HEALTH & LIFESTYLE
TREATMENT FOR UTERINE FIBROIDS
Aug 20, 2022
DEFINITION AND TREATMENT FOR UTERINE FIBROIDS
Quick Answer
Treatment for uterine fibroids depends on your symptoms, the size and location of the fibroids, your age, and whether you want to get pregnant. Many fibroids need no treatment at all. When they cause heavy bleeding or pain, options range from medicines such as tranexamic acid and hormonal therapy to procedures such as uterine artery embolization, myomectomy (removing the fibroids and keeping your uterus), and hysterectomy.
Key Takeaways
- Fibroids are almost always non-cancerous, and most do not need treatment unless they cause symptoms.
- Heavy bleeding that leads to anemia is the most common reason to treat them.
- Most medicines control bleeding and pain but do not remove fibroids for good.
- Myomectomy keeps your uterus. Hysterectomy is the only treatment that removes fibroids for good.
- Soaking a pad or tampon every hour for two hours or more, or feeling dizzy or short of breath, needs care right away.
Fibroids, also called uterine myoma, are abnormal, non-cancerous growths that develop in or on a woman’s uterus (womb). They are typically present during a woman’s reproductive years and affect up to 80% of women by the age of 50. Fibroids are, however, more common in the 40s and early 50s. Not all women have symptoms, and those who have symptoms (about 20-50% of women with fibroids) have a challenging time living with fibroids.
Fibroids can grow as single or multiple tumors of varying sizes in the uterus. Fibroids are also known as fibromas and leiomyomas. Fibroids are almost always benign. Cancer in a fibroid, called leiomyosarcoma, is very rare (less than 1 in 1,000), and doctors do not think it grows out of an existing fibroid, so having fibroids does not raise the risk of other uterine cancers.
Causes of Fibroids
The cause of fibroids is unknown, but different factors have been linked to the development of fibroids. Hormonal changes, such as estrogen and progesterone, have been shown to affect the formation of fibroids. Fibroids also have a genetic component and can run in families.
A fibroid can be as small as an apple seed, as huge as a grapefruit, or even bigger in rare cases. Since fibroids are under hormonal control, they tend to grow during pregnancy when hormone levels are rising and shrink or stop growing at menopause. If you want to know more, read what happens to fibroids after menopause.
Photo by Los Muertos Crew on Pexels.
Symptoms of Fibroids
Although most fibroids do not cause symptoms, some symptoms of fibroids can include:
- Pain during intercourse
- Constipation
- Lower back pain
- Heavy bleeding that can lead to anemia and low iron
- Feeling of fullness in lower abdomen
- Painful periods
- Enlargement of lower abdomen, making a woman look pregnant
- Rectal pressure from pressure on the bowel
- Frequent urination from pressure on the bladder
- Miscarriages
- Difficulty getting pregnant
Different Types of Fibroids
Fibroids can grow in different parts of the wall of the uterus and are categorized based on where they reside. A fibroid in the uterine cavity is a sub-mucosal fibroid; a fibroid within the wall of the uterus is an intra-mural fibroid; and, a fibroid on the outside of the uterus is a sub-serosal fibroid. Occasionally, some fibroids can grow as stalks that resemble mushrooms. These are called pedunculated fibroids.
Who Is More Likely to Get Fibroids
Fibroids can occur in any woman of reproductive age; however, certain factors can increase the risk of fibroids, including:
- Age – having fibroids is more common for women in their 30s and 40s and into menopause. However, since fibroids have a hormonal component, they tend to shrink as a woman approaches menopause
- Race – fibroids are more common in Black women, tend to appear at a younger age, and often grow faster. ACOG notes these differences may be linked to racism and inequities in society, and not only to biology
- Weight – carrying excess weight raises the risk of fibroids, and for women who are very overweight, the risk can be two to three times higher
- Diet – eating a lot of red meat and ham has been linked to a higher risk, while eating green vegetables has been linked to a lower risk
- Genetics – family history is a contributing factor. A woman whose mother had fibroids has about three times the average risk of developing them
How Fibroids Are Diagnosed
Many fibroids are found during a routine pelvic exam, when your OB/GYN feels that your uterus is larger than expected or has an uneven shape. A pelvic ultrasound is usually the next step. It uses sound waves to show the size, number, and location of the fibroids, and it can be done on the belly or with a small probe placed in the vagina.
If your OB/GYN needs more detail, there are other tests. An MRI gives a closer look at the size and position of the fibroids. A hysteroscopy uses a thin camera passed through the cervix to look inside the uterus, and a saline sonohysterogram is an ultrasound done with fluid in the uterus. You can read more about these tests from ACOG. If you have heavy periods, a blood test can also check for anemia (a low red blood cell count), which many women live with for a long time without knowing it.
Photo by Pavel Danilyuk on Pexels.
Treatment for Fibroids
If you have fibroids but do not have symptoms, chances are you may not need treatment. However, your OB/GYN will keep an eye on the fibroids during your regular exams to track their growth. For those who need treatment due to symptoms, the choice of treatment will depend on many factors, like the location and size of the fibroids, but also your age, desire for pregnancy in the future, and proximity to menopause.
Treatment usually starts with the least invasive option that fits your goals. Over-the-counter pain relievers can help control pain. Tranexamic acid (a non-hormonal medicine taken during your period) lowers blood loss. Hormonal medicines such as birth control pills or a levonorgestrel IUD can lighten your periods. If those do not give enough relief, procedures and surgery are the next step, and the right one depends on whether you want to keep your uterus or become pregnant.
Every option works differently, so the table below puts them side by side.
Fibroid Treatment Options at a Glance
Use this table as a guide for your conversation with your OB/GYN, not as a menu to choose from on your own. The best option depends on your symptoms, the size and location of your fibroids, and your plans for pregnancy. Sources include ACOG and the Office on Women’s Health.
| Option | What it does | Keeps your uterus? | Good to know |
|---|---|---|---|
| Watchful waiting | Tracks the fibroids at regular exams | Yes | Common when fibroids cause no symptoms or you are close to menopause |
| Pain relievers and tranexamic acid | Anti-inflammatory pain relievers ease cramps, and tranexamic acid lowers blood loss | Yes | Does not shrink fibroids or stop your periods |
| Hormonal birth control or a levonorgestrel IUD | Lightens heavy bleeding and eases pain | Yes | Controls symptoms but does not remove fibroids, and the IUD only suits fibroids that do not change the shape of the uterine cavity |
| GnRH medicines (leuprolide, or combination pills such as Oriahnn and Myfembree) | Lower estrogen to reduce bleeding, and leuprolide can also shrink fibroids | Yes | Used for a limited time because of bone loss, with the combination pills limited to 24 months. Fibroids usually grow back after leuprolide stops |
| MRI-guided focused ultrasound | Uses sound waves to heat and destroy fibroid tissue without an incision | Yes | A newer option that may need repeat treatments, and more research is needed |
| Uterine artery embolization | Blocks the blood supply to the fibroids so they shrink | Yes | Often done as an outpatient procedure, and the effect on future pregnancy is not clear |
| Radiofrequency ablation and myolysis | Use heat, electric current, or freezing to destroy fibroid tissue | Yes | The effect on future pregnancy needs more research |
| Endometrial ablation | Destroys the lining of the uterus to control heavy bleeding | Yes | Pregnancy is not possible afterward, and it treats the bleeding but not the fibroids |
| Myomectomy | Removes the fibroids and leaves healthy tissue in place | Yes | Pregnancy is possible afterward, though a cesarean birth may be needed, and new fibroids can grow later |
| Hysterectomy | Removes the uterus | No | The only sure cure for fibroids, and it ends the ability to carry a pregnancy |
Photo by Polina Kovaleva on Pexels.
Prevention of Fibroids
Fibroids are usually not life-threatening, but they can be an inconvenience and can cause serious medical complications and health problems. No habit can guarantee that you will not get fibroids, although a few are linked with a lower risk. They include:
- Eat a balanced diet with plenty of fruits, green vegetables, and fish. Limit red meat such as beef, ham, and lamb when possible. Also eat foods rich in potassium (like avocado, bananas, dates, and citrus), fiber (like beans, lentils, oats, and raw vegetables), dairy (like yogurt and cheese), and tea (especially green tea with antioxidants)
- Get enough vitamin D, which has been linked to a 32% lower risk of fibroids in women with enough of it in their blood. Vitamin D can be found in foods like milk, eggs, fish, and fortified cereals. It is also naturally available when your skin is exposed to sunlight. Vitamin D supplements can also provide additional vitamin D. You can learn more in my guide to vitamin D for women
- Limit alcohol, since some studies link heavier drinking, especially beer, to a higher risk of fibroids, although the evidence is mixed
- Maintain a healthy body weight, because excess weight raises the risk of fibroids. Fat cells make estrogen, which can increase the growth of fibroids
- Keep your blood pressure in a healthy range. Women with severe fibroids tend to have higher blood pressure than women without them, and healthy blood pressure protects your heart and overall health
- Quit smoking, which supports your hormone, heart, and overall health
Photo by cottonbro studio on Pexels.
Complications of Fibroids
Fibroids are not dangerous for most women, but when left untreated they can continue to grow and could lead to worsening bleeding and anemia. Anemia can be exhausting and can affect the quality of life of a woman. Most women with fibroids still have normal pregnancies, but enlarged fibroids can complicate labor and delivery. A pregnant woman with fibroids is six times more likely to deliver by cesarean section compared to a pregnant woman without fibroids, which is one reason to tell your OB/GYN about fibroids early in a higher-risk pregnancy. In rare cases, fibroids can lead to infertility as well as other reproductive problems. Fibroids, especially the larger ones, can also cause bladder and bowel dysfunction. And in acute cases, fibroids can be more complicated and potentially lead to severe disruption of the woman’s quality of life.
When to Seek Care Right Away
Fibroids are usually not an emergency. I always lead with this next part because it matters, though. Some symptoms mean you need care right away, and others mean you should book a visit soon.
Get emergency care right away if you
- Change a pad or tampon every hour for two hours or more, especially with dizziness, lightheadedness, chest pain, or shortness of breath (ACOG lists this as a sign to seek emergency care)
- Have sudden, severe pelvic pain, especially with fever, nausea, or vomiting, which can happen when a fibroid on a stalk twists or a fibroid starts to break down
- Cannot pass urine
Book a visit soon if you
- Soak a pad or tampon every hour for several hours, or pass clots the size of a quarter or larger (this is what ACOG calls heavy bleeding)
- Feel tired, weak, or short of breath with heavy periods, since these can be signs of anemia
- Notice new pressure in your lower abdomen, a growing belly, or pain during sex
- Have trouble getting pregnant or have had more than one miscarriage
You do not have to wait for an emergency to ask for help. Heavy periods are common, but they are not something you have to live with.
Frequently Asked Questions
Can fibroids go away on their own?
Fibroids do not usually go away completely on their own, but they often stop growing or shrink after menopause, when estrogen and progesterone levels fall. Until then, they can stay the same size, grow, or shrink a little. If your fibroids are not causing symptoms, your OB/GYN may simply check them at your regular visits. You can read more in my post on fibroids after menopause.
Can I get pregnant if I have fibroids?
Most women with fibroids still have normal pregnancies. Depending on their size and location, fibroids can make it harder to conceive or raise the chance of problems such as a breech baby, preterm delivery, or cesarean birth. If you want to be pregnant now or later, tell your OB/GYN, because some treatments protect fertility better than others. You can also read about the signs of infertility in women.
Which fibroid treatments let me keep my uterus?
Watchful waiting, medicines, MRI-guided focused ultrasound, uterine artery embolization, radiofrequency ablation, myolysis, and myomectomy all keep your uterus. Endometrial ablation also keeps it, but pregnancy is not possible afterward. Hysterectomy is the only option that removes the uterus. If you may want a pregnancy later, myomectomy is the option most clearly compatible with it, while the effect of embolization and ablation on future pregnancy is still being studied.
What is the difference between fibroids and endometriosis?
Fibroids are muscle growths in or on the wall of the uterus. Endometriosis happens when tissue similar to the lining of the uterus grows outside it, such as on the ovaries or the lining of the pelvis. Both can cause heavy or painful periods, so the symptoms overlap, and imaging or surgery may be needed to tell them apart. You can read my full guide to endometriosis symptoms and treatment.
What can I do at home for fibroid pain and heavy periods?
Over-the-counter anti-inflammatory pain relievers can ease cramps, and rest and warmth can add comfort. If your periods are heavy, ask your OB/GYN to check your iron level with a blood test, since low iron is common and can leave you exhausted. You can read more about low iron in women. Home care helps with comfort but it does not shrink fibroids, so keep your OB/GYN updated if your symptoms get worse.
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