Up to 70% of women will develop uterine fibroids by menopause. However, only about 25% will have symptoms significant enough to need treatment. 

“Uterine fibroids are not cancerous, they do not increase your risk for cancer and most women can still become pregnant,” says Candace Giles, DO, Nebraska Medicine obstetrician and gynecologist. 

Fibroids often develop during a woman’s childbearing years. The reproductive hormones estrogen and progesterone cause the lining of the uterus to thicken during menstrual cycles to prepare for pregnancy. Sometimes this process can result in fibroid growth. 

Fibroids can be very small or grow as large as a grapefruit. Symptoms often depend on the size, location and number of fibroids.

Common symptoms include:

• Heavy menstrual bleeding or painful periods.
• Longer or more frequent periods.
• Pelvic pain or pressure.
• Frequent urination or trouble urinating.
• Enlarged stomach area.
• Constipation.
• Pain in the lower back or stomach area or pain during sex. 

“Fibroids are often found during a routine pelvic exam when a woman comes to the clinic with significant symptoms or has experienced recurring pregnancy loss or infertility,” says Dr. Giles.

There are a variety of treatment options available for fibroids. Treatment depends on the location of the fibroids, symptoms and the patient’s goals, says Dr. Giles. Fibroids are classified by their location within the uterus. This includes fibroids that:

• Have grown within the muscular walls of the uterus.
• Bulge into the uterine cavity.
• Grow on the outer portion of the uterus. 

Fibroids that grow within the uterine cavity can often cause infertility and pregnancy loss, but can be treated to restore fertility.

Treatment options include:

Watch and wait

If you do not have symptoms or your symptoms are mild, you may choose to live with the fibroids and have your doctor keep a watchful eye on them. Fibroids often grow very slowly and usually stop growing after menopause when estrogen levels decline.

Medical management

Several drug options are available that regulate the hormones that control the menstrual cycle. They can help minimize symptoms such as menstrual bleeding and pelvic pressure. While they do not remove fibroids, they can help minimize their growth and decrease associated symptoms.

These drugs can be taken by mouth or delivered through an implanted intrauterine device (IUD) that releases medication directly to the uterus. 

“If oral medications are not providing the results you need, an IUD can be more effective at reducing bleeding,” notes Dr. Giles

Minimally invasive procedure

Women who have not had success with medical management, do not want to use drugs or are not candidates for surgery may consider a minimally invasive option called uterine artery embolization.

Uterine artery embolization

This procedure is done by an interventional radiologist. Small particles, called embolic agents, are injected into select blood vessels that feed the fibroids. This cuts off the blood supply to the fibroids, causing them to shrink and die. 

“This is a highly effective procedure that is used to remove 90% of fibroids nationwide,” says Maria O’Malley, MD, Nebraska Medicine interventional radiologist. “It eliminates fibroids and significantly reduces heavy menstrual bleeding within the first or second menstrual cycle after the procedure is performed. Most women will also see a decrease in other symptoms within two months and will become symptom-free after six months.”

The procedure is done under mild sedation, and most patients go home the same day, says Dr. O’Malley. The embolic agents are injected through a small vessel in the wrist, which allows for a faster recovery. 

Pregnancy rates after uterine artery embolization are estimated at 30% to 50%, notes Dr. O’Malley.

Advantages of uterine artery embolization include:

• Fast recovery – most patients go home the same day.
• Low risk of complications.
• High success rate of shrinking fibroids and relieving symptoms.

“Nationally, it is estimated that about 10% to 15% of patients will have a recurrence of fibroids after five years from the procedure,” notes Dr. O’Malley. The procedure can be repeated as often as needed.

Traditional surgery

Myomectomy

This is the most common surgery to remove fibroids. It is usually reserved for patients with very large, deep or multiple fibroids. 

The procedure is performed either minimally invasive (using a laparoscope or robotically assisted technique with multiple small incisions) or by making a large incision in the abdomen to remove fibroids. The patient is under general anesthesia and can stay in the hospital one to two days. Recovery takes about six weeks. 

Pregnancy rates after myomectomy are estimated at 50% to 78%. 

Hysterectomy

This surgery entails removing the uterus. It is the only method that permanently resolves uterine fibroids. This procedure may be performed for the most severe cases.

“Fibroids are very prevalent and may become symptomatic in some women,” says Dr. Giles “If you are experiencing uncomfortable symptoms, talk to your doctor to discuss the best treatment option for you to manage symptoms and to preserve fertility, if desired.”