Uterine fibroids do not always require treatment. Many women have fibroids which cause no problems and can be quite safely left alone. Fibroids are benign and not cancerous. Fibroids that do not cause symptoms are often discovered during a routine pelvic examination. The diagnosis is confirmed by abdominal and or pelvic ultrasound scanning, which is simple and painless. Small, symptomless fibroids generally do not require treatment but regular examination or ultrasound scanning may be needed to assess growth. If fibroids are causing pain or other problems they may require treatment.
Treatment with medication
Uterine fibroids can be treated with strong hormonal drugs which suppress production of the sex hormones oestrogen and testosterone. In women these block oestrogen and induce an early menopause. The drugs prevent oestrogen (the female hormone) from working. They are known as analogues of LNRH (leutinizing hormone releasing hormone). Examples include goserelin (Zoladex) and buserelin (Suprecur). These drugs are given by injection in the case of goserelin and either by nasal spray or injection with buserelin. Goserelin can be given monthly or 3 monthly. It consists of a slow release pellet which is injected under the skin usually in the lower abdomen. The drug is then released slowly into the bloodstream. These drugs are effective in shrinking uterine fibroids. The fibroids increase in size again when the drug is stopped. Goserelin is usually used to shrink fibroids before surgery. It is not often used as an alternative to surgery because of the problem of regrowth once the treatment is stopped. The main problem with these medications is that they induce a menopausal state. The main side effects are therefore temporary infertility, loss of bone mass (osteoporosis), hot flushes, mood swings, depression, tiredness and vaginal dryness. When the course of treatment is stopped the side effects will stop, but some women may have lost some bone mass. Loss of bone mass (demineralisation) can be reduced by additional treatment with a drug called raloxifene. This drug can also help shrink the fibroids further. Fertility and fibroids return when the medications are discontinued.
Surgical treatment involves either removal of individual fibroids (myomectomy) or hysterectomy. Fibroids can be removed surgically. This is known as myomectomy. It involves shelling out the fibroid from the uterus under a general anaesthetic, via a lower abdominal wall incision. Complications of myomectomy include severe bleeding requiring hysterectomy, infection and post-operative adhesions.
Hysterectomy is the ideal curative surgical treatment for women who no longer want children. Fibroids can be removed by laparoscopic (keyhole) surgery. This results in a smaller scar but is technically more difficult and requires a patient and skilled surgeon.
Embolisation of fibroids: This procedure is carried out by a radiologist (a doctor specialised in x-ray interpretation and treatment involving x-ray monitoring). It involves an injection of particles into the uterine artery supplying the uterus. This results in blockage of the uterine artery and shrinking of the fibroids. This is also known as uterine ablation. It is not widely available as a treatment and it can be very painful. The period of time spent in hospital is shorter for embolization than for surgery.