When discussing the treatment of uterine fibroids the most important question to ask is “Do the fibroids need to be treated at all?”
The vast majority of fibroids grow as a woman gets older, and tend to shrink after menopause. Obviously fibroids that are causing significant symptoms need treatment. While it is often easier to treat smaller fibroids than larger ones, most of the small ones never will need to be treated. So just because we can treat fibroids while they are small, it doesn’t follow that we should treat them. The location of the fibroids plays a strong influence on how to approach them.
Treatment of uterine fibroids with medicines
There are currently not any available medicines that will permanently eliminate fibroids. However, several medication regimens have been shown to reduce the size of fibroids or the amount of bleeding associated with fibroids. Birth control pills and ibuprofen are often used to decrease blood flow and pain. GnRH agonists, which induce a temporary chemical menopause act on the pituitary gland to decrease estrogen produced by the body. A decrease in estrogen causes fibroids to decrease in size. This type of medication often is used prior to surgery to shrink the fibroid, to decrease the amount of blood loss during surgery, or to improve preoperative blood count.
The size of the fibroid can be reduced by 50% in three months with GnRH therapy. Unfortunately, fibroids can regrow once treatment is stopped. Long-term therapy with these medications is limited by the side effects of low estrogen (much like menopause caused by drugs), which include decreased bone density, osteoporosis, hot flashes, and vaginal dryness.
Mifepristone, or RU-486, also cause a significant decrease in size of fibroids, and often stops abnormal uterine bleeding. Low doses of this drug may reduce the size of fibroids in preparation for surgery to remove them. It may also help some patients avoid surgery entirely by shrinking the fibroids and the problems they are causing. Side effects related to low estrogen, seen with GnRH agonists, may be less common. RU-486 can induce miscarriage, so this medication should be used with caution if a woman is trying to conceive.
Surgical treatment of uterine fibroids
Surgical options for fibroid treatment include myomectomy or hysterectomy. A myomectomy is the surgical removal of the fibroids only. This can be accomplished through hysteroscopy, laparoscopy, or, less frequently, an open procedure (an incision in the abdomen). The surgical approach depends on the size and location of the fibroid. Pretreatment with GnRH analogs has been shown to decrease blood loss and operative time in women undergoing myomectomy. Myomectomy has also been shown to have a decreased likelihood of injury to the bowel, bladder, or ureter than hysterectomy. The uterus is left intact in this type of procedure, and the patient may be able to become pregnant.
A hysterectomy is the surgical removal of the entire uterus (and fibroids). Depending on the size of the fibroid, hysterectomy can be performed with incisions through the vagina or abdomen. In some cases the procedure may be performed using laparoscopy. Hysterectomy is the most commonly performed surgical procedure in the treatment of fibroids and is considered a cure. However, a hysterectomy will also make you unable to carry an pregnancy.
