Should Uterine Fibroids be Removed?

Uterine fibroids are benign (noncancerous) growths in the uterus

Fibroids range in size from small seedlings that are undetectable by the human eye to bulky masses that can enlarge and distort the anatomy of the uterus. Fibroids may need surgery if:

• They are big enough to distort the uterine function.
• They cause heavy periods.
• They interfere with pregnancy.

In extreme cases, multiple large fibroids can enlarge the uterus to an extent that it reaches the rib cage and may even add to the body weight.

Pregnancy and fibroids:

Some types of fibroids can cause infertility or loss of pregnancy. Fibroids may increase the risk of certain complications during pregnancy, such as restricted fetal growth/low birth weight or premature birth.

The following require medical attention:

• Pelvic pain that doesn't go away
• Overly heavy, prolonged, or painful periods with blood clots
• Spotting or bleeding between periods
• Difficulty emptying your bladder
• Anemia (decreased red blood cells) due to blood loss during periods. Anemia presents with fatigue, pale skin and eyes, shortness of breath, etc.

Many women may not have any symptoms. In women who have symptoms, the most common signs and symptoms of uterine fibroids include:

• Heavy menstrual bleeding
• Menstrual periods lasting more than a week
• Pelvic pressure or pain
• Difficulty urinating
• Constipation
• Back pain

The treatment options are as follows:

Observation and follow-up: Many women with uterine fibroids may not have signs or have mild symptoms that can be managed conservatively to provide symptomatic relief.

Medications: These include medications that target hormones that regulate the menstrual cycle and treat symptoms such as heavy menstrual bleeding or pain. Medications don't eliminate fibroids but may help shrink them:

• Gonadotropin-releasing hormone (GnRH) agonists: They block the production of estrogen and progesterone. This causes menstruation to stop, putting the patient in a temporary menopausal state. As a result, fibroids shrink, and anemia often improves.
• Progestin-releasing intrauterine device (IUD): A progestin-releasing IUD can relieve symptoms such as heavy bleeding caused by fibroids. It provides an additional benefit of contraception but doesn't shrink fibroids or make them disappear.
• Lysteda and Cyklokapron (Tranexamic acid): These non-hormonal medications are taken to reduce bleeding during periods.
• Oral contraceptives: These can help control menstrual bleeding but don't shrink the fibroid size.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): These can be effective in relieving pain related to fibroids, but they don't reduce menstrual bleeding or shrink fibroids.
• Nutritional supplements: Vitamins and iron supplements may be advised to correct anemia and improve overall health.

Noninvasive procedures:

• Focused ultrasound surgery (FUS): It is a non-invasive treatment option for uterine fibroids that preserves your uterus, requires no incision, and is done on an outpatient basis. It is performed while the person is inside a magnetic resonance imaging (MRI) scanner. The setup is equipped with a high-energy ultrasound transducer for treatment. The images give the doctor the precise location of the uterine fibroids. When the location of the fibroid is targeted, the ultrasound transducer focuses on sound waves (sonication) into the fibroid that heats up and destroys small areas of fibroid tissue. This is a newer technology, so researchers are learning more about long-term safety and effectiveness. But so far, data collected show that FUS for uterine fibroids is safe and effective.

Minimally invasive procedures:

• Uterine artery embolization: Embolic agents (small particles) are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to regress.
• Radiofrequency ablation: Radiofrequency energy is used to destroy uterine fibroids, and it shrinks the blood vessels that feed them. 
• Laparoscopic or robotic myomectomy: During myomectomy surgery, the fibroids are removed, leaving the uterus intact.
• Hysteroscopic myomectomy: In this procedure, the surgeon inserts instruments through the vagina and cervix into the uterus to remove the fibroids.
• Endometrial ablation: A specialized instrument is inserted into the uterus. Heat, microwave energy, hot water, or electric current is used to destroy the lining of the uterus, resulting in the ending of menstruation or reducing menstrual flow.

Traditional surgical procedures:

• Abdominal myomectomy: In the case of multiple fibroids or very large or deep fibroids, the surgeon may use an open abdominal surgical technique to remove the fibroids.
• Hysterectomy: This involves the removal of the uterus. It is a permanent solution for uterine fibroids.