DEAR DOCTOR K:
I have fibroids that cause heavy menstrual bleeding and painful cramping. What are my treatment options?
As I’ll explain shortly, the first question you need to ask yourself is whether you want to have children in the future. That’s because some of the most effective treatments for fibroids make becoming pregnant more difficult, or impossible.
But, first, let me explain what fibroids are. They are tumors that form in or on the uterus. They are usually benign: They don’t spread. They do not usually cause symptoms, but in some women, they can cause heavy menstrual bleeding and painful cramps. They can also increase the risk of miscarriage.
If you want to be able to bear children, you have several options available.
MEDICAL TREATMENT. Birth control options that contain both estrogen and a progestin can help reduce extremely heavy bleeding. They also help regulate menstrual periods. Progestin-only therapies can also help reduce bleeding.
MYOMECTOMY. This surgical procedure removes fibroids while leaving the uterus in place. It is often used in women who still want to have children. Fibroids may be surgically removed through a variety of techniques. The best approach depends on the fibroids’ location. (I’ve put an illustration of different places that fibroids may be located, in or on the uterus, on my website, AskDoctorK.com.)
A myomectomy can sometimes be performed with a laparoscope, which requires only a small incision. In recent years, some doctors performing a laparoscopic procedure used a technique called “morcellation.” Instead of removing the fibroids in chunks, the technique minced them into small pieces, which were then removed. However, in 2014 the U.S. Food and Drug Administration (FDA) reported that morcellation might increase the risk of spreading a rare, cancerous fibroid. The FDA recommended that this procedure no longer be used in most women with fibroids. Some gynecologists disagree.
If you do not want to be able to bear children, then you have other options:
UTERINE ARTERY EMBOLIZATION. During this minor procedure, small particles are injected into an artery that supplies the uterus. This blocks off the blood supply to the fibroids, which shrinks them and reduces the bleeding they cause. This treatment reduces the likelihood that you will be able to bear children in the future, although you may still be able to do so.
ENDOMETRIAL ABLATION. This is a minor procedure that scars the lining of the uterus. Since the lining is the source of much of the bleeding, the procedure decreases uterine bleeding. This is usually advised only for women who have completed childbearing, as pregnancy is less likely after an ablation. Also, if you do get pregnant, complications during the pregnancy are more likely.
HYSTERECTOMY. This surgery removes the uterus along with the attached fibroids. It provides a permanent solution for fibroids in women who do not want children, or have already finished having them.
Talk to your primary care doctor about referring you to a gynecologist who can discuss the option that seems best for you.