Most uterine fibroids do not require treatment, especially if no symptoms are present. In such cases, a physician, typically a gynecologist, will perform periodic pelvic examinations and imaging tests (e.g., ultrasound) to determine if the fibroids are changing in size and monitor the development of symptoms. This is known as “watchful waiting” and patients may need to consult the gynecologist every six months to a year or as determined by their physician.

When symptoms are present, treatment will depend on several factors including the severity of the symptoms, the age of the patient and whether she plans to become pregnant in the future.

Nonsteroidal anti-inflammatory drugs (NSAIDs) may provide some relief of menstrual symptoms (e.g., pain, cramps) exacerbated by the fibroids. A physician also may recommend iron supplementation to prevent or treat anemia due to heavy menstrual blood loss.

Sometimes, a physician may prescribe hormonal medications to treat the abnormal uterine bleeding and pelvic pain. Certain hormone medications can temporarily shrink the fibroids. However, after treatment is stopped the fibroids typically will continue to grow. Hormonal therapy used in the treatment of fibroids can include:

• Birth control pills. Oral contraceptives can help reduce heavy periods and alleviate symptoms. However, they do not affect the size of the fibroids.
  
  
• Gonadotrophin-releasing hormone (GnRH) agonists. This medication reduces the production of the female hormones estrogen and progesterone by the ovaries, thereby causing the fibroids to shrink in size. GnRH agonists are typically used as an adjunct to surgery for removal of large fibroids. Making the fibroids smaller before their removal may lessen blood loss during surgery. However, GnRH agonists sometimes may make surgical removal more difficult because the fibroids can be harder to locate after treatment due to shrinkage.
  
  In some cases, a physician may prescribe this type of treatment for women who are very near menopause. However, GnRH agonists are not typically recommended for longer than 6 months because they can result in a loss of bone density and increase the risk of osteoporosis. In addition, after use of GnRH agonists is discontinued, fibroids rapidly enlarge. Because GnRH agonists induce a chemical menopause, patients often stop having their periods and can experience side effects such as hot flashes and vaginal dryness during treatment. These medications are usually administered by needle injection into a large muscle.
  
  
• Androgens. Medications containing the hormone testosterone (e.g., danazol) also can help reduce the size of fibroids and control associated symptoms. However, because these drugs sometimes have unpleasant side effects including weight gain, acne, unwanted hair growth (hirsutism), deepening of the voice and depression they are not a popular treatment option for many women.

In cases where the fibroids are large, numerous and causing severe symptoms or compromising the health of the uterus and other pelvic organs, surgical removal is often necessary. Surgery also may be recommended in cases in which the fibroids are interfering with a woman’s ability to become pregnant. Surgical treatment of uterine fibroids includes:

• Myomectomy. Surgical removal of the fibroids from the uterine wall. It is recommended for women who desire to retain the uterus or become pregnant. However, like all surgeries, myomectomy may carry risks, such as pelvic adhesions, trauma to internal organs, infection and, rarely, rupturing of the uterus. The type of myomectomy performed depends on the size, number and location of the fibroids:
  
  
• Abdominal myomectomy. In this procedure, the physician makes an incision in the abdomen to expose the uterus and excise the fibroids from the uterine wall muscle. This surgery can be performed to remove multiple fibroids.
  
  
• Hysteroscopic myomectomy. A tube with a light at the end (hysteroscope) is inserted into the vagina, through the cervix and into the uterus during this procedure. The surgeon can observe the fibroids through the hysteroscope and remove them. This surgery is only performed on fibroids that are located inside the uterus.
  
  
• Laparoscopic myomectomy. In this surgery, fibroids are removed through a small lighted viewing tube (laparoscope) inserted through a small incision in the abdomen. The laparoscope allows the surgeon to locate the fibroids and remove them. This procedure is often performed on women with one or two small fibroids located on the outer surface of the uterus.
  
  
• Uterine artery embolization (UAE). Also called uterine fibroid embolization (UFE), this is a newer technique that has demonstrated a significant reduction of symptoms with few serious complications. During embolization, a physician inserts a small, thin tube (catheter) into a large blood vessel in the groin and threads it up to blood vessels near a fibroid. Tiny particles made of plastic or gelatin are then injected into the blood vessels that feed the fibroid. These particles clog the blood vessels and significantly reduce the blood supply to the fibroid, causing it to shrink and degenerate (die off) within a few days to two weeks. Although pregnancy and normal deliveries have been reported in some patients who have undergone embolization, pregnancy is not recommended afterward and the procedure may affect ovarian function and lead to infertility.
  
  
• Endometrial ablation. This procedure uses heat to destroy the entire lining of the uterus (endometrium). Endometrial ablation will either end the menstrual period or significantly reduce its flow. During the procedure, the surgeon can remove or shave down fibroids that protrude into the uterine cavity (submucosal). However, this technique does not work on large fibroids or those that are located outside the interior lining of the uterus. Ablation also is not recommended for women who want to have children.
  
  
• Hysterectomy. Complete surgical removal of the uterus. A surgeon can remove the uterus through an abdominal incision or through the vagina and in some cases with the aid of a laparoscope. About half of all hysterectomies in the United States are performed to treat uterine fibroids, according to the American Society for Reproductive Medicine. It is the most radical way of treating uterine fibroids and accompanying symptoms, but it is 100-percent effective. However, this surgery is not recommended for women who want to retain their organs or bear children.

The newest treatment for uterine fibroids is a procedure called focused ultrasound surgery (FUS, but also called MRgFUS), which was approved by the Food and Drug Administration (FDA) in 2004. FUS is noninvasive and preserves the uterus. During FUS, a woman lies on a special type of MRI scanner machine and then a contrast dye is administered, which allows physicians to visualize the uterus and surrounding organs. Using FUS the physician can locate and destroy uterine fibroids without making any incisions. Focused high-frequency, high-energy sound waves target and destroy the fibroids. FUS can take up to several hours because it is performed on an on- and off-again fashion until the entire tumor is destroyed. In some cases, a second treatment session may be necessary. FUS is performed on an outpatient basis and side effects are minimal. However, FUS is costly and it may not be offered at most facilities because it requires special equipment. In addition, the long-term effectiveness of FUS has not been proven.

Patients are urged to discuss all treatment options with their physician to determine which type is best for them.