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Fibroid Treatment Options Based on your Symptoms

Fibroid Treatment Options at a Glance

There is usually more than one type of treatment available for each fibroid problem. It is important for each woman to make a decision about which treatment is right for her.

Things to consider:

  1. What symptoms do you have and, do the symptoms interfere with your quality of life?
  2. What are your wishes about future childbearing?
  3. What is the likelihood that a treatment will be successful FOR YOUR SPECIFIC SITUATION?
  4. What are the possible risks, the expense, the recovery time including time away from work or family?
  5. What are your opinions about each of the treatment options appropriate for you?
  6. Are you able to find a doctor who can skillfully provide the treatment option you wish? If you are knowledgeable about the treatment options, either your present doctor has the skills to perform them, or should refer you to a gynecologist who has the necessary skills.

Depending on your symptoms and medical situation, the treatment options may include:

  1. Watchful waiting
  2. Medication, including the progesterone-IUD (Mirena)
  3. Surgery
    1. Endometrial ablation
    2. Hysteroscopic myomectomy
    3. Laparoscopic myomectomy
    4. Robotic myomectomy
    5. Abdominal myomectomy (bikini incision)
    6. Hysterectomy (removal of uterus)
      1. Laparoscopic hysterectomy (without or with removal of cervix)
      2. Vaginal hysterectomy
      3. Abdominal hysterectomy (bikini incision)
  4. Uterine Artery Embolization (UAE)
  5. Focused Ultrasound (MgFUS)

The following general guidelines should be discussed with your doctor.

For a woman with no bothersome symptoms and who wishes to maintain her fertility

The effect of fibroids on your fertility usually depends on whether or not the fibroids change the shape of the uterine cavity. Therefore, it is important to have a test to “examine” the cavity.

Any of these tests are considered accurate:

  1. Ultrasound with fluid inserted inside the cavity (called saline-infusion-sonography or sonohysterogram).
  2. Hysteroscopy (telescope to look inside the cavity), usually performed in the office.
  3. Pelvic MRI. Studies show this to be the most accurate way to examine the uterine cavity, and it will accurately show other fibroids.

If the cavity is misshapen by the fibroids, removal of the fibroids by hysteroscopic myomectomy or abdominal myomectomy is usually necessary to improve fertility. Laparoscopic or robotic myomectomy can be offered by experienced laparoscopic surgeons.

If the uterine cavity is not misshapen by the fibroids, you usually would not need to be treated and you can try to get pregnant.

For a woman with no bothersome symptoms and who is not interested in future fertility

  1. Watchful waiting should be considered. I usually like to see these women at least twice a year to evaluate any changes in their symptoms or change in the size of the fibroids.

For a woman with bothersome symptoms who desires future fertility

  1. If your main symptom is abnormal bleeding,
    1. A blood count (hemoglobin or hematocrit) is helpful to make sure anemia is not present.
    2. If you have irregular bleeding, an endometrial biopsy or D&C can be performed to make sure there are no abnormal cells.
    3. The shape of the uterine cavity can be checked with saline-infusion sonography, hysteroscopy or MRI (the most accurate method). This information can help determine the appropriate treatment options.
    4. If the cavity is misshapen, myomectomy (hysteroscopic or abdominal) should be considered.
      1. Laparoscopic or robotic myomectomy can be offered by an experienced laparoscopic surgeon.
  2. If the main symptom is pain or pressure (called bulk symptoms)
    1. If the uterine cavity is not misshapen:
      1. Abdominal myomectomy can be considered.
      2. Laparoscopic or robotic myomectomy can be offered by an experienced laparoscopic surgeon.
    2. If the cavity is misshapen:
      1. Abdominal myomectomy should be considered.
      2. Laparoscopic or robotic myomectomy can be offered by an experienced laparoscopic surgeon.

For a woman with bothersome symptoms who is not interested in future fertility

  1. Watchful waiting can be considered if you do not want treatment for symptoms now. If you are close to menopause (the average age is 52), then you can consider watchful waiting until menopause, when symptoms usually diminish.
  2. If irregular bleeding is present, evaluation of the uterine lining cells with ultrasound or endometrial biopsy or D&C is a good idea to make sure no abnormal cells are present.

If the lining cells are normal, treatment options may include:

  1. a progesterone-IUD (Mirena)
  2. oral contraceptive pills
  3. hysteroscopic myomectomy and/or
  4. endometrial ablation.
  5. Myomectomy
    1. abdominal
    2. laparoscopic
    3. robotic
  6. Hysterectomy
    1. vaginal
    2. abdominal
    3. laparoscopic
  7. Uterine Artery Embolization
  8. Focused Ultrasound (MgFus)

If you have discomfort due to fibroids (bulk symptoms), treatment options may include:

  1. Myomectomy
    1. Laparoscopic
    2. Abdominal
  2. Hysterectomy
    1. Laparoscopic
    2. Vaginal
    3. Abdominal
  3. Uterine artery embolization
  4. Focused ultrasound (may be limited by size and number of myomas)

If you do not have a family history of ovarian cancer and you choose hysterectomy, you should consider keeping your ovaries. Recent studies show that the beneficial effects of ovarian hormones, both before and after menopause, on the heart, brain and over-all health may outweigh the small risk of ovarian cancer for women without a family history of ovarian cancer.

Very, Very Unusual Situations

If there is concern that the uterus may be compromising the ureters, you can have a kidney ultrasound or x-ray (IVP) to make sure there is no damage to the kidneys. If there is very rapid growth of the uterus, you can have a special timed MRI with dye and a blood test for an enzyme called LDH. (link)

By William H. Parker, MD
Clinical Professor, Obstetrics and Gynecology, UCLA School of Medicine
Director of Minimally Invasive Gynecologic Surgery, UCLA Medical Center, Santa Monica

Page last updated: October 11, 2009

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Disclaimer: The ideas, procedures and suggestions contained on this web site are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision.

Fibroid Doctor William H. Parker

Dr. William H. Parker is a board-certified Fellow in the American College of Obstetricians and Gynecologists. Dr. Parker is an internationally recognized expert in fibroid surgery and research. Based in Los Angeles, California, he is considered one of the best fibroid surgeons for abdominal and laparoscopic myomectomy in the United States and abroad. He has been chosen for Best Doctors in America and Top Doctors every year beginning in the late 90's.

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