Although many people with uterine fibroids do not have symptoms, others can experience heavy menstrual bleeding (menorrhagia), abnormal uterine bleeding, anemia, pelvic pain, reproductive problems, and painful sex.
Treatment for fibroids depends on several factors, including age, the severity of symptoms, desire for pregnancy, and size and location of the tumors. Medications, surgical procedures, and lifestyle changes can help eliminate or alleviate fibroids.
This article will discuss current treatment options for uterine fibroids.
Prescription Medications
Up to 80% of people with a uterus will develop fibroids. Medications can reduce the symptoms of fibroids, preserve fertility, and decrease the need for surgery.
Oral Contraceptives
Oral contraceptives (birth control pills or “the pill”) do not reduce the size of fibroids, but they can help decrease menstrual bleeding and pelvic pain. Since estrogen can make fibroids grow, initially scientists were concerned about using the pill to control bleeding for this condition.
However, one study showed that oral contraceptives are safe for managing fibroid symptoms. The low cost and few side effects of the pill make it a popular choice for treating fibroids.
Progestins
Like oral contraceptives, progestins (the human-made version of the hormone progesterone) can also improve heavy bleeding and dysmenorrhea (painful periods) due to fibroids. The Depo-Provera injection is an example of a progestin that alleviates symptoms. Progestins are usually tolerated well by most people.
Levonorgestrel Intrauterine System (LNG-IUS)
Originally approved to treat heavy menstrual bleeding, the LNG-IUS (Mirena and Liletta) is also effective for symptomatic fibroids. The T-shaped device is inserted in the uterus and releases small amounts of levonorgestrel, a progestin hormone, throughout the day. Minimal side effects have been noted with LNG-IUS, and it can remain in the uterus for up to seven years.
Gonadotropin-Releasing Hormone Agonist (GnRHa)
GnRHa suppresses follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are responsible for menstruation. GnRHa also decreases the size of fibroids. Lupron is a GnRHa given for several months to shrink fibroids before surgery, which helps reduce surgical times, decreases bleeding during surgery, and improves the difficulty of the surgery. GnRHa is a short-term solution for fibroid reduction as side effects include hot flashes, night sweats, vaginal dryness, and bone loss.
Selective Progesterone Receptor Modulator (SPRM)
Although mifepristone was the first SPRM, a recent study showed that another SPRM, asoprisnil, is also effective at decreasing bleeding, reducing fibroid size, and is generally well-tolerated. SPRMs can cause changes to the uterus lining, but these alterations do not increase the risk for uterine cancer.
Over-the-Counter (OTC) Medications
Painful menstrual cramps, pelvic fullness, anemia, and fatigue are symptoms that affect the quality of life of many people with uterine fibroids. Some OTC medications that can reduce these symptoms include:
Nonsteroidal anti-inflammatory drugs (NSAIDs): Decrease inflammation and discomfort Tylenol (acetaminophen): Provides mild pain relief Stool softeners: Decrease constipation, which can alleviate pelvic pain and fullness Pyrilamine maleate: An antihistamine included in menstrual products that may improve cramps Iron Supplements: Improve anemia and reduces fatigue
Surgeries and Procedures
When the symptoms from fibroids become severe, or the fibroids become too bulky, surgery may be warranted. In addition, there are several medical procedures available to reduce the number and size of fibroids.
Myomectomy
Surgically removing the fibroids while saving the healthy uterine tissue is called a myomectomy. This surgery is a beneficial option for people who wish to become pregnant later. It can be done laparoscopically (minimally invasive surgery) or as open surgery. Unfortunately, new fibroids can form after a myomectomy.
Hysterectomy
Complete removal of the uterus, called a hysterectomy, is the only cure for fibroids. Depending on the size and number of fibroids, a hysterectomy can be done vaginally, laparoscopically, or as an open abdominal procedure. The ovaries and fallopian tubes may or may not be removed, and recovery can take several weeks.
Myolysis
Myolysis is the destruction of fibroids by freezing, heating, or cutting off their blood supply. A needle is inserted into the fibroid by laparoscopy and delivers either liquid nitrogen, an electrical current, or a laser beam—causing the fibroid to shrink and eventually die. People who have this procedure should not become pregnant as it can be dangerous for the pregnant person and the baby.
Endometrial Ablation
Endometrial ablation controls or stops heavy bleeding by destroying the uterine lining. Several methods can cause the breakdown of the uterine lining, including laser, wire loops, boiling water, electric current, or freezing. This procedure is done in the healthcare provider’s office, and recovery is usually quick. Pregnancy is not achievable after this procedure.
Uterine Fibroid Embolization (UFE)
During a UFE, a thin tube is inserted into the vessels feeding the fibroids. In this minimally evasive procedure, tiny particles are then injected, which stop the blood flow to the tumors. Over weeks to months, the fibroids shrink. Fibroids are not likely to come back after a UFE; however, if the fibroids become calcified, they may need to be removed later. Pregnancy is not advisable after this procedure.
Magnetic Resonance Imaging (MRI)–Guided Focused Ultrasound
Fibroids are destroyed using high-intensity ultrasound during an MRI-guided focused ultrasound. An MRI scanner identifies the fibroids and then sends concentrated ultrasound waves through the skin to destroy them. This procedure is relatively new and may not be available or approved by insurance. More research is needed to determine the long-term effects of this procedure.
Alternative Remedies and Lifestyle
Hormones play an important role in the development of myomas, therefore, influencing hormone-related factors is one way to keep them from forming. Here are some alternative ways to improve the risk of developing uterine fibroids:
Diet: Research shows that eating fruits, vegetables, and foods with a lower glycemic index can reduce the risk of developing fibroids. Although controversial, some studies found that soy, red meat, and alcohol intake can increase the risk of fibroids.
Exercise: Fibroids are more common in overweight people, so maintaining a healthy weight reduces fibroid formation.
Vitamins: Vitamin D reduces the expression of estrogen and progesterone receptors, thereby reducing the risk of fibroids, while vitamin A may have the ability to slow down myoma growth.
Herbs: In combination with Western medicine, herbs such as radix paeoniae, peach kernel, cassia twig, and poria cocos can help shrink and improve symptoms from fibroids. In addition, there is evidence that green tea can reduce fibroid volume.
Acupuncture: More research is needed to evaluate acupuncture’s effect on fibroids; however, one study found that approximately 50% of American women used a combination of exercise, diet, herbs, and acupuncture to treat symptoms caused by fibroids.
Environmental contaminants: Any environmental pollutant that affects estrogen and progesterone has the potential to increase fibroid formation.
Home remedies for fibroid treatment that are not evidence based such as essential oils and apple cider vinegar should be used with caution, especially during pregnancy. Always check with your healthcare provider before starting alternative methods to treat uterine fibroids.
Fibroids During Pregnancy
It’s essential to eliminate or reduce fibroids before pregnancy. Although most pregnant people with fibroids will have an uncomplicated pregnancy and delivery, fibroids can cause the following conditions:
Miscarriage (loss of a pregnancy before 20 weeks) Preterm labor (labor that begins before 37 weeks) Preterm rupture of membranes (water breaking early) Placental abruption (the placenta separates from the uterine wall prematurely) Placenta previa (when the placenta is low in the uterus) Fetal growth restriction (when a baby doesn’t grow to normal weight during pregnancy) Postpartum hemorrhage (abnormally heavy bleeding after childbirth) Retained placenta (failure to expel the placenta 30 minutes after birth)
Treatment of fibroids during pregnancy focuses on relieving pain for the pregnant person. Bed rest, hydration, and acetaminophen can help with the discomfort of fibroids during pregnancy. Your healthcare provider will evaluate the size and number of fibroids often during pregnancy.
Summary
Fibroids (myomas) are benign, smooth muscle tumors of the uterus. Although the exact cause of fibroids is unknown, scientists confirm they are affected by estrogen and progesterone. Treatment for fibroids includes medications that influence hormonal balance and decrease heavy menstruation.
Several surgeries and medical procedures are available to reduce the number and volume of fibroids should symptoms become severe. In addition, alternative therapies such as diet, exercise, and herbal remedies can decrease the risk factors for developing fibroids.
A Word From Verywell
Fibroids are very common, and although they are benign (not cancerous), they may still cause discomfort. It’s essential to choose a healthcare provider that understands the complications unique to you and advocates for the most appropriate treatment options resulting in the best health outcomes.
