Uterine fibroids, also called leiomyomas or myomas, are noncancerous growths of the uterus that often appear during childbearing years. Many women have uterine fibroids sometime during their lives, although they are often unaware of them. Fibroids range in size from tiny growths to large masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones.
Although the exact cause of fibroids is unknown, doctors think that fibroids emerge from a stem cell in the smooth muscular tissue of the uterus (myometrium). This single cell then continues to divide and eventually creates a firm, rubbery mass distinct from nearby tissue. Fibroids may grow slowly or rapidly. Fortunately, fibroids hardly ever develop into cancer.
Several treatment options exist for removing or shrinking fibroids. As there is no single best approach to fibroid treatment, your doctor will discuss the best options suitable to your specific situation. Treatment will vary according to the size of your fibroids and whether you still desire to have children. Treatment options may include medication, non-invasive treatments or more traditional procedures that entail the surgical removal of the fibroids.
Medications do not eliminate uterine fibroids but may shrink them. These medications target the hormones that regulate your menstrual cycle and can treat symptoms such as heavy menstrual bleeding and pelvic pressure. Medications include:
Gonadotropin-releasing Hormone (GnRH)
Gn-RH agonists treat fibroids by stopping the production of oestrogen and progesterone. This has the effect of causing a temporary postmenopausal state that results in menstruation stopping, fibroids shrinking and anaemia improving. Your doctor may prescribe this medication to shrink the size of your fibroids before a planned surgery. Gn-RH agonists can be safely used for a maximum of three to six. Severe hot flushes are common during the use of these medications.
Progestin-releasing Intrauterine Device (IUD)
A progestin-releasing IUD, such as Mirena, can treat heavy bleeding caused by fibroids. These IUDs only provide symptom relief and do not shrink or eliminate fibroids.
Tranexamic acid medication, such as Lysteda, is taken to improve the symptoms of heavy menstrual periods.
Some hormone-based medications can control menstrual bleeding while others, such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective in relieving pain related to fibroids. These medications, however, only relieve the symptoms and do not reduce the size of the fibroids.
MRI-guided procedures use new, non-invasive techniques to treat fibroids while preserving your uterus.
The procedure is performed while you are inside the MRI scanner and provide your doctor with the exact location of the uterine fibroids. Laser energy or ultrasound energy is then used to destroy the fibroids.
It is unknown whether this is a safe procedure for women who still want to have children.
Minimally Invasive Procedures
Certain procedures can destroy or shrink uterine fibroids without needing to remove them through surgery. Myolysis is a medical procedure that uses an energy source to destroy fibroids. The energy source stops blood flow and causes the fibroids to shrink and die. These procedures include:
Uterine Artery Embolisation (UAE)
Uterine artery embolisation (UAE) is often recommended as an alternative procedure to a hysterectomy or myomectomy for treating fibroids and is particularly suitable for women with large fibroids.
This procedure, which is performed by a radiologist, blocks the blood vessels that supply the fibroids, causing them to shrink. UAE is usually carried out under local anaesthetic, and you will probably needs to spend one or two days in hospital after having the procedure.
Although it is possible to bear children after a UAE, the overall effects of the procedure on fertility and pregnancy are uncertain.
Endometrial ablation is a relatively minor procedure, taking less than 30 minutes to perform. It involves removing the lining of the uterus (womb) and is mostly used to reduce heavy bleeding in women without fibroids, although it can also treat small fibroids.
The affected uterine lining is removed by using laser energy, a heated wire loop, or hot fluid in a balloon.
Endometrial ablation is not recommended for women who want to have more children as the risk of miscarriage after this procedure is high.
Laparoscopic Or Robotic Myomectomy
A myomectomy is a procedure to remove fibroids while preserving the uterus. For women with fibroids who still want to have children in the future, myomectomy is probably the best treatment option.
If there are only a few fibroids, your doctor may opt for a laparoscopic or robotic procedure. During this procedure the fibroids are removed from the uterus using small instruments inserted through small incisions in your abdomen. The fibroids are removed through these small incisions by breaking them into smaller pieces, a process called morcellation.
Robotic myomectomy gives your surgeon a magnified, 3-D view of your uterus, offering more precision and flexibility than other techniques.
Hysteroscopic Myomectomy (Hysteroscopic Resection Of Fibroids)
A hysteroscopic myomectomy may be an option if your fibroids are contained inside the uterus (submucosal). This procedure is the most minimally invasive procedure to treat fibroids and is suitable for women who want to have children in the future.
Your surgeon accesses and removes fibroids using a hysteroscope which is inserted through your vagina and cervix into your uterus. A hysteroscope is a tube with a telescope that has an operative element that can remove fibroid tissue.
Hysteroscopic Morcellation Of Fibroids
Hysteroscopic morcellation of fibroids is a procedure where a specialist clinician uses a hysteroscope and small surgical instruments to remove fibroids.
The hysteroscope is inserted into the uterus through the cervix after which a specially designed instrument called a morcellator is used to cut away and remove the fibroid tissue.
The main benefit of hysteroscopic morcellation compared with hysteroscopic resection is that the hysteroscope is only inserted once. This reduces the risk of injury to the uterus.