Treating fibroids

Treatment may not be necessary in cases where there are no symptoms of fibroids, or where symptoms are minor.

For example, if you have heavy periods already, you may choose not to have treatment because your day-to-day life is not significantly affected. After the menopause, fibroids often shrink, and it is likely your symptoms will either ease slightly or disappear completely.

To treat fibroids, your GP may recommend medication. However, in more severe cases, a number of surgical techniques may be considered. You should visit your GP to discuss the best treatment plan for you.

Medication for symptoms

There are medicines available that can be used to treat heavy periods, but they can be less effective the larger your fibroids are. These medications are described below.

Levonorgestrel intrauterine system (LNG-IUS)

LNG-IUS is a small, plastic device that is placed in your womb and slowly releases the progestogen hormone called levonorgestrel. LNG-IUS stops the lining of your womb from growing quickly, so that it is thinner and your bleeding becomes lighter.

Side effects associated with LNG-IUS include:

• irregular bleeding that may last for more than six months
• acne (inflamed skin on the face)
• headaches
• breast tenderness

In rare cases, LNG-IUS may also stop you having periods at all.

Tranexamic acid

Tranexamic acid tablets are taken three to four times a day throughout your period. The tablets work by helping the blood in your womb to clot, which reduces the amount of bleeding.

Tranexamic acid tablets are not a form of contraception and will not affect your chances of becoming pregnant once you stop taking them. Treatment should be stopped if your symptoms have not improved within three months.

Anti-inflammatory medicines

Anti-inflammatory medicines, such as ibuprofen and mefenamic acid, can be taken for a few days during your period and will help ease your heavy bleeding. They work by reducing your body’s production of a hormone-like substance called prostaglandin, which is linked to heavy periods.

Anti-inflammatory medicines are also painkillers, but they are not a form of contraception. Indigestion and diarrhoea are common side effects.

The contraceptive pill

The contraceptive pill is a popular form of contraception that stops an egg from being released from the ovaries to prevent pregnancy. As well as making bleeding lighter, some contraceptive pills can help to reduce period pain. Your GP will be able to provide you with further advice about contraception and the contraceptive pill.

Gonadotropin releasing hormone analogues (GnRHas)

GnRHas such as goserelin acetate are hormones that are often recommended to treat fibroids. GnRHas are given by injection and work by making your body release a small amount of oestrogen, which causes your fibroids to shrink.

GnRHas stop your menstrual cycle (period) but they are not a form of contraception. They do not affect your chances of becoming pregnant after you stop using them. 

If you are prescribed GnRHas, they can help to ease heavy periods and any pressure that is felt on your stomach. They can also help to improve symptoms of frequent urination and constipation.

GnRHas can cause a number of menopause-like side effects including:

• hot flushes
• increased sweating
• muscle stiffness
• vaginal dryness

Osteoporosis (thinning of the bones) is an occasional side effect of taking GnRHas. Your GP will be able to give you more information about this and may prescribe additional medication to minimise thinning of your bones.

GnRHas are only prescribed on a short-term basis and after treatment is stopped your fibroids may return.

GnRHas can also be used to shrink fibroids prior to having surgery to remove them. Sometimes, a combination of GnRHas and low doses of hormone replacement therapy (HRT) may be recommended to shrink your fibroids, while preventing the side effects of the menopause.

Surgery

Surgery may be considered if your fibroid symptoms are particularly severe and all forms of medication have proved ineffective.

There are several different surgical procedures used to treat fibroids. Your GP will refer you to a specialist who will be able to discuss all the options with you, including the benefits and any associated risks.

Some of these surgical procedures are explained below.

Hysterectomy

A hysterectomy is a surgical procedure to remove the womb. It may be recommended if you have large fibroids or severe bleeding.

A hysterectomy is the best way of preventing fibroids from coming back. You may want to consider it if you have fibroids that are particularly troublesome and you do not wish to have any more children.

Side effects of a hysterectomy include the possibility of early menopause and a reduction in libido (sex drive). 

Myomectomy

A myomectomy is a surgical procedure to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy, particularly for women who still wish to have children.

A myomectomy involves making a small incision (cut) in your stomach through which your fibroids are removed. This type of surgery is commonly known as keyhole surgery.

A myomectomy may not always be possible as it depends on your individual circumstances, such as the size, number and position of your fibroids.

Non-surgical treatments

As well as traditional surgical techniques to treat fibroids, there are also non-surgical treatments available. These are outlined below.

Endometrial ablation

Like a myomectomy, endometrial ablation is an alternative to having a hysterectomy and involves removing the lining of the womb. It is usually only recommended for fibroids that are near to the inner surface of the womb.

The affected womb lining can be removed in a number of ways, for example by using laser energy, a heated wire loop, microwave heating or hot fluid in a balloon.

Uterine artery embolisation (UAE)

Uterine artery embolisation (UAE) is an alternative procedure to a hysterectomy and myomectomy for treating fibroids. It may be recommended for women with large fibroids.

UAE is performed by a radiologist (a doctor who has been trained to interpret X-rays and scans). It works by blocking the blood vessels that supply blood to the fibroids, causing them to shrink.

During the procedure, a chemical is injected through a small tube (catheter), which is guided by X-ray through a blood vessel in your leg. It is carried out under local anaesthetic, which means you will be awake but the area being treated will be numbed.

Following a UAE, you will need to stay in hospital for 24 to 36 hours. When you leave hospital, you will be advised to rest for one to two weeks.

New treatments

There are also two newer techniques for treating fibroids, which use magnetic resonance imaging (MRI). They are:

• MRI-guided percutaneous laser ablation
• MRI-guided transcutaneous focused ultrasound

These techniques use MRI to guide small needles into the centre of the fibroid being targeted. Laser energy, or ultrasound energy, is then passed through the needles to destroy the fibroid. These treatment methods cannot be used to treat all types of fibroids, and the long-term benefits and risks are unknown.

Although research is still being done, some evidence suggests that this non-invasive procedure has short- to medium-term benefits when performed by an experienced clinician. However, the effects on pregnancy and those wishing to have a baby in the future are not fully known, so this should be taken into consideration.

Read the NICE guidance on MRI-guided transcutaneous focused ultrasound.