My patients with fibroids often ask me, “What would you do if you were in my situation?” This is a great question.
As the Fibroid Clinic Director at Mayo Clinic in Rochester, I completely understand where folks are coming from — but it is a deceptively difficult question to answer. The truth is that the ideal treatment for one person may not be the best treatment for another person.
What Is a Fibroid?
Fibroids are very common benign smooth muscle growths of the uterus, affecting up to 80% of women over the course of their lifetime. As I am fond of reminding my patients, it would actually be more unusual for you not to have fibroids than to have them.
The symptoms caused by fibroids can vary depending on their size, number and location, and many fibroids don’t cause any noticeable issues at all. Some fibroids that are closer to the inside of the uterus (uterine cavity) can cause heavy abnormal bleeding. Some fibroids can grow quite large and result in pelvic pressure, heaviness, or may push on the bowel and bladder. Some women can even look pregnant when they have large fibroids.
What Is The Treatment For Fibroids?
The good news is that numerous treatment options exist for uterine fibroids, so much so that it can be quite difficult to sort out an optimal treatment plan.
I think about fibroid treatments in three main categories:
- Medications to control bleeding symptoms. Examples include hormonal treatments, including oral contraceptives or a progestin-releasing intrauterine device (IUD). Non-hormonal medications such as tranexamic acid (Lysteda) are another option. These will lighten blood flow or even help skip your menses, but do not directly target the fibroids.
- Interventional procedures to shrink the fibroids. These help with both bleeding and symptoms related to the bulk of the fibroids. These procedures can shrink fibroids using high-intensity sound waves (focused ultrasound surgery), low-frequency heating of the tissue (radiofrequency ablation), or injections that block the fibroid blood supply (uterine artery embolization).
- Surgical procedures to remove the problem. These procedures remove the fibroids (myomectomy) or remove the entire uterus (hysterectomy).
As you move down the list from option 1 (medications) to option 3 (surgery), the associated risks and recovery period increases, but so does the potential of the treatment to cure your fibroid symptoms.
Questions to consider
To help women weigh their decisions, we take an individualized treatment planning approach at the Fibroid Clinic in the Mayo Clinic Department of Obstetrics and Gynecology. If you are deciding on a fibroid treatment, it may be helpful to think through the following questions:
- Are you someone who values quickly returning to work and minimal downtime? You may prefer one of the interventional options, such uterine artery embolization, focused ultrasound surgery or radiofrequency ablation. These procedures do a great job at improving bleeding symptoms and can decrease the volume of fibroids by anywhere from 25% to 70%, depending on which method is used and the individual case. Recovery time ranges from a few days to a few weeks, although there is approximately 15% to 20% risk of needing another procedure for fibroids in the future if your symptoms are not fully improved or the fibroids come back.
- Are you planning a pregnancy in the future? You may want to consider a myomectomy procedure, or surgical removal of the fibroids. This has long been considered the best option if you want to optimize chances of carrying a future pregnancy. This can often be done through small incisions (laparoscopically), with or without robotic assistance, so that the recovery is about 2 to 4 weeks, but it is still a major surgery that requires general anesthesia. There is also a need to wait about 3 to 4 months before trying to conceive to allow your body time to heal from the procedure, and there is a good chance you may need a cesarean section for future deliveries. Successful pregnancies have also been reported after the interventional options (option 2), but there is a chance of having a higher-risk pregnancy following these procedures.
- Are you close to menopause and not interested in keeping your uterus? Some women in this situation — especially those with many large fibroids or those who have not had success with prior treatments — will choose to have a hysterectomy. The surgical removal of the uterus is the most aggressive fibroid treatment option, but it is also the most likely to result in complete resolution of symptoms. We are learning that having a hysterectomy at a young age (for example, under age 35) could have some long-term health consequences such as increased risk of heart disease, so that is another consideration for some younger women with fibroids. However, this should be less of a concern as you get into your mid-to-late 40s.
More to consider
These examples are just a few of the many situations to consider while trying to decide among your treatment options. Other factors that come into play include your other health issues, cultural and religious beliefs, the type of work you do, and your activity level, to name a few. Some women feel it is particularly important to retain their uterus — even if not planning for a pregnancy — and that is an important consideration as well.
Many factors need to be considered when people are deciding on a treatment plan for uterine fibroids. Though it can seem overwhelming, specialty teams such as our group at the Fibroid Clinic can help walk people through these decisions one step at a time.
