Surgical and Non-Surgical Options Explained
Uterine fibroids, also known as leiomyomas or myomas, are benign (noncancerous) tumours that develop in or on the uterus. Affecting up to 70% of women by age 50, fibroids vary in size – from as small as a seed to as large as a melon – and often cause symptoms such as heavy menstrual bleeding, pelvic pain, bloating, and infertility.
Thankfully, a variety of fibroid removal surgery and fibroid treatment without surgery options are available to suit different health needs and lifestyle goals. This comprehensive guide explores these treatments in detail, helping you or your loved ones make informed decisions.
What Are Fibroids?
Fibroids originate from the smooth muscle tissue of the uterus and may grow:
- Intramurally (within the uterine wall),
- Submucosally (bulging into the uterine cavity), or
- Subserosally (projecting outside the uterus).
While the exact cause of fibroids is unknown, factors such as genetics, estrogen levels, and lifestyle can influence their development. Fibroids are most common during reproductive years and often shrink after menopause due to decreased estrogen.
Understanding Symptoms and Diagnosis
Not all fibroids cause noticeable symptoms. When they do, the following issues may arise:
- Heavy or prolonged menstrual periods
- Pelvic pressure or pain
- Frequent urination
- Constipation
- Painful intercourse
- Enlarged abdomen
- Miscarriages or infertility
Diagnosis typically involves pelvic exams and imaging techniques like:
- Ultrasound
- MRI scans
- Hysterosonography (saline infusion ultrasound)
- Hysteroscopy
Surgical Treatment Options
When fibroids are significantly affecting quality of life or fertility – and conservative treatments are not enough – surgical intervention may be necessary.
-
Myomectomy: Targeted Fibroid Removal
Myomectomy is the surgical removal of fibroids while preserving the uterus.
Types of Myomectomy:
- Hysteroscopic Myomectomy: Best for submucosal fibroids. A scope is inserted through the vagina and cervix to shave off fibroids protruding into the uterine cavity.
- Laparoscopic or Robotic Myomectomy: Involves small abdominal incisions and is ideal for intramural or subserosal fibroids. Robotics can enhance precision.
- Abdominal (Open) Myomectomy: Recommended for large or numerous fibroids. A larger incision gives the surgeon direct access to the uterus.
Pros:
- Uterus preserved
- Improved fertility outcomes
- Symptom relief
Cons:
- Risk of recurrence (about 15-30%)
- Recovery time ranges from 2 to 6 weeks
- Potential for significant blood loss
-
Hysterectomy: A Permanent Solution
A hysterectomy involves the complete removal of the uterus and is the only guaranteed cure for fibroids. It’s usually considered when:
- Fibroids are very large or rapidly growing
- Other treatments have failed
- The patient does not desire future pregnancies
Types of Hysterectomy:
- Total Hysterectomy: Removes uterus and cervix
- Subtotal (Supracervical): Removes uterus only
- With or without Oophorectomy: Depending on hormonal considerations the ovaries may or may not be removed.
Pros:
- Eliminates fibroids permanently
- Resolves symptoms completely
Cons:
- Permanent infertility
- Long recovery time (4–8 weeks)
- Potential hormonal changes if ovaries are removed
Non-Surgical Fibroid Treatments
For those preferring uterus-sparing, less invasive approaches, fibroid treatment without surgery is both effective and increasingly popular.
-
Uterine Fibroid Embolization (UFE)
Also called uterine artery embolization, UFE involves blocking the arteries that supply blood to the fibroids, causing them to shrink.
How It Works:
- A catheter is inserted into the femoral or radial artery.
- Tiny particles (embolic agents) are released to obstruct blood flow to the fibroid.
- The fibroid gradually shrinks.
Success Rate: Over 85% of women report significant symptom improvement.
Recovery: 7–14 days.
Pros:
- Minimally invasive
- Outpatient procedure
- High efficacy
Cons:
- Long-term fertility outcomes still under research
- Some experience post-embolization syndrome – flu-like symptoms for a few days.
-
MRI-Guided Focused Ultrasound Surgery (MRgFUS)
MRgFUS uses high-intensity focused ultrasound waves to thermally destroy fibroid tissue under precise MRI imaging.
Key Features:
- No incisions
- Outpatient procedure (lasting 2–3 hours)
- Immediate return to daily activities
Limitations:
- Fibroids must meet specific criteria (location, size)
- Not ideal for multiple fibroids
- Less accessible due to equipment availability
-
Medication-Based Management
While medications don’t “cure” fibroids, they can provide substantial symptom relief, often as a temporary or pre-surgical solution.
Common Medications:
- GnRH Agonists (e.g., Leuprolide): Shrink fibroids temporarily by inducing a menopausal state.
- SPRMs (e.g., Ulipristal Acetate): Help reduce bleeding and size.
- Birth Control Pills or Progestins: Regulate menstrual cycles.
- Tranexamic Acid: Reduces heavy bleeding without hormonal effects.
- NSAIDs: Control pain and inflammation.
Pros:
- Non-invasive
- Useful in short-term symptom control
- Can prepare fibroids for easier surgical removal
Cons:
- Temporary relief
- Hormonal side effects (hot flashes, bone thinning)
- Rebound fibroid growth once medication stops
Choosing the Right Fibroid Treatment
Every woman’s journey with fibroids is different. Factors to consider when selecting a treatment:
- Do you want to get pregnant in the future?
- What are your symptom severity and fibroid size?
- How close are you to menopause?
- Are you willing to undergo surgery?
Working closely with a gynaecologist or reproductive specialist can help tailor a treatment plan to your goals.
Lifestyle and Holistic Considerations in Fibroid Management
While medical and surgical interventions are central to fibroid treatment, lifestyle adjustments and holistic strategies may play a supportive role in symptom management and overall well-being.
Diet and Nutrition
Emerging evidence suggests that diet may influence fibroid growth. Although dietary changes can’t eliminate fibroids, they may reduce inflammation and help manage symptoms:
- Increase intake of fruits and vegetables rich in antioxidants and fibre, which may help regulate estrogen levels.
- Avoid high-fat, processed foods that can elevate inflammatory markers and estrogen.
- Limit red meat, especially processed types, which are associated with an increased risk of fibroid development.
- Increase intake of Vitamin D, as low levels have been linked to a higher fibroid risk.
Physical Activity and Weight Management
Regular exercise helps maintain hormonal balance, reduces stress, and supports metabolic health. Obesity is a known risk factor for fibroids, so maintaining a healthy weight may reduce your risk of developing larger or more symptomatic fibroids.
Psychological Impact of Fibroids
Chronic pelvic pain, heavy menstrual bleeding, and fertility concerns can take a significant toll on mental health. Women with symptomatic fibroids may experience:
- Anxiety and depression due to persistent discomfort and unpredictability of bleeding
- Sexual dysfunction linked to pain or self-consciousness
- Social withdrawal and work absenteeism, particularly during menstruation
Support from mental health professionals, patient support groups, and open conversations with healthcare providers can greatly improve quality of life.
Advanced and Experimental Therapies
Radiofrequency Ablation (RFA)
An FDA-approved technique, RFA uses radiofrequency energy to heat and destroy fibroid tissue. It can be performed laparoscopically or transcervically and results in fewer complications and a faster recovery than traditional surgery. However, its long-term fertility outcomes are still under investigation.
Endometrial Ablation
Though not a direct treatment for fibroids, this method destroys the uterine lining to reduce or stop heavy bleeding. It’s most effective for submucosal fibroids and not recommended for women who wish to preserve fertility.
Emerging Drug Therapies
New classes of drugs, such as selective estrogen receptor modulators (SERMs) and novel SPRMs (a selective progesterone receptor modulator (SPRM) s an agent that acts on the progesterone receptor (PR), the biological target of progestogens like progesterone) are under clinical trials. These aim to shrink fibroids and control bleeding without the menopausal side effects of GnRH agonists.
Fertility Considerations in Fibroid Treatment
Fibroids—particularly submucosal and large intramural types—can interfere with conception and pregnancy outcomes. Treatments like myomectomy or UFE may improve fertility, though each case requires individualized assessment.
Key considerations include:
- Location and size of fibroids
- Number of fibroids
- Age and ovarian reserve
- Previous miscarriage history
Patients pursuing pregnancy should consult a reproductive endocrinologist or fertility specialist before initiating treatment.
Follow-Up and Monitoring
For asymptomatic or minimally symptomatic fibroids, a “watchful waiting” approach with periodic ultrasounds may be appropriate. Monitoring frequency typically depends on:
- Fibroid growth rate
- Onset of new symptoms
- Patient’s age and reproductive goals
You Have Options in Managing Fibroids
With expanding treatment options, better diagnostics, and individualised care plans, managing fibroids has never been more hopeful. Whether opting for fibroid removal surgery or exploring fibroid treatment without surgery, your path to relief is a personalized journey supported by science, technology, and expert care.
Whether you’re exploring fibroid removal surgery like myomectomy or hysterectomy, or prefer fibroid treatment without surgery such as UFE or hormonal therapy, the most important thing is that you have safe, effective options.
Your journey toward relief begins with informed decisions—and expert support.
Explore more for additional resources, FAQs, and patient stories.