Treating Fibroids

Saschan Fearon  |  23rd Feb 2019

Not all fibroids cause symptoms. Even those that do cause symptoms may not require treatment. In the majority of cases, the symptoms are inconvenient and unpleasant, but do not result in health problems.

Occasionally, they lead to such heavy menstrual bleeding that the woman becomes severely anaemic. In these cases, treatment of them may be necessary. Very large fibroids are much harder to treat. Therefore, many doctors recommend treatment for moderately-sized ones, in the hopes of preventing them from growing and causing worse symptoms.

The following are possible treatment plans:

Observation. This is the most common plan. Most women already have symptoms at the time they are discovered, but feel that they can tolerate their symptoms. Therefore, no active treatment is given, but the woman and her physician stay alert for signs that the condition might be getting worse.

Hysterectomy. This involves surgical removal of the uterus, and it is the only real cure. In fact, 25% of hysterectomies are performed because they are symptomatic. By the time a woman has a hysterectomy, she has usually endured several years of worsening symptoms. That’s because they tend to grow over time. A gynaecologist can remove a fibroid uterus during either an abdominal or a vaginal hysterectomy. The choice depends on the size and other factors such as previous births and previous surgeries.

Myomectomy. In this surgical procedure only the fibroids are removed; the uterus is repaired and left in place. This is the surgical procedure many women choose if they are not finished with childbearing. At first glance, it seems that this treatment is a middle ground between observation and hysterectomy. However, myomectomy is actually a difficult surgical procedure, more difficult than a hysterectomy. Myomectomy often causes significant blood loss, and blood transfusions may be required. In addition, some are so large, or buried so deeply within the wall of the uterus, that it is not possible to save the uterus, and a hysterectomy must be done, even though it was not planned. There are exceptions to this, however. Sometimes, fibroids grow on a stalk (pedunculated fibroids), and these are easy to remove.

Medical treatment. Since they are dependent on estrogen for their growth, medical treatments that lower estrogen levels can cause them to shrink. A group of medications known as GnRH antagonists can dramatically lower estrogen levels. Women who take these medications for three to six months find that their fibroids shrink in size by 50% or more. They usually experience dramatic relief of their symptoms of heavy bleeding and pelvic pain.

Unfortunately, GnRH antagonists cause unpleasant side effects in over 90% of women. The therapy is usually used for only three months, and should not be used for more than six months because the risk of developing brittle bones (osteoporosis) begins to rise. Once the treatment is stopped, they begin to grow back to their original size. Within six months, most of the old symptoms return. Therefore, GnRH agonists cannot be used as long-term solution. At the moment, treatment with GnRH antagonists is used mainly in preparation for surgery (myomectomy or hysterectomy). Shrinking the size of them makes surgery much easier, and reducing the heavy bleeding allows a woman to build up her blood count before surgery.