an oral drug used to reduce heavy menstrual bleeding due to uterine fibroids. A 2014 review in the World Journal of Clinical Cases describes this non-hormonal option as generally safe.
RELATED: What's Really Causing Your Pelvic Pain?
Surgery for treating uterine fibroids
The type of surgery you undergo for a uterine fibroid takes location, size, and fertility preservation into account; your doctor can advise you on which approach is best based on these three factors.
"Size and location, [such as if the fibroid is growing] into the uterine cavity, matter in terms of the operative approach, including whether or not you get surgery and, if so, which type," advises Dr. Chang-Jackson. "If the woman has a desire for fertility, the surgery is focused on draining or removing fibroids versus performing a hysterectomy."
"The only proven and safe way to treat fibroids is excision," says Dr. Hansard, "so depending on location and size, the surgery might be laparoscopy, hysteroscopy, or laparotomy, which is an open incision."
Myomectomy
Per NYU Langone Health, fertility-safe procedures fall under the surgical category of myomectomy and are designed to remove the fibroids surgically while keeping the uterus intact. the procedures typically involve:
- making multiple small incisions so a surgical scope can allow for minimally-invasive surgery (laparoscopy)
- making one larger incision so fibroids can be manually removed (laparotomy)
- inserting a surgical scope into the uterus via the vagina, so fibroids within the uterine cavity can be removed (hysteroscopy)
Hysterectomy
Surgical removal of the uterus is the only treatment to prevent fibroids from returning, per NYU Langone Health. It's usually reserved for instances in which the person is near or past menopause, has large fibroids, has heavy bleeding, or doesn't want children, says the federal Office of Women's Health (OWH).
RELATED: What Every Woman Needs to Know About Uterine Cancer, Now That It's on the Rise
Other uterine fibroid procedures
If fertility isn't a concern, Dr. Hansard says other options may be on the table. These include:
Uterine embolization, a procedure that involves cutting off the blood supply to the uterus to stop the growth of fibroids.
Radiofrequency ablation, or use of high frequency sound waves to break up the fibroid from outside your body.
Endometrial ablation, in which a probe sends an electrical current to the fibroid to make it stop growing.
What is the expected outcome after fibroid treatment?
The prognosis for fibroids depends on the type of treatment, since medication options don't remove the fibroids—they only slow their growth or reduce symptoms. In many cases, once you discontinue the medication, your symptoms return or the fibroids begin to grow again, reports UCSF Health.
If you've had surgery to remove fibroids, the outlook may be different. According to the Mayo Clinic, many people experience relief from their symptoms after fibroid removal, and some may find it easier to become pregnant if they struggled previously with infertility.
However, it's important to note that any non-hysterectomy surgery isn't foolproof; fibroids can grow back and new fibroids can begin growing, says University of Michigan Health. How often this happens—aka the "recurrence rate"—varies from study to study and by type of procedure. A small 2018 study found a higher rate of recurrence at eight years post-surgery in those having laparoscopic myomectomy (76.2%) versus open myomectomy (63.4%). Among patients having uterine fibroid embolization, studies show a 13% rate of a repeat procedure after year and 32% at five years, according to Cleveland Clinic.
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