Fibroids are benign growths of different sizes, which form in or around the womb. They are usually harmless and in time will typically shrink and disappear on their own. This is particularly so after the menopause.
As such, treatment is only necessary if your fibroids are causing noticeable symptoms or discomfort on a daily basis. If you believe that your fibroids need medical intervention then there is a range of options to choose from.
Each type of fibroid should also be treated differently and the choice of treatment depends on the severity of your symptoms, among other factors.
Medications to shrink Fibroids
1). Medications don’t eliminate fibroids but they do shrink them or slow down their growth velocity. They work by affecting the hormones that regulate the menstrual cycle. They help to reduce heavy periods, however, they can be less effective for larger fibroids.
2). Levonorgestrel intrauterine system (LNG-IUS) is a small plastic t-shaped device that’s carefully placed inside the womb. It slowly releases the progestogen hormone levonorgestrel to stop the uterus lining growing too quickly. In fact, it helps it to become thinner and bleeding becomes noticeably lighter
3). Gonadotropin-releasing hormone (Gn-RH) agonists block the production of estrogen and progesterone to create an artificial and temporary menopausal state. This effectively stops periods so fibroids can shrink. Sometimes we may prescribe a Gn-RH agonist to reduce the size of a woman’s fibroids before elective surgery. It’s only prescribed on a short-term basis, usually between 3 to 6 months.
There are a range of side effects to bear in mind with this category of treatment. You may experience menopausal symptoms like:
- hot flushes
- increased sweating
- muscle stiffness
- vaginal dryness
To mitigate against these side effects gynaecologists may prescribe a combination of GnRH as and a low dose of hormone replacement therapy (HRT). Fibroids may also start growing again and the symptoms gradually return after the medication is stopped.
4). Ulipristal acetate (Esamya) is a new approach to treat fibroids that cause moderate to severe symptoms. Women only over 18 years of age are given 1 tablet a day for up to 3 months. Fibroid symptoms lesson, bleeding stop and fibroids shrink.
After the initial course of treatment, you will be advised to see that your first two periods. If they’re heavy then another three month course of ulipristal acetate may be given. Long-term use of symptomatic uterine fibroids is usually well-tolerated and typically given when surgery is not a preferred treatment.
5). Contraception. The contraceptive pill is another popular option. As well as making bleeding lighter they can help to reduce menstrual pain.
Meanwhile, the intra-uterine system (Mirena coil) can be implanted inside the womb. 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.
Surgical options to remove Fibroids
Fibroids can be removed by surgery. This method is usually opted for when a woman is suffering from severe symptoms and medication has been ineffective.
The main surgical procedures used to treat fibroids include:
1). Hysteroscopic myomectomy. This procedure is used 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 internal scars.
2). Laparoscopic myomectomy: This procedure involves removal of the fibroids while leaving the uterus in place. Through 3 or 4 very small scars the instruments are inserted into 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.
3). Hysteroscopic resection. This is a procedure where hysteroscope (a thin telescope) and small surgical instruments are used to remove submucosal fibroids from inside the womb. No incisions are needed because the hysteroscope is inserted through the vagina and into the womb. The procedure is often carried out under general anaesthetic and patients can usually go home on the same day. After the procedure, patients often report having stomach cramps but they don’t last for long. Normally only a couple of hours. There may also be a small amount of vaginal bleeding but this usually stops after a couple of weeks. This surgery is suitable for women who want to have children in the future.
4). Hysteroscopic morcellation. Our experienced gynaecologists can also remove fibroids by, again, carefully placing a hysteroscope inside the womb and using a morcellator to cut away and remove the fibroid tissue. The procedure can be carried out under general or spinal anaesthetic. In comparison with the hysteroscopic resection procedure, this option only requires one insertion. This ultimately reduces the risk of injuring the womb and recovering time is far quicker. Patients can also go home the same day.
Minimally invasive surgery to remove Fibroids
Whilst we can offer surgical procedures, keyhole surgery is preferable. These include:
1). 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 day care procedure. The fibroids shrink but do not disappear.
2). Magnetic Resonance Imaging (MRI) treatment preserves the uterus and is done as an outpatient procedure. The MRI scanner is equipped with a high-energy ultrasound transducer. It omits ultrasound waves through a series of small needles which heat and destroy the fibroids. We offer 2 techniques:
- MRI-guided percutaneous laser ablation
- MRI-guided transcutaneous focused ultrasound
This method is not frequently used on patients as it has strict inclusion criteria and the long term consequences are still not widely understood.
3). Endometrial ablation. This is a minor procedure that involves removing the lining of the womb. This can be done using:
- Laser energy
- Heated wire loop
- Hot fluid inside a medical balloon
This option is often used to treat women who have small fibroids. It can be carried out under local or general anaesthetic and usually takes less than 30 minutes to perform.
Patients can usually go home on the same day. They may experience some vaginal bleeding and tummy cramps for a few days but, on some occasions, women can experience bloody discharge for up to a month. In this eventuality, we would advise a follow-up appointment with your doctor or gynaecologist so that they can prescribe stronger painkillers.
While it’s still possible to get pregnant after having endometrial ablation the procedure isn’t recommended for women who are planning to have children. This is because there is an increased risk of serious complications during pregnancy, including miscarriage.