10 Ways to Treat Uterine Fibroids

Watchful Waiting

If you have uterine fibroids but don't have any symptoms or only minor symptoms, doing nothing—while staying alert for any changes—is an option.

"If the fibroids are not causing any problems, and they're not dramatically enlarged, they can be watched," said Mitchell S. Kramer, MD, chairman of obstetrics and gynecology at Northwell Health's Huntington Hospital in Huntington, New York. "You do not necessarily need to intervene."

This is often the strategy when you are nearing menopause or post-menopause. According to OWH, estrogen causes fibroids to grow; often, as estrogen naturally diminishes, so do fibroids.

Watchful waiting is also an option if you want to get pregnant and the fibroid doesn't look like it will interfere with pregnancy. "From a pregnancy point of view, some fibroids are very problematic, some aren't," said Dr. Kramer.

Your healthcare provider can help you decide if this option is a safe and effective one for you.

Diet and Lifestyle Changes

"Because we actually don't understand what causes fibroids to form, it's difficult to say what you should do to prevent them," said Dr. Newsome.

But there may be some possible lifestyle changes to consider. According to a 2016 review published in the journal Fertility and Sterility, some studies suggest that lifestyle factors like having a healthy diet and exercising regularly may help prevent fibroids.

Dr. Newsome also stated that such factors might help improve fibroid symptoms.

Estrogen affects fibroids, and fat cells produce estrogen, said Dr. Newsome. Having less excess body fat could therefore improve fibroid symptoms, she said.

While there are no large studies on diet or foods that can shrink fibroids, there is some anecdotal evidence. She added that people who follow a plant-based diet have improved fibroid symptoms.

Exercise may also help ease some uterine fibroid symptoms, but there are no known ways to get rid of fibroids naturally, said Dr. Newsome.

GnRH Agonists

If watchful waiting and lifestyle changes aren't options for you, healthcare providers may move on to hormonal medications to control symptoms and even shrink the fibroids.

According to OWH, several of these medications, like leuprolide (Lupron), are gonadotropin-releasing hormone (GnRH) agonists. They work by blocking hormone production.

This causes the fibroids to shrink, which relieves uterine fibroid symptoms like heavy bleeding, pelvic pain, or needing to urinate all the time. Reducing bleeding is especially important to lower your risk of anemia.

But halting hormone production means you may also end up with menopausal symptoms like hot flashes. According to UpToDate, some healthcare providers prescribe "add back" medications, which are low doses of hormones, to counter that effect without decreasing how well the GnRH agonist works.

GnRH agonists, available in pill, nasal spray, and injection forms, are typically used for a short period of time. They can be helpful in reducing the size of a fibroid before surgery, for example. OWH states that fibroids will grow back after these medications are stopped.

Hormonal Medications

Hormonal contraceptives are another option to treat uterine fibroid symptoms. They won't necessarily reduce the size of uterine fibroids, but they may regulate periods or reduce heavy bleeding, according to UpToDate.

This could be the pill or a progestin-releasing IUD, as long as the location of the fibroids doesn't interfere with inserting one safely, said Dr. Jaque.

A 2014 literature review published in Annals of Medical and Health Sciences Research found a few studies suggesting that danazol, a synthetic drug that mimics testosterone, can shrink fibroids and reduce symptoms. However, this treatment might also result in weight gain, acne, and unwanted hair.

Non-hormonal Medications

According to UpToDate, non-hormonal options include tranexamic acid (Lysteda), which can lighten bleeding if it's taken on the days when your period is heavy.

And while they won't do anything to reduce fibroid size, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help relieve fibroid pain. "For the most part, medical therapy tends to be more of a temporizing measure," said Dr. Kramer.

MRI-guided Focused Ultrasound

In this non-surgical procedure, healthcare providers use a magnetic resonance imaging (MRI) system to locate your uterine fibroids and then zap them with high-frequency ultrasound. "It's considered to be a permanent procedure to eliminate or decrease the size of the fibroids," Dr. Kramer said.

The actual procedure is painless and noninvasive. It's performed inside an MRI machine, and you can usually go home the same day.

So far, using MRI-guided focused ultrasound to treat uterine fibroids appears to be safe, even if you still want to get pregnant, according to a 2020 literature review published in the journal ecancer. Research is ongoing to see if there are risks of adverse effects.

Uterine Artery Embolization

Also called uterine fibroid embolization, this procedure deprives fibroids of their lifeblood—literally. "Embolization can block off blood supply to the fibroids," explained Dr. Newsome. "The fibroids shrink and die."

According to John Hopkins Medicine, your healthcare provider will inject tiny particles into the arteries that supply blood to the fibroids. The particles set up a roadblock for any blood trying to get to the uterine fibroid. Uterine artery embolization can be done as either an inpatient or outpatient procedure.

According to UpToDate, embolization is generally an option if you have uterine fibroids that are causing heavy bleeding, but it's not recommended if you plan to get pregnant.

"There are studies being done now to assess whether or not it's safe to have this procedure and get pregnant," said Dr. Kramer. It's thought to weaken the walls of the uterus, he said, putting you at risk for complications during pregnancy.

Endometrial Ablation

Endometrial ablation is a type of minor surgery that doesn't just destroy a fibroid, it destroys the entire lining of the uterus (called the endometrium). This usually takes care of heavy bleeding, according to UpToDate, but the procedure tends to only work on some uterine fibroids.

"Endometrial ablation doesn't treat all fibroids, just ones that are towards the inside portion of the uterus," said Dr. Newsome.

Endometrial ablation is usually done on an outpatient basis, even right in your healthcare provider's office. An instrument is inserted through the vagina and into the uterus, where it uses heat, electric currents, or microwave energy to destroy the fibroids and uterine tissue.

It's unlikely for you to be able to get pregnant after endometrial ablation, according to the American College of Obstetricians and Gynecologists (ACOG). If pregnancy does occur after ablation, there is a higher risk of abnormal pregnancy.

Myomectomy

Unlike endometrial ablation, a myomectomy is an option if you still want to get pregnant and can be used to take care of intracavitary fibroids or those that go into the uterine cavity, according to UpToDate. "Myomectomy is surgery to remove the fibroids from the uterus, and it keeps the uterus intact," said Dr. Kramer.

According to the University of North Carolina Department of Obstetrics & Gynecology, there are several different ways to perform a myomectomy: hysteroscopic, laparoscopic, abdominal, or robotic. Some involve inserting an instrument through the vagina and cervix into the uterus to destroy or remove the fibroids.

Others involve making small incisions in the uterine and abdominal walls to do the job. The procedures are minimally invasive and are considered permanent.

"The fibroids do not grow back," said Dr. Kramer. However, in some cases, it's not the end of fibroids entirely. "Theoretically, there could be very small ones that will grow over time that weren't detected at the time of the surgery," he explained.

Sometimes myomectomy is accompanied by morcellation, a procedure that breaks fibroids into smaller pieces before removing them.

However, the Food and Drug Administration (FDA) recommends against this practice, especially if you are near or in menopause, in case there is an undiagnosed cancerous tumor present. If a cancerous tumor is broken into little pieces, it could spread.

Hysterectomy

A hysterectomy is a surgical procedure to remove the uterus. According to John Hopkins Medicine, fibroids are one of the most common reasons for a hysterectomy. This procedure is permanent and typically cures heavy menstrual bleeding and other fibroid-related symptoms, according to UpToDate.

Today, the procedure is usually reserved for those with very large uterine fibroids and heavy bleeding who are nearing or post-menopause.

However, it may be the preferred treatment method for other patients. "If a woman has a family history of ovarian cancer or endometrial cancer, maybe they're not the best person to have a uterine-sparing procedure," said Dr. Newsome.

Healthcare providers may opt to remove just the uterus, part of the uterus, or also the ovaries and fallopian tubes. According to UpToDate, it's not uncommon for the ovaries and cervix to be left in place if the procedure is for fibroids. Removing the uterus means you won't be able to have children. Taking out the ovaries means you will go into menopause.

According to the ACOG, notable ways of performing a hysterectomy involve making incisions in the abdomen or vagina, or a laparoscopy—a procedure where a thin telescope (laparoscope) is inserted through small incisions made in the abdomen.

Hysterectomy is considered a major procedure. As with any major procedure, there can be risks that include bleeding, blood clots, and infection.