Uterine fibroids are noncancerous growths that develop in or around the uterus. They’re extremely common, especially during the reproductive years, and many people never experience symptoms or need treatment.
When fibroids do cause problems, however, several effective treatment options are available. The best approach depends on your symptoms, the size and location of the fibroids, your age, your overall health, and whether you hope to become pregnant in the future.
Not everyone with uterine fibroids needs treatment. If fibroids are causing heavy bleeding, pelvic pain, pressure, infertility, or other significant symptoms, treatment may include medication, minimally invasive procedures, myomectomy, or hysterectomy depending on your individual goals and medical history.
What are uterine fibroids?
Fibroids are growths made of muscle and connective tissue that develop in or around the uterus.
Although hearing the word “tumor” can sound alarming, fibroids are almost always benign, meaning they are not cancer.
According to the Office on Women’s Health, fibroids become more common with age until menopause, and many people never know they have them because they cause no symptoms.
Does every fibroid need treatment?
No.
Many fibroids are discovered during routine pelvic exams or imaging performed for another reason.
If fibroids are small and not causing symptoms, your healthcare provider may simply recommend monitoring them during routine visits.
Treatment is usually considered when fibroids begin affecting your quality of life or overall health.
When should uterine fibroids be treated?
Your healthcare provider may recommend treatment if fibroids are causing:
- Heavy or prolonged menstrual bleeding
- Pelvic pressure or pain
- Frequent urination
- Constipation caused by pressure on nearby organs
- Pain during sex
- Difficulty becoming pregnant
- Recurrent pregnancy loss related to fibroids
- Iron-deficiency anemia from heavy bleeding
If symptoms are mild, your provider may recommend watchful waiting before considering more invasive treatment.
How are uterine fibroids diagnosed?
If your symptoms suggest fibroids, your healthcare provider will usually begin with a pelvic examination.
Additional testing may include:
- Pelvic ultrasound
- MRI
- Saline infusion sonography
- Hysteroscopy in selected situations
Imaging helps determine the number, size, and location of fibroids, all of which influence treatment recommendations.
What are the treatment options for uterine fibroids?
Treatment depends on your symptoms and reproductive goals.
Medications
Medication can often help manage symptoms without removing the fibroids themselves.
Options may include:
- Hormonal birth control
- Hormonal IUDs
- Tranexamic acid for heavy menstrual bleeding
- Gonadotropin-releasing hormone (GnRH) agonists
- GnRH antagonists
- Other hormone-regulating medications
These treatments may reduce heavy bleeding, improve anemia, and temporarily shrink fibroids in some people.
The American College of Obstetricians and Gynecologists (ACOG) notes that medications may improve symptoms but generally do not permanently eliminate fibroids.
MRI-guided focused ultrasound
MRI-guided focused ultrasound uses concentrated ultrasound energy to destroy fibroid tissue without making surgical incisions.
It may be appropriate for selected patients depending on the size and location of their fibroids.
Recovery is generally faster than with traditional surgery, but not everyone is a candidate.
Uterine artery embolization
Uterine artery embolization (UAE), sometimes called uterine fibroid embolization, reduces blood flow to fibroids, causing them to shrink over time.
This minimally invasive procedure is performed by an interventional radiologist rather than a gynecologic surgeon.
While many people experience symptom improvement, UAE may not be the best option for everyone who hopes to become pregnant in the future.
Discuss your fertility goals with your healthcare provider before choosing this treatment.
Myomectomy
A myomectomy removes fibroids while preserving the uterus.
This option is often recommended for people who want to maintain the possibility of future pregnancy.
Depending on the number, size, and location of the fibroids, myomectomy may be performed through:
- Hysteroscopy
- Laparoscopic or robotic surgery
- Traditional abdominal surgery
Although fibroids can return after myomectomy, the uterus remains intact.
Hysterectomy
A hysterectomy removes the uterus completely.
It is the only treatment that permanently eliminates fibroids and prevents them from returning.
Because pregnancy is no longer possible after hysterectomy, this option is generally reserved for people who have completed childbearing or whose symptoms have not improved with other treatments.
How do doctors decide which treatment is best?
There is no single “best” treatment for everyone.
Your healthcare provider will consider factors such as:
- Severity of symptoms
- Fibroid size
- Number of fibroids
- Fibroid location
- Age
- Overall health
- Fertility goals
- Personal preferences
A treatment that is ideal for one person may not be appropriate for another.
Shared decision-making helps ensure your treatment aligns with your priorities.
Can fibroids come back after treatment?
It depends on the treatment.
Fibroids may return after medications or myomectomy because the uterus remains.
After hysterectomy, fibroids cannot return because the uterus has been removed.
Your healthcare provider can discuss the likelihood of recurrence based on your individual treatment plan.
When should you see a doctor?
Schedule an appointment if you experience:
- Very heavy menstrual bleeding
- Periods lasting longer than usual
- Pelvic pain or pressure
- Frequent urination without another explanation
- Difficulty becoming pregnant
- New or worsening pelvic symptoms
Seek immediate medical care if you experience severe bleeding, sudden intense pelvic pain, or symptoms of significant blood loss such as dizziness or fainting.
The bottom line
Uterine fibroids are very common, and many never require treatment.
When symptoms become disruptive, however, several effective options are available, ranging from medication to minimally invasive procedures and surgery.
The right treatment depends on your symptoms, overall health, and future pregnancy plans. Working with an OB-GYN can help you understand the benefits and tradeoffs of each option so you can choose the approach that best fits your needs. Find the right provider for you today with Zocdoc.
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Frequently asked questions
What is the best treatment for uterine fibroids?
There is no single best treatment. The right option depends on your symptoms, the size and location of the fibroids, your overall health, and whether you want to become pregnant in the future.
Can uterine fibroids be treated without surgery?
Yes. Many people manage fibroid symptoms with medication or minimally invasive procedures such as uterine artery embolization or MRI-guided focused ultrasound.
Do all fibroids need to be removed?
No. Fibroids that do not cause symptoms often do not require treatment and may simply be monitored during routine healthcare visits.
Can fibroids come back after treatment?
Fibroids can recur after medication or myomectomy because the uterus remains. They do not return after hysterectomy.
Which doctor treats uterine fibroids?
An obstetrician-gynecologist (OB-GYN) usually diagnoses and manages uterine fibroids. Depending on your treatment plan, you may also work with an interventional radiologist or a gynecologic surgeon.
The information in this article is provided for general informational purposes only and should not be relied on as medical advice. It is not intended as, and Zocdoc does not provide, medical advice, diagnosis or treatment. Zocdoc does not recommend any specific provider. Find one you’ll love on Zocdoc today.