Fibroids - Treating fibroids

Treatment may not be necessary in cases where there are no symptoms of fibroids, or where symptoms are minor and your everyday activities are not significantly affected.

Fibroids often shrink after the menopause, and your symptoms will usually either ease slightly or disappear completely.

If you have fibroids that need treatment, your GP may recommend medication to help relieve your symptoms. However, you may need to see a gynaecologist (specialist in the female reproductive system) for further medication or surgery if these are ineffective.

You should visit your GP to discuss the best treatment plan for you.

Medication for symptoms

There are medicines available that can be used to reduce heavy periods, but they can be less effective the larger your fibroids are. These medications are described below.

Levonorgestrel intrauterine system (LNG-IUS)

LNG-IUS is a small plastic device placed in your womb that slowly releases the progestogen hormone levonorgestrel. LNG-IUS stops the lining of your womb from growing quickly, so it is thinner and your bleeding becomes lighter.

Side effects associated with LNG-IUS include:

• irregular bleeding that may last for more than six months
• acne
• headaches
• breast tenderness
• in rare cases, no periods at all (absent periods)

LNG-IUS also acts as a contraceptive, but does not affect your chances of getting pregnant after you stop using it. 

Tranexamic acid

If LNG-IUS is unsuitable (for example, if contraception is not desired), tranexamic acid tablets may be considered. These tablets work by helping the blood in your womb to clot.

Tranexamic acid tablets are taken three times a day during your period for up to four days. Treatment should be stopped if your symptoms have not improved within three months.

Tranexamic acid tablets are not a form of contraception and will not affect your chances of becoming pregnant.

Possible side effects include indigestion and diarrhoea.

Anti-inflammatory medicines

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, can be taken three or four times a day from the first day of your period until bleeding stops or reduces to satisfactory levels.

They work by reducing your body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods.

Anti-inflammatory medicines are also painkillers, but are not a form of contraception.

Indigestion and diarrhoea are common side effects.

The contraceptive pill

The contraceptive pill is a popular form of contraception that stops an egg from being released from the ovaries to prevent pregnancy.

As well as making bleeding lighter, some contraceptive pills can help reduce period pain.

Your GP can provide you with further advice about contraception and the contraceptive pill.

Oral norethisterone

Norethisterone is a type of man-made progestogen (one of the female sex hormones) that can help reduce heavy periods. It is usually taken as a daily tablet from days 5 to 26 of your menstrual cycle, counting the first day of your period as day one.

Oral norethisterone works by preventing your womb lining growing quickly. It is not a form of contraception, although it can reduce your chances of conceiving while you are taking it.

The side effects of oral norethisterone can be unpleasant, and include weight gain, breast tenderness and short-term acne.

Injected progestogen

Progestogen is also available as an injection to treat heavy periods. This medication works by preventing the lining of your womb growing quickly.

This form of progestogen can be injected once every 12 weeks for as long as treatment is required.

Common side effects of injected progestogen include:

• weight gain
• irregular bleeding
• absent periods
• premenstrual symptoms, such as bloating, fluid retention and breast tenderness

Injected progesterone also acts as a contraceptive. It does not prevent you becoming pregnant after you stop using it, although there may be a delay after you stop taking it before you are able to get pregnant.

Medication to shrink fibroids

If you are still experiencing symptoms related to fibroids despite treatment with the medications outlined above, your GP can refer you to a gynaecologist. They may prescribe medication called gonadotropin releasing hormone analogues (GnRHas) to help shrink your fibroids.

GnRHas, such as goserelin acetate, are hormones given by injection and work by making your body release a small amount of the hormone oestrogen, which causes your fibroids to shrink.

GnRHas stop your menstrual cycle (period), but are not a form of contraception. They do not affect your chances of becoming pregnant after you stop using them. 

If you are prescribed GnRHas, they can help to ease heavy periods and any pressure that is felt on your stomach. They also help improve symptoms of frequent urination and constipation.

Sometimes GnRHas are used to shrink fibroids prior to surgery to remove them.

GnRHas can cause a number of menopause-like side effects, including:

• hot flushes
• increased sweating
• muscle stiffness
• vaginal dryness

Sometimes a combination of GnRHas and low doses of hormone replacement therapy (HRT) may be recommended to prevent these side effects.

Osteoporosis (thinning of the bones) is an occasional side effect of taking GnRHas. Your GP can give you more information about this, and may prescribe additional medication to minimise thinning of your bones.

GnRHas is only prescribed on a short-term basis (a maximum of six months at a time). Your fibroids may grow back to their original size after treatment is stopped.

Surgery

Surgery may be considered if your fibroid symptoms are particularly severe and medication has been ineffective.

There are several different procedures used to treat fibroids. Your GP will refer you to a specialist, who will discuss options with you, including benefits and any associated risks.

The main procedures used to treat fibroids are outlined below.

Hysterectomy

A hysterectomy is a surgical procedure to remove the womb. It is the most effective way of preventing fibroids coming back.

It may be recommended if you have large fibroids or severe bleeding and you do not wish to have any more children.

There are a number of different ways a hysterectomy can be carried out, including through the vagina or through a number of small incisions in your abdomen (tummy).

Depending on the technique used, the procedure can be carried out under local anaesthetic (where you will be numbed from the waist down) or general anaesthetic (where you are unconscious during the procedure).

You will usually need to stay in hospital for a few days after a hysterectomy. It takes about six to eight weeks to fully recover, during which time you should rest as much as possible.

Side effects of a hysterectomy can include early menopause and a reduction in libido (sex drive).

Myomectomy

A myomectomy is a surgical procedure to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy, particularly for women who still wish to have children.

However, a myomectomy is not suitable for every type of fibroid. Your gynaecologist will be able to tell you if the operation is suitable for you based on things such as the size, number and position of your fibroids.

Depending on the size and position of the fibroids, a myomectomy may involve making either a number of small incisions (cuts) in your tummy (keyhole surgery) or a single larger incision (open surgery).

Myomectomies are carried out under general anaesthetic and you usually need to stay in hospital for a few days after the procedure. Like a hysterectomy, you will normally be advised to rest for several weeks while you recover.

Myomectomies are generally an effective treatment for fibroids, although there is a chance the fibroids will grow back and further surgery will be needed.

Non-surgical procedures

As well as traditional surgical techniques to treat fibroids, there are also non-surgical treatments available. These are outlined below.

Uterine artery embolisation (UAE)

Uterine artery embolisation (UAE) is an alternative procedure to a hysterectomy or myomectomy for treating fibroids. It may be recommended for women with large fibroids.

UAE is performed by a radiologist (a doctor trained to interpret X-rays and scans). It involves blocking the blood vessels that supply the fibroids, causing them to shrink.

During the procedure, a chemical is injected through a small tube (catheter), which is guided by X-ray through a blood vessel in your leg. It is carried out under local anaesthetic, which means you will be awake but the area being treated will be numbed.

You will usually need to stay in hospital a day or two after UAE. When you leave hospital, you will be advised to rest for one to two weeks.

Although it is possible to have a successful pregnancy after UAE, the effects of the procedure on fertility and pregnancy are generally uncertain. The procedure should therefore only be carried out after a detailed discussion with your doctor about the potential risks, benefits and uncertainties.

Endometrial ablation

Endometrial ablation is a relatively minor procedure that involves removing the lining of the womb. It is mainly used to reduce heavy bleeding in women with fibroids, but it can also be used to treat small fibroids in the womb lining.

The affected womb lining can be removed in a number of ways, for example by using laser energy, a heated wire loop, microwave heating or hot fluid in a balloon.

The procedure can be carried out either under local anaesthetic or general anaesthetic. It is fairly quick to perform, taking around 20 minutes, and you can often go home the same day.

You may experience some vaginal bleeding and tummy cramps for a few days afterwards, although some women have bloody discharge for three or four weeks.

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation. In this case, you should speak to your GP or a member of your hospital care team who may be able to prescribe a stronger painkiller.

While it may still be possible to get pregnant after having endometrial ablation, the procedure is not recommended for women who want to have more children. This is because the risk of serious problems, such as miscarriage, is high.

More information about endometrial ablation is available from the Royal College of Obstetricians and Gynaecologists (RCOG), who have produced a leaflet called Information for you after an endometrial ablation (PDF, 3.75Mb).

Hysteroscopic resection

Hysteroscopic resection of fibroids is a procedure that involves using a thin telescope called a hysteroscope and a number of small surgical instruments to remove fibroids. The procedure is carried out through the vagina, so no incisions are needed.

The procedure can be used to remove small fibroids located inside the womb (submucosal fibroids) and is suitable for women who wish to have children in the future.

Hysteroscopic resection of fibroids is often performed under a general anaesthetic, although local anaesthetic may also be used. You can usually go home the same day the procedure is carried out.

You may experience stomach cramps after the procedure, but these should only last a few hours. There may also be a small amount of vaginal bleeding, which should stop within a few weeks.

Newer procedures

As well as the procedures outlined above, there are two newer techniques for treating fibroids that use magnetic resonance imaging (MRI). They are:

• MRI-guided percutaneous laser ablation
• MRI-guided transcutaneous focused ultrasound

These techniques use MRI to guide small needles into the centre of the fibroid being targeted. Laser energy or ultrasound energy is then passed through the needles to destroy the fibroid.

These treatment methods cannot be used to treat all types of fibroids, and the long-term benefits and risks are unknown. As these procedures are relatively new, they are not yet widely available in the UK.

Although research is still being done, some evidence suggests this non-invasive procedure has short- to medium-term benefits when performed by an experienced clinician.

However, the effects on pregnancy and those wishing to have a baby in the future are not fully known, so this should be taken into consideration.

Read guidance on MRI-guided transcutaneous focused ultrasound and MRI-guided percutaneous laser ablation from the National Institute for Health and Care Excellence (NICE).