Fibroid Management

Observation

Many fibroids do not cause symptoms and do not require any intervention. Watchful waiting is a reasonable option for these patients.  

Medical management

There are multiple options for medical treatment:
  • Hormonal   
Birth control pills can control bleeding symptoms, but will not shrink fibroid size.

Progesterone medications can also control bleeding symptoms and may be associated with a decreased risk of fibroid formation.

Lupron is a medication that causes temporary menopause. It can improve bleeding and decrease the size of fibroids by 30-50%. It can be used for up to a year, but fibroids may start to slowly regrow after stopping medication.

Ulipristal (progestrone modulator) and mifepristone (antiprogestin) are medications that have been shown to improve bleeding and shrink fibroids temporarily. However, neither is FDA approved for fibroid management but may be made by compounding pharmacies, although this can be expensive and difficult.
  • Non-hormonal 
Tranxenamic acid (Lysteda) can be used to treat the bleeding symptoms associated with fibroids. This is typically used to increase blood levels prior to a surgical intervention.

NSAIDs (Motrin) can improve pain with heavy bleeding, but have not been shown to reduce blood loss due to fibroids.
  • Interventional options
These include surgical or minimally invasive techniques. These are broken down into which are appropriate for women wishing to maintain fertility or not.
  • Not interested in fertility
Uterine artery embolization – this option permanently shrinks fibroids by 30-50%. It is performed by interventional radiologists by selectively cutting off the major blood supply to the fibroids through a small incision in the groin.

Hysterectomy — frequently the uterus and all fibroids can be removed through minimally invasive surgical techniques. The ovaries are typically retained preventing menopause and associated symptoms. This method is the most definitive management of fibroids.

Magnetic resonance guided focused ultrasound — uses ultrasound energy to cause thermal destruction of fibroids. This technology is still time consuming and costly (most major insurance companies do not cover).
  • Desires future fertility
Myomectomy — this is a surgical procedure that removes just the uterine fibroids and repairs the uterus so that it can carry a pregnancy in the future. In expert hands, many of these procedures can be done through small, Band-Aid-sized incisions.