Treatment Options for Uterine Fibroids

If a woman is experiencing symptoms suggestive of uterine fibroids, a pelvic exam and imaging studies are done to confirm the diagnosis. Occasionally, a fibroid uterus may be found on a routine physical exam or on imaging studies for unrelated reasons, such as pregnancy.

Pelvic exam: Pelvic examination is used to assess the size and shape of the uterus; however, it is not a sufficient test to exclude other possibilities, such as ovarian tumors or other uterine abnormalities. If an abnormality is suggested  on pelvic exam, this is evaluated further with the use of imaging studies.

Imaging: The presence of uterine fibroids is usually confirmed by ultrasound. Ultrasound is extremely effective at identifying fibroids in uteri smaller than 10 weeks and distinguishing them from ovarian tumors. In some cases saline (a salt solution) may be infused into the uterus to improve the accuracy of ultrasound and identify the location of a fibroid within the uterus; this technique is called sonohysteropgraphy.  An MRI is very effective at identifying and characterizing uterine fibroids, as well as distinguishing them from other uterine abnormalities. Because this test is extremely expensive, it is usually reserved for complex cases not adequately diagnosed by ultrasound.

The aim of treatment for women with uterine fibroids is to relieve severe symptoms that impact quality of life.  For women with mild symptoms it is appropriate to wait and observe the natural course of the fibroid as many of these tumors regress in size on their own. For women with worsening symptoms or complications such as pain, anemia, infertility, or urinary obstruction it is appropriate to consider other treatment options, such as:

Medications: Women with mild symptoms mainly related to excessive menstrual bleeding can often be treated with hormonal therapies such as birth control pills or long acting progesterone injections. However, since the relationship between hormones and the development and growth of fibroids is not completely understood, women treated hormonally for symptoms related to fibroids should be observed by their health care provider to ensure symptoms improve and do not worsen.

GnRH agonists are a class of medications that create a menopausal like state in women and effectively treat uterine fibroids by decreasing their size. These medications are associated with many side effects and once treatment is stopped tumors will return to their original, premedication, size. For these reasons this class of medication is reserved for use prior to surgery in women with severe symptoms. By using these medications for a period of three to six months preoperatively, uterine and tumor size may be decreased significantly to allow for minimally invasive surgical techniques and to minimize blood loss during surgery.

Surgery: Women with severe symptoms such as pain or bleeding, or women with infertility or recurrent pregnancy loss, are candidates for surgery. Hysterectomy, removal of the uterus, is generally used only for women who have completed child bearing. For women who desire a future pregnancy, tumors can be removed without removing the entire uterus, a procedure known as myomectomy. Women who undergo this procedure will often have a recurrence of fibroid tumors within the uterus and often require additional treatment in the future.

Women who do not desire a future pregnancy and whose only symptom related to fibroids is excessive bleeding, may be candidates for endometrial ablation. In this procedure, the lining of the uterus is destroyed with heat, thereby decreasing future bleeding.

Interventional Radiology: Uterine artery embolization is a minimally invasive procedure for women who do not desire future pregnancy, but prefer not to undergo hysterectomy. The procedure involves injecting tiny particles into the arteries supplying the uterus and the fibroids to decrease their blood supply and encourage their regression.

Prognosis

The general prognosis for uterine fibroids is good. While they often can cause uncomfortable symptoms, they are not usually dangerous. They can on occasion cause some complications, including:

  • Emergency surgery from excessive bleeding
  • Anemia caused by excessive bleeding
  • Urinary tract infections which occurs if a fibroid prevents the bladder from emptying completely
  • A blood flow blockage from a twisted or enlarged fibroid
  • Infertility; a fibroid can block the fallopian tubes or make it difficult for implantation of a fertilized egg.
  • Early term delivery if the fibroid is so large it prevents the baby from growing
  • The need for a C section if a fibroid is blocking the birth canal.