Treatments for Uterine Fibroids
1) How are fibroids treated ?
There isn’t one single way of treating fibroids. The options can vary from simple ones like supportive treatment to radical treatment such as hysterectomy. There are many important factors to consider such as age, size and location of fibroids, fertility aspirations and more importantly your symptoms and your wishes.
2) How big do the fibroids have to be before they need to be removed ?
There is no hard and fast rule about size. Surgery is deferred unless an individual fibroid is larger than 4-6cm in size or the uterus is larger than the size of one of 12 weeks of pregnancy. Even smaller fibroids can cause severe symptoms particularly if they are submucous and may need removal.
3) When do Fibroids need to be removed ?
Once symptomatic, most fibroids need to be surgically removed. Removal of fibroid is recommended in women with symptoms of abnormal uterine bleeding, pain during menstruation, pressure symptoms or Infertility.
4) What are the treatment options for fibroids ?
Surgery is not the only way to treat fibroids. Some of the options are described below:
Hormones: The simplest form of treatment is to start the Oral Contraceptive Pill to regulate the menstrual bleeding . If there is breakthrough bleeding, progesterone tablets could be used to stabilize the endometrium. GnRH analogues can be used to stop menstrual periods and also to shrink the fibroids before surgery.
Mirena Intrauterine System (IUS) : This is a hormonal Intra Uterine Device (IUD), which secretes a small amount (20 micrograms) of progesterone hormone per day within the uterus. This works very well in small to medium sized fibroid uterus where the cavity is not affected by fibroids. The effect of Mirena lasts for 4 to 5 years. It is also a very effective method of contraception.
Tranexamic Acid : This drug in tablet form can be used for reducing the amount of bleeding. It will typically cut down the blood loss by about 40- 50%. Haematinics and iron supplements can be used to correct anaemia.
Ullipristal Acetate : This is a new medication and is effective in reducing the size of fibroids. This is a new drug and evidence is limited but encouraging. It is licensed only for reducing the size and blood supply of fibroids before surgery. It is a 5mg tablet to be taken once a day for three months.
MRI guided Focused Ultrasound:. MRgFUS (Magnetic Resonance Guided Focus Ultrasound) uses MRI and ultrasound to find fibroids and then to apply ultrasound-generated energy to heat the fibroids up in order to destroy them. This procedure aims to relieve symptoms caused by fibroids. Fibroid volume may be shrunk by 20 % after 4 months. MRgFUS is only suitable for small fibroids (larger than 3 cm and less than 10 cm) of average size less than 7 cm where the high intensity ultrasound energy does not pass through the bowel or bladder on its way to reach the fibroids. It is NOT recommended for women who still want children and in 6 or more symptomatic fibroids. As tissue is not removed surgically for laboratory studies, rare malignant tumours like Leiomyosarcoma can be missed.
Endometrial Ablation: This is an operation to destroy the lining of your womb (endometrium) using an energy source and replace it with a scar tissue so there will be little or no menstrual bleeding. This works better if the uterine cavity is normal with no submucous fibroids. But this method is not recomended if uterus is more than 12 weeks . It is recommended only in women who completed the child bearing function .
Uterine Artery Embolization: This is a procedure where blood supply to the fibroids is blocked using silicon pellets. It is performed under short general anesthesia or sedation. It is about 60 – 80% effective in reducing mass related symptoms and 70 -90% effective in improving bleeding related symptoms. The main risks are pain for the first few days, risk of infection, vaginal discharge and recurrence of symptoms. Very large fibroids enlarged above the level umbilicus are not suitable for this procedure. There is also a very small risk of ovarian blood supply being affected and premature menopause. Hence this procedure is usually performed for women in their forties when fertility is no longer desired.
Hysteroscopic Resection of Fibroid (Hysteroscopic Myomectomy): This procedure is ideally suited for submucous fibroids where the fibroids have grown within the uterine cavity. It is performed as a day case procedure under general anesthesia. A hysteroscope (camera) is inserted through the neck of the womb (cervix) and fibroids are resected under direct vision using an electrical wire loop. View Video
Myomectomy: Myomectomy is an operation performed to surgically remove the fibroids. This can be performed laparoscopically (key-hole surgery) in almost all cases.
Hysterectomy: is reserved for very large and multiple fibroids or where fertility is no longer desired. Hysterectomy can also be performed as a key-hole procedure in almost all cases.
5) When does someone require a hysterectomy for Fibroids ?
Hysterectomy in a fibroid condition is recommended only when one wants a permanent solution to your fibroid problem. Typically, the person does not wish to bear children in the future or is near or past menopause. The fibroids are large and cause heavy bleeding and other alternatives for fibroids have failed.
One of the most important factors in helping you choose appropriate medical care is your full understanding of the reasons for treatment, the risks, and the potential benefits for you. If hysterectomy has been suggested to you as an option, you should carefully weigh the potential benefits and risks so that you are able to make a comfortable and informed decision about whether hysterectomy is right for you.
6) Can you recommend one treatment option over all the others ?
One treatment may not suit all women with fibroids. Consultation with an experienced Gynecologist will allow you to assess various factors and come to a decision regarding the optimal option for you.