Diagnosis and Treatment of Fibroids
When to Treat Fibroids
Learn more about fibroids and when physicians usually recommend treating them. Read more
A pelvic examination may reveal an irregularly shaped, lumpy or enlarged uterus. Frequently, this diagnosis is reliable.
In some cases, diagnosis of fibroids can be difficult. Fibroid tumors have been mistaken for ovarian tumors, inflammation of the fallopian tubes, and pregnancy.
A transvaginal ultrasound may be done to confirm the diagnosis of fibroids. In some cases, additional imaging with an MRI or saline infusion sonogram is recommended. An endometrial biopsy (biopsy of the uterine lining) may be recommended to rule out cancer.
Medical Treatment of Uterine Fibroids
Medications can be used to decrease the flow of periods and sometimes relieve pelvic pressure. They can also temporarily shrink the size of fibroids, but do not eliminate them.
Hormonal suppression: These medications target the hormones responsible for your menstrual cycle. They attempt to decrease the flow of your period and cramping. Their success is often dependent on the size and location of your fibroid(s). The type of hormones offered depends on your underlying medical conditions and will be assessed by your physician. Hormonal suppression may include birth control pills, nuva ring, depo provera, nexplanon, or a progestin IUD.
Tranexamic Acid: This is a non-hormonal medication used to decrease period flow and is used only during the heaviest days of your period.
GnRH agonist: This medication is used to block estrogen and progesterone and places you in a temporary menopausal state. It can decrease menstrual flow and temporarily shrinks the size of fibroids. It is sometimes recommended preoperatively to optimize surgery.
Surgical Treatment of Uterine Fibroids
When fibroids become symptomatic primarily with pain or bleeding, or when a woman is experiencing infertility, it may be necessary to remove the fibroid(s). Procedures used to treat fibroids include:
Office Hysteroscopy: A small camera measuring half the diameter of a pencil is inserted through the vagina and into the uterus. This allows a better assessment of the uterine cavity. Small fibroids can sometimes be removed using this method which causes minimal discomfort, requires no sedation and is performed in the office or treatment room.
Myomectomy: If you want to get pregnant in the future, your doctor might suggest a myomectomy. This surgery removes the fibroids, but leaves the healthy uterine tissue. This can be performed hysteroscopically (through the vagina) or laparoscopically (through small incisions on your abdomen) depending on the size and location of your fibroids. Rarely, a laparotomy, or large abdominal incision required.
Uterine Artery Embolization: This minimally invasive procedure shrinks fibroids by blocking their blood supply. An interventional radiologist will use a catheter to inject very small particles that will stick to arteries feeding the fibroid(s) causing a clot to develop. This will block the flow of blood to the fibroids.
Hysterectomy: A hysterectomy removes your uterus completely. It prevents future pregnancy and is the only way to make sure your fibroids will not come back. This can typically be performed through minimally invasive techniques to allow for quicker return to daily activities.