Surgery one approach to fibroids, but others can work

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Most women with fibroids don’t have symptoms severe enough to warrant treatment. For those who do, there are a variety of therapies, which are usually selected based on a woman’s age, medical history and whether she may want to get pregnant at some point; other factors include the size and location of the fibroids. Here is a brief description of some of the most common treatments. More information is available on the National Institute of Child Health and Human Development website.

• Watchful waiting: Many fibroids shrink with time, and most shrink or disappear after menopause. This approach is commonly used by women whose symptoms aren’t severe and whose fibroids aren’t interfering with their urinary system or fertility.

• Hormonal therapies: These are temporary measures to control symptoms; they don’t permanently eliminate the fibroids, and symptoms usually resume when the medications are stopped. Observational studies suggest that hormone-releasing intrauterine devices (such as Mirena) and some oral contraceptives can reduce symptoms. Injections of leuprolide (Lupron) create a temporary menopauselike state by significantly reducing the body’s estrogen production. These medications are mainly used to shrink fibroids before surgery. Their side effects include hot flashes and other menopausal symptoms, and they can cause osteoporosis when used long-term. Antiprogestins, such as mifepristone (RU-486, in doses that are a tiny fraction of the dose used for medical abortions) and ulipristal acetate (Ella, in doses that are a fraction of the dose used for emergency contraception), have shown promise in improving fibroid symptoms, with fewer side effects than leuprolide. Neither is approved for fibroid treatment by the Food and Drug Administration, though both are approved for this indication in Europe.

• Clotting agents: Tranexamic acid (Lysteda) can reduce the heaviness of menstrual bleeding, but it also has the potential to cause clots elsewhere in the body.

• Surgical procedures: Fibroids can be removed through hysterectomy, or removal of the uterus. Another option is myomectomy, in which fibroids are cut from the uterine muscle. A recent article in the Journal of the American Medical Association drew attention to the rare risk of spreading an undetected cancer when surgeons use a myomectomy technique called electric morcellation, in which large fibroids are cut into small pieces so that they are easier to remove. This technique “is used uncommonly, and my guess is it will fall out of favor,” given the risk, Christine Colie of Georgetown said. Another procedure is endometrial ablation, which involves removing the uterine lining with cauterizing or energy-emitting instruments; it should not be done in women who are planning to get pregnant.

• Radiology: Procedures include uterine fibroid embolization, in which blood flow to fibroids is blocked by applying polyvinyl pellets into the uterine artery through a catheter. It should not be done in women who want a future pregnancy. In a newer option, doctors use ultrasound energy to destroy the fibroids. Radiologic procedures generally have a shorter recovery time and a lower risk of complications than surgical procedures, but they aren’t always successful.