Your choice of fibroid treatment depends on the type and severity of your symptoms, as well as the size and location of your fibroids. Sydney Fibroid Clinic offers a number of treatments, including medical therapies, Mirena IUD, uterine fibroid embolisation, myomectomy and more.It’s possible to have one or several fibroids, which can vary from a few mm to more than 20cm. Not all uterine fibroids need to be treated, but for those that do, there are many options available.
Medical Therapy for Fibroids
Tranexamic acid, nonsteroidal anti-inflammatory drugs (NSAIDs), birth control pills, or progesterone agents may be used to treat heavy menstrual bleeding, however these treatments do not reduce the size of uterine fibroids.
Tranexamic acid reduces heavy periods by enhancing the body’s clotting ability. Rare but serious side effects such as deep venous thrombosis (DVT) and pulmonary embolism (clots in the lung) may occur. Therefore, it is not recommended for women with an increased risk of arterial or venous thrombosis.
NSAIDs are mainly used for period pain, but are not as effective as tranexamic acid for heavy periods.
Combined birth control pills are commonly prescribed for heavy menstrual periods. As fibroid growth is dependent on oestrogen, fibroid growth showed be monitored. A progestogen-only pill can also be used to control heavy periods.
Gonadotropin-releasing hormone (GnRH) agonists can be used to induce temporary menopause, so as to reduce blood supply and shrink fibroids. They are usually used for 3 – 6 months prior to fibroid surgery. Common side effects include hot flashes, mood changes and osteoporosis. Use is generally limited to six months and fibroids usually regrow after GnRH agonists are stopped.
Mirena IUD for Fibroids
Mirena is an intrauterine device (IUD). It is a T-shaped plastic device that slowly releases the sex hormone progesterone over five years. It is used as contraceptive device that is effective for five years.
Though helpful for relieving heavy periods, Mirena does not reduce the size of fibroids, nor does it stop fibroid growth. If uterine fibroids are large and distort the cavity, Mirena may also be difficult to insert or remove and the device may not stay in place.
Please note: in some women, heavy bleeding is converted to prolonged spotting, which can be annoying for patients. Well-known side effects of Mirena are prolonged light bleeding (25%) and irregular bleeding (14%), with less common side effects of weight gain, ovarian cysts, lower abdominal pain and acne.
Mirena can be inserted in the rooms of your GP or gynaecologist. In some cases, it may need to be inserted in an operating room under sedation or a light general anaesthetic, depending on the perceived difficulty.
Endometrial Ablation for Fibroids
Endometrial ablation uses heat energy to surgically destroy the inner lining of the uterus. It is performed under general anaesthetic in an operating theatre. After ablation, most women will no longer have menstrual periods and the uterus can no longer carry pregnancy.
Though the treatment relieves menstrual periods, it does not shrink fibroids and will not relieve symptoms related to the bulk of uterine fibroids. Also, if the uterine cavity is distorted by fibroids, ablation may not be successful – due to a lack of effective contact between the heating device and the lining of the uterus.
Uterine Fibroid Embolisation for Fibroids
Uterine fibroid embolisation (UFE) is also known as uterine artery embolisation (UAE).
UFE is a safe, effective and minimally invasive, non-surgical alternative to a hysterectomy. Shrinking fibroids, reducing heavy periods and relieving pain, UFE has been shown to be as effective as a hysterectomy in improving women’s quality of life.
The procedure and its benefits can be summarised as follows:
- Local anaesthetic procedure
- Proven safety and effectiveness
- Over 90% patient satisfaction rate
- No surgical cuts, no general anaesthesia
- 1 – 2 nights hospital stay
- 1-week recovery
- Multiple fibroids treated in one go
- Keep your uterus and pelvic floor intact
Uterine fibroid embolisation (UFE) is performed by an interventional radiologist. During the procedure, tiny particles are injected inside the uterine arteries to block the blood flow, thereby starving the fibroids, causing shrinkage and alleviating symptoms. Only a tiny nick on the skin is needed to allow insertion of a small, 1 – 2mm diameter catheter into the femoral artery in the groin. This catheter is advanced into the arteries of the uterus under X-ray guidance.
The procedure is suitable for women who wish to avoid a hysterectomy, keep their uterus and recover quickly. Condoleezza Rice, the 66th US Secretary of State, successfully underwent uterine fibroid embolisation for her fibroids in 2004. She chose UFE over hysterectomy.
For more information on UFE as a uterine fibroid treatment, click the link to UFE FAQs
Hysteroscopic Resection for Fibroids
Hysteroscopic resection removes fibroids with the aid of a camera through the vagina and cervix. The procedure is suitable for small fibroids (up to 4 cm) and the fibroid needs to be protruding into the cavity of the uterus. It is much less invasive than a hysterectomy.
Hysteroscopic resection is a general anaesthetic procedure performed in an operating theatre. First the cervix is dilated. Then the hysteroscope (a mini telescope or endoscope) is inserted into the uterine cavity. A ‘shaving’ device is then used to remove the part of the fibroid protruding into the cavity.
Only small fibroids – less than 4 cm, protruding more than 50% into the cavity – are suitable for hysteroscopic resection. When there are other fibroids and/or adenomyosis symptoms present, hysteroscopic resection alone may not be sufficient to successfully control symptoms.
If a woman wishes to avoid a hysterectomy, hysteroscopic resection can be combined with UFE to achieve the goal of keeping her uterus, using two minor procedures to avoid a major operation like hysterectomy and its associated long-term side effects.
Myomectomy for Fibroids
A myomectomy is a surgical operation to remove one or a few fibroids. A myomectomy is offered to women who wish to retain both their uterus and fertility.
A myomectomy is possible for fibroids with suitable size and in suitable locations. Compared to a hysterectomy, a myomectomy is technically more demanding on the surgeon, takes longer to perform, and is more likely to require a blood transfusion. There is the risk that a myomectomy is sometimes converted to a hysterectomy if the surgeon is unable to control the bleeding or reconstruct the uterus.
Development of adhesion (internal scarring of the abdomen) is a potential complication that can affect future fertility and pregnancy. Fibroids left behind may grow and cause symptom recurrence in 40 – 50% of women after a myomectomy.
A myomectomy can be performed through open incision, or via keyhole (laparoscopic or robotic). Though recovery is quicker with laparoscopic/robotic myomectomy, major surgical risks may not be lower. Laparoscopic/robotic surgery is technically more demanding, with a steeper learning curve for surgeons, due to limited access and visualisation. The major surgery risks still exist, in terms of injuries to blood vessels, the bowel, the bladder and the ureter. An open myomectomy takes longer to recover, due to the larger surgical incision. The access and visualisation of adjacent structures are better and uterine reconstruction can be easier.
Whether an open or laparoscopic/robotic myomectomy is the right choice for you depends on the reason for your myomectomy, your desire for a quick recovery, and the skill and the experience of your surgeon.
At Sydney Fibroid Clinic, a myomectomy is discussed as a preferred option for women who still desire future pregnancy. To enable us to provide you with more definitive opinion, we would require you to have an MRI of your uterus, performed by one of our preferred MRI service providers.
Hysterectomy for Fibroids
A hysterectomy is a surgical operation in which all or part of the uterus is removed. A hysterectomy is performed for a number of reasons, including relieving the symptoms presented by uterine fibroids. If you have uterine cancer, your only choice may be to remove the uterus. However, an overwhelming majority of hysterectomies in developed countries – like Australia and the United States – are performed for benign conditions such as uterine fibroids.
Traditionally when conservative treatments fail or are deemed unsuitable, a hysterectomy is offered. However, a hysterectomy is a major surgery that requires 3 – 5 days stay in hospital and 5 – 6 weeks of recovery, carries the risks of a major surgery and is associated with long-term adverse side effects.
A hysterectomy is a major surgery. The risk of severe complications from hysterectomy remains significant, at 3.5% to 11% to date in 2019. In addition to the immediate surgical risks, hysterectomy patients may experience long-term side effects like pelvic prolapse, urinary incontinence, early onset of menopause, increased cardiovascular risk, sexual dysfunction and constipation.
Since there are now many less invasive means to treat fibroid-related symptoms, hysterectomies should be considered as the last resort, when all other less invasive methods have failed. Depending on your specific situation, uterine fibroid embolisation, endometrial ablation, hysteroscopic resection, Mirena IUD or MRgFUS treatment may be your less invasive choice.
Magnetic Resonance-Guided Focused Ultrasound (MRgFUS) for Fibroids
MRgFUS stands for Magnetic Resonance-guided Focused Ultrasound. MRgFUS produces heat energy to cause cell death in fibroids. This non-invasive technique uses a MRI thermal imaging system to continuously measure temperature changes inside the body, guiding the treatment.
It is important to note that MRgFUS treatment may cause skin burns, bone or nerve damage, or thermal injury to bowels. The procedure is only suitable for a small fraction of patients.