How to Decide on a Treatment Plan for Uterine Fibroids 

Uterine fibroids are noncancerous growths that develop in or around the uterus. They are one of the most common gynaecological conditions, affecting up to 70% of women by the age of 50. These growths vary in size, number, and location, and while many fibroids remain asymptomatic, others can significantly impact a woman’s quality of life.  

Symptoms such as prolonged menstrual bleeding, pelvic pressure, urinary frequency, constipation, and complications with fertility can occur, making appropriate treatment essential. Choosing the right treatment for uterine fibroids depends on a combination of factors, including the severity of symptoms, fibroid size and location, age, overall health, and future pregnancy goals. 

For a comprehensive guide on uterine fibroids, visit Understanding Fibroids – A Comprehensive Guide. 

Factors Influencing Treatment Decisions 

1. Symptom Severity – Women experiencing mild symptoms, such as occasional discomfort or slightly heavier menstrual cycles, may not require immediate intervention. However, those with severe symptoms, including chronic pelvic pain, heavy menstrual bleeding leading to anaemia, or fertility issues, may need active treatment to improve their quality of life and overall health. 

1. Fibroid Characteristics – The size, number, and location of uterine fibroids significantly influence treatment choices. For example: 

• Fibroids growing within the uterine cavity often cause excessive menstrual bleeding and can contribute to infertility. 

• Fibroids growing within the uterine wall can cause bloating, heavy periods, and pelvic pressure. 

• Fibroids growing outside the uterus may press on nearby organs, leading to urinary urgency or bowel discomfort. 

• Fibroids attached to the uterus by a stalk may cause sharp pain due to twisting. 

For more details on fibroid characteristics, visit Understanding Fibroids – A Comprehensive Guide. 

1. Age and Reproductive Goals – Women of reproductive age who plan to conceive in the future typically seek fertility-preserving treatments such as myomectomy or minimally invasive procedures. In contrast, those who have completed childbearing may consider definitive treatments like a hysterectomy, particularly if symptoms are severe and other treatments have failed. 

1. Overall Health – Existing medical conditions can affect treatment options. For instance, women with cardiovascular conditions may not tolerate certain hormonal therapies, while those with anaemia from heavy bleeding may require aggressive intervention to prevent complications. 

1. Personal Preferences – Some women prioritize non-surgical, uterus-preserving treatments, while others seek a permanent solution, such as surgery. The choice also depends on tolerance for side effects, willingness to undergo procedures, and recovery time considerations. 

Treatment Options for Uterine Fibroids 

Watchful Waiting 

For women with small, asymptomatic fibroids, a “watchful waiting” approach may be recommended. This involves regular ultrasounds and gynaecological assessments to monitor fibroid growth and symptom progression. Many fibroids remain stable in size, particularly after menopause when estrogen levels decline, and do not require immediate intervention. 

Medical Treatments 

• Hormonal Therapies – These treatments help regulate hormone levels to reduce symptoms: 

• Birth control pills and hormonal IUDs – Can help manage heavy menstrual bleeding but do not shrink fibroids. 

• GnRH agonists (e.g., leuprolide) – Induce a temporary menopausal state, leading to fibroid shrinkage, but are typically used short-term due to side effects like bone density loss. 

• Selective progesterone receptor modulators (SPRMs) – Can reduce bleeding and shrink fibroids but require careful monitoring. 

• Non-Hormonal Medications – While these do not shrink fibroids, they can help control symptoms: 

• Nonsteroidal anti-inflammatory drugs (NSAIDs) – Alleviate pain but do not reduce bleeding. 

• Tranexamic acid – Helps control heavy menstrual bleeding without affecting hormone levels. 

Minimally Invasive Procedures 

• Uterine Fibroid Embolization (UFE) – A procedure in which small particles are injected into the arteries supplying the uterus, blocking blood flow to fibroids, causing them to shrink. This technique is effective in reducing symptoms and requires minimal to no down time and no invasive surgery. For a guide to the UFE process, read more here. 

• Magnetic Resonance Imaging-Guided Focused Ultrasound Surgery (MRgFUS) – A non-invasive approach using focused ultrasound waves to heat and destroy fibroid tissue while sparing surrounding structures. This procedure is effective for specific fibroid types and has a shorter recovery period compared to surgery. 

• Radiofrequency Ablation (RFA) – This technique uses controlled heat to shrink fibroids. It can be performed laparoscopically, transcervically, or through a small abdominal incision. RFA is associated with symptom improvement and minimal downtime. 

Surgical Options 

• Myomectomy – A uterus-preserving surgery that removes fibroids while leaving the uterus intact. It is suitable for women who wish to conceive but requires a careful surgical approach to avoid excessive scarring that could impact fertility. 

• Hysteroscopic Myomectomy – Performed through the vagina and cervix to remove submucosal fibroids. 

• Laparoscopic or Robotic Myomectomy – Uses small abdominal incisions for fibroid removal, offering a shorter recovery time compared to open surgery. 

• Abdominal Myomectomy – Performed through a larger abdominal incision for extensive fibroid removal. 

• Hysterectomy – The surgical removal of the uterus, offering a permanent solution to fibroids. It is typically considered when other treatments have failed or when fibroids cause severe symptoms. Hysterectomy options include: 

• Total hysterectomy – Removal of the uterus and cervix. 

• Supracervical hysterectomy – Removal of the uterus but leaving the cervix intact. 

• Laparoscopic or robotic hysterectomy – A minimally invasive technique with a faster recovery compared to open surgery. 

A Personalised Approach to Treating Uterine Fibroids 

Deciding on a treatment plan for uterine fibroids requires a personalized, evidence-based approach. A consultation with a fibroid specialist ensures that all factors—including symptom severity, reproductive goals, overall health, and treatment preferences—are carefully considered. Each treatment option has benefits and risks, so understanding the long-term implications is crucial. 

Women should also consider lifestyle modifications, such as maintaining a healthy diet, managing stress, and incorporating exercise, which may help in symptom management. With advancements in medical and surgical options, effective relief from uterine fibroids is possible, enabling women to take control of their health and well-being. 

For a comprehensive resource on uterine fibroids and personalised treatment options, visit Understanding Fibroids – A Comprehensive Guide.