Surveillance

Most fibroids do not need treatment. Unless the fibroids are causing discomfort, bleeding or infertility you probably don’t need to do anything. You and your provider may decide to simply follow the fibroids over time, either by physical exam or by ultrasound. Further treatment may be considered in the future if symptoms arise. Fibroid symptoms often diminish when menopause occurs.

Medical Treatment

Birth Control Pills. If the main symptom is abnormal bleeding, low dose birth controls pills can often stabilize the uterine lining and decrease the amount and duration of bleeding.

Antiprostaglandins. Medications like Ibuprofen can be used to decrease uterine bleeding associated with fibroids. Ibuprofen taken 24-48 hours prior to a woman’s period and continuing throughout the period can sometimes decrease the amount of menstrual bleeding.

GNRh agonists. Agonists such leuprolide (Lupron) can result in a 35-50% reduction in the size of fibroids. This medication is sometimes used for preoperative shrinking of fibroids. Lupron creates a temporary menopausal state and the fibroids tend to shrink in that low estrogen environment. Side effects include menopausal symptoms such as hot flashes, moodiness and vaginal dryness. There can often be regrowth of the fibroids following discontinuation of the therapy.

Surgical Treatment

Myomectomy Myomectomy is the surgical removal of fibroids from the uterus. This can be done hysteroscopically, laproscopically or through an abdominal incision. This procedure is generally reserved for situations where the fibroid(s) is causing infertility or recurrent pregnancy loss (miscarriage), or when preservation of future fertility is desired. Complications from myomectomy include bleeding, scar formation and recurrence of the fibroid(s).
Hysterectomy Hysterectomy is the surgical removal of the uterus. This surgery can be performed vaginally, laproscopically, or through an abdominal incision.
Uterine Artery Embolization (UAE) This is a radiological procedure in which small particles are injected into the uterine artery to cut off the blood supply to the fibroid. This causes the fibroid to shrink in size. This procedure is not for women who desire pregnancy. In selected patients this procedure can offer reduction of symptoms.

MRI-Guided Focused Ultrasound

MR-guided, focused ultrasound obliterates tumors by focusing high-intensity ultrasound beams on the growths, raising the temperature enough to destroy them. The treatment is guided by magnetic resonance (MR) images. The MR scanner allows the doctor, without opening up the body, to see where the fibroid is and what has been treated and to monitor temperature changes inside the body.

This is still experimental and is being researched in several centers.  This is generally not covered by insurance as its efficacy is still uncertain.