What are the treatment options for fibroids?

It is important to emphasise that fibroids are very common; the mere identification of a fibroid, for instance on ultrasound scan, does not necessitate treatment unless there are symptoms that can be ascribed to fibroids. Treatment options depend on the main symptoms involved and very importantly, on the patient’s fertility plans. Treatment may include either medication (hormonal treatments) or surgery.

For patients with fibroids, hormonal treatments may be helpful and can be considered on an individual basis. Esmya (Ulipristal acetate) is a recently developed treatment that blocks the effect of progesterone to cause fibroid shrinkage. Recently, however, concerns have been raised regarding serious liver injury in a very small fraction of women using Esmya.

Surgery to remove fibroids (known as myomectomy) is a well-established form of treatment. The most problematic fibroids are the submucous variety and these can be removed using a form of minimal access surgery called hysteroscopy. Because hysteroscopy only requires operation through the neck of the womb, and does not involve cuts in the abdominal wall, hysteroscopic fibroid surgery can be performed as a day-case procedure and recovery is fast. Hysteroscopic surgery is therefore very appealing, especially for fertility-related issues such as miscarriage and in preparation for IVF.

For fibroids that cannot be reached via the womb cavity (such as intramural fibroids), surgery cannot be performed using hysteroscopy and instead requires an abdominal approach. This can be performed either via key-hole surgery (laparoscopy) or with more conventional larger incisions in the tummy known as laparotomy.

Alternative treatment options include radiologic (X-Ray) approaches such as uterine artery embolization (UAE). This treatment is performed by radiologists and involves the injection of very tiny particles into the blood stream to block the tiny blood vessels that supply the womb and fibroids. This deprives fibroids of their blood supply causing them to shrink or die. UAE is an effective treatment especially for women whose fibroids are not easily treated by surgery or for whom surgery is not safe or desired. However, it is very important to be aware that Prof Homer’s research found that UAE is not advisable for women wishing to have pregnancies in the future since it increases the risk of miscarriage.