Table of Contents
- Summary
- What are Fibroids?
- Types of Fibroids
- Treating Fibroids
- Bulk Symptoms
- Fertility and Pregnancy-Related Concerns
- Bleeding
- Medical Management of Fibroids
- Non-Hormonal Treatment Options
- Hormonal Treatment Options
- Surgical Management of Fibroids
- Uterine Artery Embolization
- Myomectomy
- Hysterectomy
- Navigating Treatment Solutions for Fibroids
Summary:
- Fibroids are non-cancerous growths within the uterine muscle that are common among women, with occurrences increasing with age, potentially causing symptoms like heavy bleeding and pelvic pressure.
- They come in four main types—submucosal (beneath the uterine lining), intramural (within the uterine wall), subserosal (on the surface of the uterus), and pedunculated (attached with a stalk)—each requiring specific treatment approaches based on their location and size.
- Symptomatic fibroids can be managed with various treatments, including medications to reduce symptoms, procedures like uterine artery embolization or myomectomy to remove fibroids, and hysterectomy for definitive management when future pregnancies are not desired.
- It’s essential to consult with your healthcare provider to determine the best treatment plan for your individual needs, whether you have symptoms or just want to monitor the fibroids.
Fibroids are benign growths that develop within the muscular layer of the uterus, affecting many women, especially as they age. While some may go unnoticed and cause no issues, others can lead to uncomfortable symptoms such as heavy menstrual bleeding and pelvic pressure.
Understanding your options for managing fibroids is crucial, whether you’re experiencing symptoms or simply want to stay informed. With a variety of treatment methods available, including medication and surgery, you can work closely with your healthcare provider to find the best approach tailored to your needs.
What are Fibroids?
Fibroids are benign growths within the uterine muscle layer and are very common among women of reproductive age, increasing in prevalence with age and affecting up to 70% of women over 50.
Symptoms may include abnormal uterine bleeding or “bulk” symptoms, which arise from pressure exerted by the fibroids. Treatment options for fibroid symptoms depend on both the size and location of the fibroids.
Types of Fibroids
Fibroids can vary in type based on their location within the uterus, each potentially causing different symptoms and requiring specific treatment approaches.
There are four main types of fibroids:
- Submucosal Fibroids: Beneath the lining of the uterine cavity
- Intramural Fibroids: Found within the uterine wall
- Subserosal Fibroids: On the surface of the uterus
- Pedunculated Fibroids: Attached to the uterus with a stalk
Treating Fibroids
If you have fibroids without symptoms, treatment isn’t necessary, though your doctor may recommend periodic imaging or follow-up. For symptomatic fibroids, your doctor will recommend treatments based on your symptoms, as well as the size and location of the fibroids.
Bulk Symptoms
Bulk symptoms, including pelvic pain, discomfort, and pressure, can be managed with medications to shrink fibroids (such as Leuprolide), or through procedures like uterine artery embolization, myomectomy, or hysterectomy.
Fertility and Pregnancy-Related Concerns
If fibroids are causing difficulty with conception or you have had pregnancy-related concerns in past pregnancies, your gynaecologist may suggest the removal of the fibroid(s). Again, the size and location of the fibroids will determine the best management.
If fibroids are affecting conception or have caused pregnancy-related concerns in the past, your gynaecologist may recommend removing them. The best approach will depend on the size and location of the fibroids.
Bleeding
Bleeding is a common concern with fibroids, and heavy bleeding can lead to anemia, or low iron levels in the blood.
Medical Management of Fibroids
Not all patients can be treated with the eligible treatment options available. Your doctor will determine which options are suitable for you.
Non-Hormonal Treatment Options
These options offer alternative ways to manage symptoms of fibroids without affecting hormone levels.
Treatments include:
- Non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and naproxen, can be used during menstruation to help reduce menstrual blood flow.
- Tranexamic acid (TXA) is a medication that slows the breakdown of blood clots, helping to reduce menstrual flow.
Hormonal Treatment Options
Combined Hormonal Contraception (CHC): Oral contraceptive pills containing both estrogen and progesterone, stabilize and thin the uterine lining, reducing blood flow during menstruation. Additionally, CHCs can be used in a manner that allows you to skip your period altogether.
Progesterone Intrauterine Device (IUD): Progesterone from an IUD thins the uterine lining, helping to reduce the amount of bleeding.
GnRH Agonist (Leuprolide): This injection, administered every one to three months (depending on the dose), blocks the ovaries from producing estrogen and progesterone, inducing a medical menopause.
GnRH agonists can help reduce bleeding and may also shrink fibroids. However, because estrogen is essential for bone health, “add-back therapy” with a medication like Norethindrone Acetate, which has estrogenic properties, is recommended.
Surgical Management of Fibroids
Surgical management of fibroids offers a range of options for patients seeking relief from symptoms when other treatments have proven ineffective or are not suitable.
Uterine Artery Embolization
This procedure reduces blood supply to the uterus, which may lead to a shrinkage of fibroids. Not all patients are candidates for this treatment, and it is performed by an interventional radiologist.
Myomectomy
A myomectomy, or removal of fibroids, can be performed using various techniques depending on their location and size.
- For small fibroids located within the uterine cavity, hysteroscopy may be employed.
- If the fibroids are situated in the uterine wall and are not too large, a minimally invasive approach such as laparoscopy may be used.
- For larger fibroids or in cases with multiple fibroids, an open abdominal procedure may be recommended.
Hysterectomy
The removal of the uterus may be recommended for patients seeking definitive surgical management who do not plan to have future pregnancies.
Navigating Treatment Solutions for Fibroids
Fibroids are common benign growths in the uterus that many women, particularly those over 50, may encounter. While some experience no symptoms, others may face heavy bleeding or discomfort. Fortunately, a range of treatment options, including medications and surgical procedures, are available. It’s essential to discuss your unique situation with your healthcare provider to determine the best plan for you.
