Uterine fibroids: When to treat them and how to choose the right option

Choosing the right treatment option for uterine fibroids can depend on various factors. Find out more about when to treat them, and how to know what’s the best management strategy for you, here.

What are uterine fibroids?

Uterine fibroids are non-cancerous growths, and grow in the uterus. They vary in size and number, often occurring during a woman’s childbearing years. While many fibroids cause no symptoms and some go undetected, others can lead to heavy periods, pressure symptoms if they impinge surrounding structures, and rarely pain if they undergo degeneration. The symptoms fibroids cause depends upon the position with respect to the cavity of the womb and their size. 

When should fibroids be treated?

Treatment is typically considered when fibroids cause:

• Heavy or prolonged periods: Fibroids can lead to excessive menstrual bleeding, which may result in anaemia or fatigue.
• Pelvic pain or pressure: Large fibroids can press on surrounding organs, leading to discomfort, frequent urination or constipation.
• Early Pregnancy problems: In some cases, fibroids can interfere with conception or increase the risk of miscarriage.
• Rapid growth: A sudden increase in fibroid size may require closer monitoring or intervention to exclude malignant change (rare)
• Complications during pregnancy: Some fibroids can complicate pregnancy by causing miscarriage or preterm labour, they can also increase the risk of a abnormal presentation of the baby and increase the chances of an assisted delivery and increase the risks of Caesarean section.

Choosing the right treatment option
 

The treatment options for Fibroids will depend upon the size, location and the symptoms caused by the fibroids. Your gynaecologist will work with you to determine the best approach based on your specific condition and health goals. Common options include:

• Watchful waiting: If fibroids are small and not causing significant symptoms, regular monitoring may be all that's needed.
• Medications: Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) agonists, can temporarily shrink fibroids and manage symptoms like heavy bleeding by inducing a temporary menopause that need to be given with replacement hormones. Non-hormonal options like tranexamic acid can also help reduce bleeding during periods. Newer treatments such as Ryeqo, a GnRH antagonist combined with Oestrogen and Norethisterone, are also effective. The Mirena coil is very useful to prevent the heavy bleeding associated with fibroids.
• Minimally invasive procedures: Techniques like uterine artery embolization (UAE), which blocks blood flow to the fibroid, or radiofrequency ablation, which shrinks the fibroid, offer less invasive alternatives to surgery.
• Myomectomy: For women who wish to preserve fertility, myomectomy is a surgical procedure that removes fibroids while leaving the uterus intact. This can be performed through traditional open surgery or minimally invasive methods. When the fibroids encroach on the cavity these can be removed hysteroscopically using MyoSure technique of Trans-cervical resection under direct vision.  This is a minimum invasive day case procedure.
• Endometrial ablation using NovaSure is effective at treating fibroids up to three centimetres situated near the cavity of the womb; this technique delivers an individually calculated electrical cautery. This is a minimally invasive hysteroscopic day-case procedure.
• Hysterectomy: In cases where other treatments have failed, and a woman no longer wishes to preserve her uterus, a hysterectomy (removal of the uterus) can provide a permanent solution.

How to choose the right option
 

The right treatment depends on factors such as:

• Symptom severity
• Fibroid size and location
• Desire for future fertility
• Overall health and age

Working with your healthcare provider to discuss the risks and benefits of each option ensures that you choose the most suitable treatment based on your individual needs and long-term health goals.