Uterus Fibroids Treatment – Medication and Surgery

Treatment of Uterine Fibroids

Not all fibroids require treatment. Fibroids that are asymptomatic, are very small, or if diagnosed in a woman approaching menopause may require no treatment at all. Since most fibroids regress after menopause and rarely become cancerous, a “wait and watch” approach with periodic re-evaluation is usually favored in such cases.

Treatment may become necessary in case of

  • Prolonged, heavy periods over a considerable time, leading to anemia.
  • Heavy or painful periods affecting daily functioning
  • Bleeding in between periods
  • A fibroid that is growing rapidly in size
  • Uncertainty in diagnosis, where there is doubt about whether the tumor is a fibroid or some other growth, such as a tumor
  • Pelvic pain
  • Infertility with a history of recurrent spontaneous abortion.

Treatment, where necessary, will be guided by factors such as age, severity of symptoms, possible causes of the uterine fibroid, the patient’s desire to fall pregnant, and her wish to retain her uterus.

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Medication (Drugs) for Uterine Fibroids

Medication may provide symptomatic relief for pain, regulate heavy periods, or reduce growth of the fibroid. The commonly used drugs include :

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be used for pain relief.
  • Oral contraceptive pills may decrease heavy menstrual bleeding and pelvic pain. However, the estrogen* in the pill may increase the size of the fibroid.
  • Gonadotropin-releasing hormone (GnRH) analogues such as leuprolide act by decreasing estrogen production and thus help to limit the fibroid size. Its often used pre-operatively when surgery is contemplated as reducing the size of the fibroid makes surgery easier.
  • Progestins * such as medroxyprogesterone and oral contraceptives have no action on reducing growth of fibroids but are helpful in controlling symptoms such as heavy periods.
  • Antiprogestins such as mifepristone may help reduce fibroid growth.
  • Selective estrogen receptor modulators (SERMs) such as raloxifene may also help reduce fibroid growth.
  • Progestin-releasing intrauterine device (IUD) may help to reduce heavy menstrual bleeding.
  • Danazol is a synthetic drug similar to testosterone and is effective in reducing size of the fibroids as well as reducing heavy periods. However, it has certain undesirable side effects such as facial hair growth, deepening of the voice, weight gain, oily skin, and fatigue which may limit its use.

Surgery for Uterine Fibroids

Myomectomy

In this procedure the fibroid is removed but the uterus is left intact. Women eager to have fall pregnant in the future may opt for this procedure. However, the chance of fibroid recurrence is a possibility. Depending on the location and size of the fibroid, myomectomy may be performed by any of the following methods – laparotomy, laparoscopy, or hysteroscopy.

With laparoscopy, tiny incisions are made in the abdomen and the fibroid is viewed by means of the laparoscope – a long, flexible, fiberoptic tube with a camera and light source at its end. This instrument is passed through one of the incisions. Other tiny surgical instruments are introduced through the other incisions and the fibroids are removed.

In laparotomy, a larger incision is made in the abdomen for removal of the fibroids.

In hysteroscopy, an instrument called the resectoscope is introduced through the hysteroscope into the uterine cavity through the vagina. The resectoscope uses electricity or laser to destroy fibroids protruding into the uterine cavity and to control bleeding caused by deep-seated fibroids within the uterine wall.

Hysterectomy

Hysterectomy is the surgical removal of the uterus and fibroids. This offers a permanent solution for uterine fibroids. The ovaries may or may not be removed. However, women who wish to fall pregnant in the future cannot consider a hysterectomy as pregnancy is not possible afterwards. Hysterectomy is usually recommended when the fibroids are very large, the symptoms of pain and abnormal menstrual bleeding are not relieved with other treatments, or when other forms of treatment are not possible.

Other Surgical Procedures

  • Endometrial ablation involves using any form of energy such as heat, microwave energy or electric current to destroy the uterine lining. Women with heavy periods or with fibroids smaller than 3 centimeters can be treated by this method. There is risk of bleeding and infection. Women treated by this method may find it difficult to fall pregnant.
  • Uterine artery embolization involves introducing tiny embolic agents into the arteries supplying the uterus by means of a catheter passed through a tiny incision in the groin. By interfering with the blood supply, the fibroids are made to shrink. The effect of this procedure on future pregnancy is not yet clear.
  • Myolysis is a laparoscopic procedure where an electric current or laser is used to destroy the fibroid.
    In cryomyolysis, liquid nitrogen is used to freeze the fibroid.
  • Focused ultrasound surgery or MRI-guided ultrasound surgery is a non-invasive procedure where the patient is placed inside a specially-designed MRI machine. High energy sound waves are used to destroy the fibroids.

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