Medical Treatment for Uterine Fibroids

How are fibroids treated?

There isn’t one way of treating fibroids. The options can vary from simple ones like supportive treatment to radical treatment such as hysterectomy. There are many important factors to consider such as age, size and location of fibroids, fertility aspirations and more importantly your symptoms and your wishes.

How big do the fibroids have to be before they need to be removed?

There is no hard and fast rule about size. Surgery is deferred unless an individual fibroid is larger than 6cm in size or the uterus is larger than 12 weeks of pregnancy. Even smaller fibroids can cause severe symptoms particularly if they are submucous and may need removal.

What are the treatment options?

Surgery is not the only way to treat fibroids. All the options are described below:

Conservative Options:

Hormones: The simplest form of treatment is to start the Oral Contraceptive Pill to regulate the oral contraceptive pill. If there is breakthrough bleeding, progesterone tablets could be used to stabilise the endometrium. GnRH analogues can be used to stop periods and also to shrink the fibroids before surgery.

Mirena Intrauterine System (IUS) is a hormonal IUD which secretes a small amount (20 microgm) of progesterone hormone per day within the uterus. This works very well in small to medium sized fibroid uterus where the cavity is not affected by fibroids. Effect of Mirena lasts for 4 to 5 years. It is also a very effective method of contraception.

Endometrial Ablation may be used similarly to treat uterine lining which is then replaced by scar tissue. This works better if the uterine cavity is normal with no submucous fibroids.

Tranexamic Acid tablets can be used for reducing the amount of bleeding. It will typically cut down the blood loss by about 50%. Haematinics and iron supplements can be used to correct anaemia.

Uterine Artery Embolisation: This is a procedure where blood supply to the fibroids is blocked using silicon pellets. It is performed under short general anaesthesia or sedation. It is about 80% effective in reducing mass related symptoms and 90% effective in improving bleeding related symptoms. The main risks are pain for the first few days, risk of infection, vaginal discharge and recurrence of symptoms. Very large fibroids enlarged above the level umbilicus are not suitable for this procedure. There is also a very small risk of ovarian blood supply being affected and premature menopause. Hence this procedure is usually performed for women in their forties when fertility is no longer desired.

MRI guided Focussed Ultrasound: This is a relatively new procedure which is approved by National Institute of Clinical Excellence (NICE) but only in research settings. This procedure is ideally performed for a single fibroid up to 10cm in size. It reduces the fibroid volume by about 20%. St Mary’s Hospital in Paddington has a research and referral centre for this procedure.

Surgical Options:

Hysteroscopic (Transcervical) Resection of Fibroid (TCRF): This procedure is ideally suited for submucous fibroids where the fibroids have grown within the uterine cavity. It is performed as a day case procedure under general anaesthesia. A hysteroscope (camera) is inserted through the neck of the womb (cervix) and fibroids are resected under direct vision using an electrical wire loop.

Myomectomy: Myomectomy is an operation performed to surgically remove the fibroids. This can be performed either laparoscoically (key-hole surgery) or as an open abdominal procedure.

Hysterectomy is reserved for very large fibroids or where fertility is no longer desired. Hysterectomy can also be performed as a key-hole procedure in many cases.

Many of these options are described in detail in other parts of this website.

What about tablets for treatment of fibroids?

A new medication called Ullipristal Acetate (Esmya) is effective in reducing the size of fibroids. This is a new drug and evidence is limited but encouraging. It is licensed only for reducing the size and blood supply of fibroids before surgery. It is a 5mg tablet to be taken once a day for three months.

Can fibroids recur after removal?

There is always a chance of recurrence after surgical removal of fibroids. A myomectomy operation typically should give you a five year window before the fibroids return. Timing of surgery is therefore of critical importance.

Can you recommend one treatment option over all the others?

One treatment may not suit all women with fibroids. Consultation with an experienced Gynaecologist will allow you to assess various factors and come to a decision regarding the optimal option for you.