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DEAR MAYO CLINIC: I’ve had heavy bleeding with bad cramps for almost two months and was recently diagnosed with uterine fibroids. My doctor prescribed hormone treatment, which helped with the bleeding for a couple weeks,
but when I stopped taking it due to negative side effects the bleeding started again. What are my other options for treatment? I am 31.
ANSWER: When uterine fibroids cause symptoms such as bleeding and cramping, treatment is either directed at managing the symptoms, as is the case with hormone therapy, or it is focused on shrinking or removing the fibroids themselves. Treatment choices are typically based on severity of symptoms, as well as the size and location of the fibroids.
Uterine fibroids are growths of the uterus that are not cancer. These firm masses can range from tiny and almost undetectable to large and bulky. Many women have uterine fibroids without knowing it because about 70 percent don’t have any symptoms.
When uterine fibroids do cause symptoms, those you’ve experienced — bleeding and cramping — are the most common. Uterine fibroids can also lead to increased urinary frequency, constipation and a feeling of pressure within the pelvic area.
Before deciding on treatment, it’s important to have a thorough evaluation to confirm a diagnosis of uterine fibroids and to make sure that they are the true cause of your symptoms. A variety of disorders can trigger heavy bleeding and cramping, so it’s possible to have uterine fibroids as well as another underlying condition that could actually be the source of those symptoms. In most cases an ultrasound of the uterus can reveal the size and location of the fibroids, as well as provide enough information for a physician to determine the root cause of the symptoms.
As in your case, the first line of treatment for uterine fibroids that cause bothersome symptoms is often hormone therapy. The purpose of hormone therapy is to ease bleeding and cramping. It has little to no effect on the actual fibroids, though. Another option to reduce heavy bleeding and cramping is treatment called the levonorgestrel intrauterine system, marketed under the brand name Mirena. Depending on the size and location of your fibroids, this choice may be highly effective. It usually causes fewer side effects than oral hormone medications.
You also could try medication that is not hormone-based to control your symptoms. These include nonsteroidal anti-inflammatory drugs, or NSAIDs (such as ibuprofen), as well as the oral medication tranexamic acid, brand name Lysteda.
Before you pursue that, though, you may want to talk with your doctor about treatment that targets the fibroids. This discussion is particularly important for someone your age, as fibroids can sometimes hinder fertility, as well as raise the risk for miscarriage. Fibroids can be targeted with surgery or through a minimally invasive procedure, depending on size, location and symptoms. Minimally invasive techniques include uterine artery embolization, focused ultrasound surgery, and radiofrequency ablation. The process for each of these procedures is different, but the goal is the same: to shrink the fibroids and reduce your symptoms.
A surgical option to remove the fibroids while leaving the uterus intact is called a myomectomy. It can be done through several small incisions or one larger incision. A hysterectomy — removal of the uterus — can be used to treat uterine fibroids, as well, through similar types of incisions. But it is a major surgery that ends your ability to have children. Although hysterectomy is the most frequent treatment for eliminating uterine fibroids, today women have other alternatives that allow them to keep the uterus, as well as receive symptom relief.
Talk to your doctor or make an appointment to see a physician who specializes in gynecology to discuss your options. A variety of treatments are available that can effectively treat uterine fibroids, but the best choice for you will be based on your individual circumstances. — Shannon Laughlin-Tommaso M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.