40w LaterGuide

Finding out that you have uterine fibroids does not necessarily mean they need to be removed.

If fibroids are not causing symptoms, they can often be monitored without treatment. When treatment is needed, the choice depends on your symptoms, the location and size of the fibroids, your age and your plans for future pregnancy.

1. Monitoring fibroids without treatment

If fibroids are not causing significant symptoms, your healthcare professional may recommend monitoring them rather than treating them immediately.

Fibroids can change in size over time and often become smaller after menopause. Ultrasound may be used to assess their size and location. MRI is generally reserved for situations where more detailed information is needed.

2. Medications to manage symptoms

Medication may be used to manage symptoms such as heavy menstrual bleeding or period pain.

Nonsteroidal anti-inflammatory drugs (NSAIDs) can help relieve menstrual pain, while tranexamic acid can reduce heavy menstrual bleeding. Depending on your situation, hormonal contraception, progestogen-based treatments or a levonorgestrel-releasing intrauterine system (LNG-IUS) may also be considered.

GnRH agonists or antagonists may be used in some situations to control symptoms or temporarily reduce fibroid size.

Medication mainly aims to control symptoms, and not every treatment makes the fibroids themselves disappear.

3. Procedures and surgery

If symptoms are severe or cannot be adequately controlled with medication, a procedure or surgery may be considered.

Myomectomy removes the fibroids while leaving the uterus in place and may be considered for people who wish to preserve the possibility of future pregnancy. Depending on the fibroids, surgery may be performed hysteroscopically, laparoscopically or through open surgery.

Hysterectomy removes the uterus and may be considered when symptoms are severe or other treatments are not appropriate. Pregnancy is no longer possible after hysterectomy.

Uterine artery embolization (UAE) and other procedures may also be options in some situations. If you are planning a future pregnancy, discuss how each treatment could affect fertility and pregnancy before making a decision.

What about pregnancy after myomectomy?

Pregnancy is still possible after myomectomy. However, pregnancy care and the recommended method of delivery may depend on where the fibroids were located and how deeply the uterine wall was affected during surgery. Cesarean delivery may be recommended in some cases.

The right treatment is different for everyone

Treatment decisions should take into account your symptoms, the size, location and number of fibroids, anemia, age, future pregnancy plans and whether you wish to preserve your uterus.

This is why two people with similar-sized fibroids may receive very different treatment recommendations.