DEAR MAYO CLINIC: What is the best treatment option, other than hysterectomy, for uterine fibroids? If they return after treatment, does that mean I should then consider a hysterectomy?
ANSWER: A range of options exist for treating uterine fibroids. The treatment that is right for you depends on your individual situation. If fibroids come back after one treatment, a hysterectomy may be the next step in some cases. But again, that option is not the only choice.
Uterine fibroids are noncancerous growths that develop from the smooth muscular tissue of the uterus, called the myometrium. Fibroids can range in size significantly. Some are so tiny that they cannot be seen by the human eye. Others are bulky masses that can distort and enlarge the uterus.
One of the key considerations when deciding on treatment for uterine fibroids is the symptoms they cause. In some women, fibroids do not cause any symptoms. They may be found during a test being done for another reason, such as a pelvic exam or a prenatal ultrasound. In these cases, no treatment is needed. Fibroids are not cancerous, and they usually grow slowly. Some do not grow at all.
Fibroids can, however, lead to heavy or prolonged menstrual bleeding. Treatment in these cases may include taking medication to regulate the menstrual cycle and decrease bleeding. These medications do not get rid of the fibroids. But when bleeding is the main concern, they can often effectively control that symptom. Other options for bleeding can include an intrauterine device (IUD) or a minimally invasive surgery performed inside the uterus with no incisions.
Additional factors that need to be considered when deciding on treatment for uterine fibroids include how big the fibroids are, how many there are and where they are located. Large size, certain locations and significant numbers of fibroids may lead to additional symptoms beyond problems with menstrual bleeding. Those symptoms can include pelvic pressure and pain, frequent urination, constipation, and problems emptying the bladder. In some cases, the location of fibroids also can make it difficult to become pregnant.
In these cases, removing or destroying the fibroids may be necessary. A variety of techniques are available that can eliminate fibroids. Many are minimally invasive procedures that do not require traditional surgery. One approach, called MRI-guided focused ultrasound, requires no incision and is done on an outpatient basis. With these procedures, though, there is a risk that new uterine fibroids could develop later. But most of the procedures can be repeated, if need be.
If you are trying to become pregnancy or if pregnancy is an important future goal for you, that needs to be factored into your treatment decision. Some treatments are safer for future pregnancy than others.
A hysterectomy, the surgical removal of the uterus, is the only permanent solution for uterine fibroids. But it is a major surgery that ends a woman’s ability to bear children. It is typically not used as a first option for treating uterine fibroids. Even if fibroids do come back, other treatment choices are available if you prefer not to have a hysterectomy.
A final consideration to take into account, too, is how close you are to menopause. For most women, symptoms from fibroids fade after menopause. So if you are getting close to menopause and symptoms from fibroids require treatment, you may want to take a less aggressive approach at this time.
Because there are so many options for treating uterine fibroids, it is important to discuss your situation with your doctor. There is no single best choice for everyone. Your treatment should be tailored to meet your needs. — Elizabeth Stewart, M.D., Reproductive Endocrinology, Mayo Clinic, Rochester, Minn.