• Depends on the severity of the symptoms
• Different treatments apply to each fibroid type
• Fibroids will shrink and maybe eventually disappear after the menopause
• Medical and surgical treatments are available
• Treatment should be individualised according to each woman’s symptoms and concerns
• Minimally invasive surgery (keyhole surgery) is preferable
Medications don’t eliminate fibroids, but may shrink them or slow down their growth velocity.
They affect the hormones that regulate your menstrual cycle. ate fibroids, but may shrink them.
Gonadotropin-releasing hormone (Gn-RH) agonists: They block the production of estrogen and progesterone, and create an artificial and temporary menopausal state. This way your periods stop and the fibroids shrink. Sometimes we may prescribe a Gn-RH agonist to shrink fibroids before elective surgery. This category of drugs can cause menopausal symptoms like hot flushes during the duration of treatment that is generally between 3 and 6 months. The fibroids start growing again and the symptoms gradually return after the medication is stopped.
Intra-uterine system (Mirena coil): This progesterone releasing coil can reduce heavy bleeding caused by fibroids. It can improve the symptoms but doesn’t affect the size of the fibroids.
Ulipristal acetate ( Esmya): It is a progesterone receptor modulator and can shrink the fibroids and offer relieve from the symptoms. Three month courses of this drug can be repeated and is usually well tolerated. It is indicated for the long term treatment of symptomatic uterine fibroids when surgery is not your preferred treatment.
Non invasive treatments
MRI-guided ultrasound focused treatment for preserves the uterus and is done as an outpatient procedure. You’re inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment. The ultrasound waves target the fibroid in order to heat and destroy it. This method applies to few patients with fibroids as it has strict inclusive criteria.
Minimally invasive Treatments
Uterine artery embolization: Small particles are directed into the arteries supplying the uterus with blood and cut off the blood supply to the fibroids. As a result the fibroids shrink and die. It is a very effective technique and requires an MRI beforehand in order to decide whether the fibroids are suitable for embolisation. It is performed by an interventional radiologist and is a daycare procedure. The fibroids shrink but do not disappear.
Laparoscopic myomectomy: This procedure involves removal of the fibroids with leaving the uterus in place. Through 3 or 4 very small scars the instruments are inserted in your abdomen and remove the fibroids from your uterus. We view the abdominal area on a monitor through a small camera attached to one of the instruments. It is the preferred treatment for intramural and subserosal fibroids as it allows quick recovery, shorter hospital stay, less pain after the operation and quick return to your regular daily activities.
Hysteroscopic myomectomy: This procedure is indicated when the fibroids are projecting inside the uterus (submucosal). The cavity of the womb is assessed via instruments inserted through your vagina and cervix and they also allow the removal of the fibroids. It is a day case procedure and it does not involve any scars in your abdomen.