What are the Treatment Options?

As explained earlier, most fibroids do not cause symptoms and are not treated. When they do cause symptoms, drug therapy is often the first step in the treatment. This might include a prescription for birth-control pills or other hormonal therapy, or the use of non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen sodium. In many patients, symptoms are controlled with these treatments and no other therapy is required. Further treatment options are described below:

• GnRH (gonadotropin-releasing hormone) therapy is a medication therapy that reduces the production of estrogens and causes the shrinkage of the fibroid.
  
  • Advantages: The reduction in the size may allow its removal by surgery without significant blood loss, but this is controversial. Allows time for to be treated by decreasing bleeding.
  • Disadvantages: Can provoke 'menopause-like' symptoms such as hot flushes. The size of tumor increases when the medication is stopped.
    
• Total or subtotal hysterectomy/removal of the uterus and possibly ovaries. Open surgery, laparoscopy or hysteroscopy.
  
  • Advantages: Total suppression of the symptoms.
  • Disadvantages: General anesthesia, surgical risks: hemorrhage, infection, adhesions, and irreversible sterilization
    
• Myomectomy is a surgical removal of the uterine fibroids. It can be performed by laparotomy (incision in the abdomen), laparoscopy (incision in the umbilicus) or by Hysteroscopic resection.
  
  • Advantages: Allows those women who wish to become pregnant to keep the uterus. A cesarean will frequently be necessary to deliver a subsequent pregnancy.
  • Disadvantages: Long convalescence period (depending on the type of myomectomy), general anesthesia, risk of blood transfusions, formation of adhesions. Possible need to perform a hysterectomy.
    
• Laparoscopic myolysis is destruction of the fibroid using a laser.
  
  • Advantages: 40% reduction in size after six months of follow-up.
  • Disadvantages: High risk of adhesions (these adherences occur between the uterus and the small intestine).
    Not applicable to all fibroids.
    
• Uterine embolization of fibroids (angiography table) is an insertion of a catheter via the femoral artery into the uterine artery and injection of fine particles that will stop circulation in the myoma and cause its death. The fibroid narrows, eliminating the symptoms at the same time.
  
  • Advantages: Improvement of bleeding and abdominal symptoms (pressure, constipation, pains) in 80% to 90% of the cases. No surgical incision or general anesthesia necessary. Very little hemorrhagic risk, and all the fibroids are treated at one time.
  • Disadvantages: Pain post-embolization controlled generally well by medications. Possible vaginal discharge, cessation of menstrual period (rare), or infection (extremely rare).