Fibroid Treatment

Women who have no symptoms from their fibroids do not need to have treatment. Women with significant symptoms may try medical or surgical treatment. The best treatment depends on which symptom(s) is most bothersome. The size, number and locations of fibroids and your desire for future pregnancy also factor into most treatment decisions.

Medical Fibroid Treatment

Most medical treatments use a medicine to reduce the heavy menstrual bleeding, which is common in women with fibroids. A few medical treatments also shrink the fibroid too, and some are focused on reducing pain or correcting anemia. Medical treatments are often recommended before surgical treatments.

•  Iron and vitamins : For women who are anemic, the combination of iron supplements and a multivitamin, which will help the body effectively use the iron, is an effective option to combat anemia.
•  Nonsteroidal antiinflammatory drugs (NSAIDs) : Nonsteroidal antiinflammatory drugs (NSAIDs), such as ibuprofen (sold as Motrin or Advil) and naproxen (sold as Naprosyn or Aleve), can help reduce menstrual cramps and decrease menstrual flow in some women. You can buy some NSAIDs (including ibuprofen) without a prescription.NSAIDs are not expensive, have few side effects, reduce pain, and you only need to take them during your menstrual period. You can take NSAIDs in combination with any of the medical treatments discussed here. However, NSAIDs do not reduce bleeding as well as most other medical treatments do.                                                         For women who do not get relief with non-prescription NSAIDs, there are other similar medications available by prescription that may be helpful for some women.
•  Hormonal Birth Control : Hormonal methods of birth control include the pill, skin patch, vaginal ring, shot, hormonal IUD, and implant. These treatments reduce bleeding, cramps, and pain during your menstrual period and can correct anemia. It might take three months for bleeding to improve after you start taking hormonal birth control.                                                                                 Pills- Most forms of hormonal birth control, including the pill, are designed to be used for three weeks in a row, followed by one week off. During the fourth week, you will have menstrual bleeding. It might take three months for bleeding to improve after you start taking hormonal birth control.
•  Hormonal Intrauterine Device : There is an intrauterine device (IUD) that slowly releases a form of a progesterone-like hormone called a progestin, into the uterus. There is no estrogen in the IUD. The IUD prevents pregnancy and reduces menstrual bleeding for up to five years. A doctor or nurse places the IUD inside the uterus. This treatment is best for women who do not have plans to become pregnant within the next 6 to 12 months
•  Implant : There is an implant that slowly releases a progestin into your bloodstream. It prevents pregnancy and reduces menstrual bleeding for up to three years. A doctor or nurse places the implant (which is about the size of a match stick) under the skin in the upper inner arm. It is called Mirena. This treatment is best for women who do not have plans to become pregnant within the next 6 to 12 months. The most common side effect of the progestin implant is irregular menstrual bleeding.
•  Antifibrinolytic Medicines : Antifibrinolytic medicines do not contain hormones and can help to slow menstrual bleeding quickly. These medicines work by helping blood to clot. Antifibrinolytic medicines do not shrink fibroids or correct anemia. Tranexamic acid (Lysteda) is approved by the United States Food and Drug Administration for the indication.

Surgical Treatment

Surgery is indicated when There is excessively enlarged uterine size. Pressure symptoms like difficulty in passing urine or stools, increased frequency of passing urine are present. Medical management is not sufficient to control symptoms. The fibroid is submucous and fertility is reduced.

Surgical Options Include

Surgery is indicated when There is excessively enlarged uterine size. Pressure symptoms like difficulty in passing urine or stools, increased frequency of passing urine are present. Medical management is not sufficient to control symptoms. The fibroid is submucous and fertility is reduced.

 Myomectomy (Removal of only fibroid) : 

                         This is used in patients who wish to maintain their reproductive potential or keep their uterus:

Abdominal myomectomy is a safe alternative to a hysterectomy. However, there is a risk of excessive bleeding and a risk of requiring hysterectomy at the time of the operation. Therefore, blood should be cross-matched pre-operatively and the patient needs to give their consent to hysterectomy should the need arise. Also 4-17% of women will later go on to have a hysterectomy.

Laparoscopic myomectomy is associated with less pain, shorter hospital stay and reduced recovery time. It is the best treatment option for symptomatic women with symptomatic subserous fibroids, who wish to maintain their fertility.

Hysteroscopic myomectomy is an established surgical procedure for women with submucosal fibroids and excessive uterine bleeding, infertility or repeated miscarriages.When performed for treatment of abnormal bleeding, this resolves in 74-94% at two years. 12% subsequently require hysterectomy.

 Total hysterectomy :

                                   This has been the mainstay of treatment for many years, eliminating both symptoms and the possibility of recurrence, and fibroids are the indication for approximately one third of hysterectomies in the USA.In women who have completed their family, hysterectomy remains the most effective treatment for excessive uterine bleeding.

It is also indicated when there are many fibroids. If these are small then the vaginal route is appropriate but if they are large (especially if intraligamentous) then laparotomy is indicated with preservation of ovaries if possible.

The risk of blood loss is directly related to the uterine size. This may be reduced by pre-treatment with GnRH agonists.

Studies recommends that laparoscopic techniques for hysterectomy (eg, laparoscopically assisted vaginal hysterectomy, laparoscopic hysterectomy, laparoscopic supracervical hysterectomy and total laparoscopic hysterectomy) appear to be sufficiently safe and effective to support their use.

 Uterine artery embolisation (UAE)  :

                          This procedure has been shown to be both effective (for short- and medium-term symptom relief) and safe for women who wish to keep their uterus, although the effects on fertility and pregnancy are uncertain. If patients are considering pregnancy, there is a theoretical risk of placental insufficiency leading to small-for-gestational-age babies, increased caesarean section and prematurity.

Ensuring the tumour is a benign fibroid and not cancerousis essential prior to UAE

Women should be informed during consenting that symptom relief may not be achieved for some women and that symptoms may return. Although complications are rare, they may necessitate life-saving hysterectomy, consent for which is required prior to the procedure.

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