I have fibroids – what are my options?

I created this site to focus on hysterectomy, but as I had fibroids I’m very aware they are the most common reason for women to have a hysterectomy and it’s likely there are a lot of you reading this and dealing with fibroids. It’s also true that a hysterectomy is not the right choice for every woman but that there are doctors out there who will try to push it as a treatment options. There are various other treatment options out there and one of the hardest things is deciding which one to choose because, unless there is an emergency, it’s your choice.
(This site isn’t about persuading you to have a hysterectomy, it’s about getting you informed about your options and what will happen so you can choose 🙂 )

 

So, you’ve been diagnosed with fibroids and your doctor has suggested a hysterectomy. But maybe that’s not what you want – perhaps you still want to have children. Or maybe you just don’t really know what options are available, or what the differences are between them. Here are the other options; which are available to you will depend on your particular situation so if one interests you discuss it with your GYN.

 

Myomectomy

The most common alternate surgical option for fibroids. A myomectomy just removes the fibroids and leaves the uterus. There are a lot of variations with this surgery. ike a hysterectomy it can be done as open surgery or as laparoscopic. It can be fairly quick, if you only have one fibroid, or it can be a long surgery, if you have many. Depending on the location of your fibroids in your uterus it can be fairly easy, or very involved. It is often a longer surgery than a hysterectomy, and there can be more chance of needing a blood transfusion as there is more incision work being done. One factor worth taking into account if you are thinking of going for a myomectomy is that the more fibroids you have the more chance more will grow after surgery. So if you only have one fibroid the odds are good no more will grow (different studies show different results but as low as 11% recurrence with only one fibroid to as high as 55% recurrence after 5 years.)
It’s also worth noting that, depending on the location of the fibroids being removed, if you become pregnant you may have to have a c-section birth (the uterus may not be strong enough for a natural birth).

 

UFE

Uterine Fibroid Embolization is a relatively new treatment for fibroids which is carried out by a radiologist rather than a surgeon. It is minimally invasive; there are no large incisions and no internal incisions at all. It works by injecting tiny PVA (polyvinyl alcohol) particles into the bloodstream via a catheter and directing these particles to the uterine arteries which provide blood flow to the fibroids. The particles build up and block the blood flow and the fibroid dies.
It can be a painful procedure for the 6-12hrs after the treatment, but generally recovery is fairly fast and doesn’t require a hospital stay.
There is some disagreement over whether this procedure is one that women should have if they hope to become pregnant in the future. Because it is still fairly new there is not a lot of long-term study of the effects of the treatment on the uterus as a whole; as a result some doctors do not recommend UFE if you want to get pregnant (the issue being that the partices may block blood flow to the uterus itself).
Results can take several months to appear, as the fibroid slowly dies off, and it may break down and be passed out of the body. UFE isn’t recommended for all types of fibroids, and it is possible for more fibroids to grow after treatment.

 

Ultrasound – MRgFUS

A new treatment; not available in many places and is still considered a trial treatment in some countries. This means you may be able to get on a clinical trial, or it may also mean that your insurance won’t cover it (if you have an insurance system).
The full name for this treatment is MGFuS – Magnetic Resonance Guided Focused Ultrasound. It is a completely non-invasive treatment which uses focused ultrasound waves to essentially burn away the fibroids. It’s carried out inside an MRI machine as the technology is similar. Women have become pregnant after this treatment but, like UFE, there are no long-term studies on pregnancy after treatment because the treatment is so new.
Another advantage of this procedure is the fast recovery time. For more information:
https://www.mayoclinic.org/tests-procedures/focused-ultrasound-surgery/about/pac-20384707

 

Acessa

Another fairly new treatment, also not available in many places, which is similar to the ultrasound treatment above. It uses radiofrequency ablation to destroy the fibroids. Currently there is not a lot of information about this treatment available online other than the information provided by the creator and provider of the treatment (I try to avoid that type of source to find unbiased info if I can!)
Treatment involves small incisions to allow a thin instrument to be injected into the fibroid and treat it directly.

 

Medication

Currently there are 2 medications prescribed to try to shrink fibroids. Neither offer a permanent solution; usually they are prescribed to try to shrink fibroids before surgery. This may change in the future though.
Lupron
Lupron (leuprolide acetate) is an “antineoplastic agent” drug, which puts it in the same family as chemotherapy drugs. It works by blocking the production of estrogen, which can help shrink fibroids (it can also be used to treat symptoms of endometriosis). It’s a temporary treatment, not a permanent solution, and is usually given to try to shrink fibroid size before surgery.
The downside of this drug is the side-effects; it can mimic the menopause causing hot flashes etc. but in some women it can cause worse side effects and if you’re considering taking it I would recommend reading about these and deciding yourself whether it’s worth the risk.
Fibristal/Esyma
Fibristal (Ulipristal Acetate) is a new drug. It has been used in Europe and Canada for a few years and was recently cleared for use in the USA. Like Lupron it is also given to try to shrink fibroids, but it has far fewer side effects and is supposed to work well both to shrink fibroids and reduce bleeding (I have not personally tried it). Currently it is a temporary solution, like Lupron it is often given to shrink fibroids before surgery, but this may change over time (originally only a 3 month course of fibristal was recommended, now it is allowed for longer-term use).
Birth control
I’m including this here not because it’s a treatment for fibroids but because some doctors seem to suggest it as if it is. Birth control can hep with fibroid symptoms, in particular heavy bleeding, but it will not shrink fibroids in any way. In fact some birth control can cause fibroids to grow. Be wary of the mirena IUD if you have fibroids; it is designed to sit inside a normal uterus, not one containing fibroids. If the shape of the uterus is distorted it can lead to problems including expelling the device, or having the device embed itself in the wall of your uterus – in some cases this can require surgery to remove.

 

Watch and wait

If you are having symptoms from your fibroids I wouldn’t recommend this option. Often all it does is give the fibroid/s more time to grow and cause more problems. However if you’re not having any symptoms then there is no reason to rush for treatment.

 

Ablation (Novasure)

Endometrial ablation is not a treatment for fibroids but rather a treatment for heavy bleeding. It can help with symptoms but it will not remove fibroids. The treatment destroys a thin layer of lining of the uterus and for many women stops monthly bleeding entirely. For others it makes bleeding levels normal of light. It’s not possible to become pregnant after ablation and women are recommended to use birth control until menopause to avoid pregnancy (bear in mind that birth control may make fibroids grow so honestly I wouldn’t recommend an ablation as a fibroid treatment option).

 

Natural treatments

I was wary of even putting this on the list, but I suspect some of you will have already read articles about natural treatments. I’m not going to talk a lot about this here because there is no recommended natural treatment for fibroids. There is no scientific data to say a natural route will work, and many of the products being sold are just the equivalent of snake oil (ie. a scam). If your fibroids are not causing any symptoms then there is nothing wrong with trying to improve your diet and reduce stress; those are things we should all try to do! But just don’t expect these things to make your fibroids shrink and go away.

 

I had most of the above available to me and I chose to have a hysterectomy. The main reason behind this decision was I did not want more fibroids growing. I didn’t want children which made the decision simpler (so the ‘birth control’ aspect of a hysterectomy was quite appealing!) but for me personally I knew I couldn’t go through a recurrence of all the symptoms and another surgery. I just wanted them gone, never to come back. This was my reasoning, it may not be yours, and above all else I would say to make sure whatever you choose it’s right for you, and you understand the options.

One way to think things through is to make a pros and cons list; I have a handy template you can download to do this! If you’re weighing up several options print several copies and do one for each.
Download here