Uterine fibroids are very common. These non-cancerous growths can cause heavy bleeding, pressure in the belly, or pain during sex, but not always. Some women don’t even realize they have them. So, what’s the best way to treat them? That depends on your symptoms, your age, and whether you plan to have children in the future.
- how medications can shrink fibroids
- procedures like a myomectomy that remove the fibroids but preserve the uterus
- when a hysterectomy might be needed
- devices like an intrauterine device (IUD) that can ease symptoms without surgery.
About uterine fibroids
What are uterine fibroids?
Uterine fibroids are growths that develop from fibroid tissue in or around the uterus. They’re also called leiomyomas. These are made from muscle and connective tissue, and they’re not cancerous. Most fibroids grow slowly, and many women don’t have any symptoms at all. However, some fibroids grow large enough to cause pain, pressure, or bleeding.
What are the signs and symptoms of uterine fibroids?
The symptoms of fibroids vary depending on their size and location. Some common symptoms include:
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Heavy or prolonged menstrual bleeding
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Pelvic pain or pressure
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Frequent urination
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Pain during sex
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A feeling of fullness or bloating
Women in their 30s and 40s are more likely to be affected, especially if fibroids run in the family. Fibroids can also make it harder to get pregnant in some cases.
About treating uterine fibroids
What FDA-approved treatments for uterine fibroids are available?
Several FDA-approved treatments are available for fibroids. One option is medication, such as gonadotropin-releasing hormone (GnRH) agonists, which lower estrogen levels and can shrink fibroids before surgery. Examples are Lupron/Lucin, and Zoladex. Hormonal birth control (including an intrauterine device or pill) can also help reduce bleeding. For women who need surgery, myomectomy (which removes the fibroids but keeps the uterus) and hysterectomy (removal of the uterus) are both approved options.
How do current treatments help uterine fibroids? 
These treatments aim to shrink the fibroids, control bleeding, or remove the fibroid tissue. Medicines like GnRH agonists work by putting the body into a temporary menopause-like state, which causes fibroids to shrink. Myomectomy and hysterectomy are surgical options that remove the fibroids or the uterus itself. Hormonal treatments can help reduce symptoms, but usually don’t remove the fibroids entirely. Most treatments are chosen based on symptoms and the woman’s fertility goals.
Are there off-label treatments for uterine fibroids?
Yes, some medications used off-label include certain types of anti-hormonal pills or injections that are not specifically approved for fibroids but may help reduce symptoms. For example, Ella (ulpristal acetate) has been used in other countries to manage fibroids but is not FDA-approved in the U.S. Some doctors may also use pain relief medications or iron supplements to manage symptoms indirectly.
What are the most common side effects of treatments for uterine fibroids?
Side effects depend on the treatment:
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GnRH agonists: hot flashes, mood swings, bone thinning
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Hormonal IUDs: irregular bleeding, breast tenderness
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Birth control pills: nausea, headaches, mood changes
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Myomectomy: recovery time, possible scarring inside the uterus
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Hysterectomy: permanent loss of fertility, surgical risks
It’s important to talk to a healthcare provider about which side effects are most relevant to your situation.
Conclusion
Uterine fibroids are common, and for many women, they don’t cause problems. But when symptoms like heavy bleeding or pelvic pain start to interfere with daily life, it’s worth exploring your treatment options. FDA-approved choices range from medications that shrink fibroids to surgeries that remove the fibroids completely. Some treatments help you keep your uterus, which can be important if you want children in the future. Others focus more on long-term symptom relief.
Hormonal options like gonadotropin-releasing hormone agonists or an intrauterine device are often used to control symptoms without surgery. For women with more serious problems, surgery like myomectomy or hysterectomy may be the best choice. And while off-label treatments exist, they’re usually considered when standard options aren’t suitable.
There’s no single “best” treatment for every woman. It depends on your symptoms, age, and whether you’re planning to get pregnant. But with today’s wide range of fibroid treatments, most women can find an approach that helps them feel better and get back to life.
Frequently asked questions about uterine fibroids
What is the gold standard treatment for fibroids?
The “gold standard” treatment varies from person to person. For women who still want to have children, a myomectomy is often preferred. This surgery removes the fibroids but keeps the uterus intact. If someone has completed their family or has severe symptoms, a hysterectomy (removal of the uterus) may be recommended. While a hysterectomy is the only permanent cure, it’s a big decision and not right for everyone. Other treatments, like hormone therapy or uterine artery embolization, are also effective but may not be considered the “gold standard” for every case.
What happens if fibroids go untreated?
Some fibroids don’t need treatment, especially if they’re small and don’t cause symptoms. But if they’re left untreated and they grow, they can cause problems. These might include very heavy periods, anemia from blood loss, pain, bladder or bowel pressure, and even issues with fertility or pregnancy. In rare cases, untreated fibroids can twist or outgrow their blood supply, causing sudden pain. It’s important to keep track of symptoms and get regular checkups.
Can you get rid of uterine fibroids without surgery?
Yes, some treatments don’t involve surgery. Medications like gonadotropin-releasing hormone agonists can shrink fibroids, though the effect may not last after stopping the medicine. An intrauterine device can help control bleeding but doesn’t make fibroids go away. Uterine artery embolization is a non-surgical procedure that blocks blood flow to fibroids, causing them to shrink. Focused ultrasound therapy is another non-invasive option. These treatments don’t work for everyone, but they can be helpful for people who want to avoid surgery.
Is it better to shrink fibroids or to surgically remove them?
That depends on your situation. Shrinking fibroids with medication can be a good short-term option, especially if you’re not ready for surgery or want to reduce symptoms quickly. However, medications often need to be stopped eventually, and the fibroids may return. Surgically removing fibroids, like with a myomectomy, is more permanent but involves recovery time and potential risks. Some people prefer to start with less invasive treatments and move to surgery only if needed. The best choice is the one that fits your needs, symptoms, and life plans.
Do fibroids grow back after treatment?
Fibroids can come back after treatment, especially if you have a myomectomy and still have your uterus. Hormonal treatments may delay regrowth, but they don’t prevent it completely. A hysterectomy is the only treatment that guarantees fibroids won’t return.
Can fibroids cause infertility?
Yes, fibroids can affect fertility, especially if they distort the shape of the uterus or block the fallopian tubes. But many women with fibroids still get pregnant naturally. Treatment may improve fertility depending on where the fibroids are located.
What size fibroids need surgery?
There’s no specific size that always requires surgery. Surgery is usually considered when fibroids are causing serious symptoms—like pain, heavy bleeding, or pressure—or if they’re interfering with fertility. Your doctor will base this decision on symptoms, not just size.
Are fibroids common in women over 40?
Yes, fibroids are especially common in women between 35 and 50. Hormonal changes during this time can cause fibroids to grow. Many women first notice symptoms in their late 30s or early 40s.
