• By Kelley Luckstein

Exploring Treatment Options for Women with Fibroids

April 23, 2015

Mayo Clinic expert demonstrates women have options that preserve the uterus

Medical illustration of a woman's reproductive system highlighting the different types of uterine fibroids

There are three major types of uterine fibroids. Intramural fibroids grow within the muscular uterine wall. Submucosal fibroids bulge into the uterine cavity. Subserosal fibroids project to the outside of the uterus.

ROCHESTER, Minn. — A 47-year-old African-American woman has heavy menstrual bleeding and iron-deficiency anemia. She reports the frequent need to urinate during the night and throughout the day. A colonoscopy is negative and an ultrasonography shows a modestly enlarged uterus with three uterine fibroids, noncancerous growths of the uterus. She is not planning to become pregnant. What are her options?

Elizabeth (Ebbie) Stewart, M.D., chair of Reproductive Endocrinology at Mayo Clinic, says the woman has several options, but determining her best option is guided by her symptoms, the size, number and location of the fibroids, as well as where she is in her reproductive life span. These options are highlighted in a Clinical Practice article by Dr. Stewart in this month’s New England Journal of Medicine.

“Uterine-conserving therapy should be an available option for women even if there is no plan for childbearing,” says Dr. Stewart, a uterine fibroid researcher. “Although myomectomy, a surgical procedure to remove uterine fibroids, is the traditional alternative to hysterectomy, there are other options for medical and interventional treatment. Before determining which alternative therapy may be an option, the symptoms caused by fibroids must first be assessed.”

MEDIA CONTACT: Kelley Luckstein, Mayo Clinic Public Affairs, 507-284-5005 or newsbureau@mayo.edu

Journalists: Sound bites with Dr. Stewart are available in the downloads.

Uterine fibroids are common in women of reproductive age; about 1 in 4 U.S. women have them, and they are particularly prevalent and associated with illness in African-American women. The lifetime prevalence of fibroids exceeds 80 percent among African-American women compared to nearly 70 percent among white women. African-American women also report having significantly more severe fibroid symptoms and more impairment of daily activities. Hysterectomy provides the most effective treatment for fibroids and eliminates the risk of new fibroid formation, but it is not the only treatment available. There are often less invasive, alternate therapies. This information should provide hope for all women and particularly for African-American women who have been reported to value uterine-sparing and fertility-sparing therapies.

Alternative treatment options include:

Therapies for isolated heavy menstrual bleeding

  • Tranexamic acid, an oral antifibrinolytic agent that is taken only on the days of heavy menstrual bleeding, decreases bleeding and improves quality of life with minimal side effects.
  • A levonorgestrel-releasing intrauterine device (IUD) or oral contraceptives, decreases menstrual bleeding and provides contraception.
  • Hysteroscopic myomectomy, an outpatient surgical procedure that allows the woman to return to work within a few days and increases the potential for clinical pregnancy. This is only an option for women with submucosal fibroids.
  • Endometrial ablation, uses heat, cold or mechanical means to destroy the endometrium and thus reduces menstrual bleeding. Ablation is only an option for women who have completed childbearing.

Therapies for women where the size of the fibroid(s) causes symptoms

  • Gonadotropin-releasing hormone agonists (GnRH-a), medications that turn off the ovaries’ production of hormones, which reduces menstrual bleeding and causes considerable reduction in uterine volume. They are only useful for six months or less of treatment.
  • Progesterone-receptor modulators block the action of the ovarian hormone progesterone and decrease fibroid symptoms and reduce fibroid volume but are currently not available in the United States.
  • Uterine artery embolization, a minimally invasive interventional radiologic technique that has been shown in randomized trials to result in quality of life that is similar to that after surgery, with shorter hospital stays and less time to resumption of usual activities.
  • MRI-guided, focused ultrasound surgery, a fibroid-specific therapy that uses ultrasound thermal ablation to treat fibroids with no incisions and no hospital stay.
  • Radio frequency ablation during laparoscopy is useful for destruction of fibroids during laparoscopy that would be difficult to remove in this minimally invasive way.
A magnetic resonance image of a fibroid

A subserosal fibroid

“It is extremely important for women to know the options available for treatment of uterine fibroids,”says Dr. Stewart. “Equally important is the need to continue to study fibroids to assist in developing better treatments.”

To that end, Mayo Clinic is leading an effort to compare treatments for uterine fibroids. Comparing Options for Management: Patient-Centered Outcomes for Uterine Fibroids (COMPARE-UF) is a voluntary registry of 10,000 women with uterine fibroids funded by the Patient-Centered Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality (AHRQ). COMPARE-UF seeks to answer questions that matter most to patients with fibroids when considering the pros and cons of different treatment options. To help women make these decisions, COMPARE-UF will collect information from participants about their medical history, planned and previous treatment for their fibroids, current symptoms and quality of life.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to medical research and education, and providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or https://newsnetwork.mayoclinic.org/.

"Generose behavioral health services are not being expanded due to the project"-Are there any plans to expand Mayo's behavioral health services? I feel like this is a need in RST. I often hear of Generose being too full to accommodate new patients.

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I am very surprised that the behavioral services are not being expanded. There is a very great need for those types of services not only in Rochester but all over Minnesota. Why are the services not being expanded? Are there future plans to expand Generose?

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Great, another glass box building. I suppose making a building blend into the sky is a good way to hide bad architecture.

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I'm glad they will be replacing the garden area, I was sad when I saw them cutting down the trees & taking everything out. I love going to that area on my break when it's warm outside. I'm also surprised that the behavioral health services unit is not being expanded. Will they have any kind of expansion in the future?

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@meaganbussell

"Generose behavioral health services are not being expanded due to the project"-Are there any plans to expand Mayo's behavioral health services? I feel like this is a need in RST. I often hear of Generose being too full to accommodate new patients.

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I agree!! When I saw the article I automatically assumed that would expand the behavioral health area. I was very disappointed to find out this is not the case. Minnesota is in dire need of more options to take your loved ones with behavioral health issues. This is very sad…..

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Am I the only one wondering how many birds will run into these windows??

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I feel the same way. Yes; services need to be expanded but I feel at this time something needs to be focused on doing more for behavior health. This has been a need for a long time.

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@carlmichaelbrandlsalutz

Great, another glass box building. I suppose making a building blend into the sky is a good way to hide bad architecture.

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What would you rather see used?

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@meaganbussell

"Generose behavioral health services are not being expanded due to the project"-Are there any plans to expand Mayo's behavioral health services? I feel like this is a need in RST. I often hear of Generose being too full to accommodate new patients.

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I was thinking the same thing. The services are so lacking in Minnesota and while we have more beds and can handle sicker patients at Generose than most other hospitals' psychiatry services, the need is still there. However, the opening of the CIU on JO7 has been helpful with some of the most acute patients – check it out if you aren't familiar with what they do up there. Thanks to everyone who works to help these patients reach their full potential!

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@meaganbussell

"Generose behavioral health services are not being expanded due to the project"-Are there any plans to expand Mayo's behavioral health services? I feel like this is a need in RST. I often hear of Generose being too full to accommodate new patients.

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FYI, Mayo is expanding behavioral health services with the Herman House across the street. See this article: http://newsletters.mayo.edu/newscenter/Article.aspx?contentID=DOCMAN-0000166606 There has also been an expansion of behavioral health facilities here on the St. Mary's Campus that just opened.

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I feel like the existing structure should have a new facade over it so the building looks cohesive as one. Not a new building stacked on an old. This current design needs help

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