There are many treatment options but there is no single “best” treatment for fibroids. Treatment options range from no treatment at all to surgery. There is no clear winner of one treatment over the other but in discussion with a urologist specialist in Chennai, the most suitable treatment for fibroids may be chosen as the best for the individual, based on preferences, reproductive plans, and medical considerations.
When to treat fibroids ?
Treatment may not be a necessity if a woman has fibroids but does not have any symptoms, or has only minor symptoms that are not significantly affecting everyday activities. The need for fibroid treatment from a urologist specialist does not arise unless fibroids are causing excessive bleeding, discomfort, or bladder problems. If fibroids are not causing such major symptoms as in most women, no treatment is needed.
All fibroids may not grow. Fibroids that do grow do not indicate the need for treatment unless the growth is accompanied by disabling symptoms. Even large fibroids may not cause any symptoms, and most shrink after menopause. The choice for best treatment arises on whether the growing fibroid causes any problems. The urologist specialist can check on the growth of the fibroid, especially if symptoms like bleeding or pain may develop. Pelvic examination done every year with the best urogynecologist can keep track of the fibroid growth and likely symptoms so as to plan for treatment if necessary.
What are the symptoms that indicate treatment for fibroids ?
Many women have uterine fibroids sometime during their lives but most uterine fibroids cause no symptoms or only mildly annoying signs and symptoms that they can live with. If noticeable symptoms do occur, they can be influenced by the location, size, and a number of fibroids. Common signs and symptoms of uterine fibroids include:
- Severe menstrual bleeding
- Menstrual periods extending longer than a week
- Pelvic pain or feeling of pressure
- More frequent urination
- Difficulty in emptying the bladder
- Low back pain or pain in the legs
Factors that influence the choice of best treatment for fibroids
Information on the symptoms that affect the woman’s quality of life will guide in choosing the best treatment for her. Some questions that may provide such information are:
- is the woman missing work ?
- are there frequent hospitalizations ?
- is daily life affected ?
- is the woman likely to have children ?
- which treatment gives the best chance of having a healthy pregnancy ?
- which treatment offers permanent removal of fibroids ?
- her age – how close she is to menopause ?
- Does the woman prefer to retain the uterus for later years ?
- What are the personal risks vs benefits of various treatment options ?
Best treatment options for fibroids
The severity of symptoms and the impact of those symptoms on a woman’s quality of life are to be considered as the foundation of treatment for decision making. Various treatments available for fibroids include:
Medicines to reduce heavy periods – They work by stopping the small blood vessels in the womb lining from bleeding, reducing blood loss by about 50%. These can be less effective if the size of the fibroids is larger.
Contraceptive pills – This method makes bleeding lighter and can help reduce menstrual period pain.
Hormonal analogs to shrink fibroids – They work by affecting the pituitary gland to stop the ovaries from producing oestrogen. They are often used to help ease heavy periods and any pressure felt on the stomach in the treatment of fibroids. They also help improve symptoms of frequent urination and relieve constipation and are also used to shrink fibroids prior to surgery to remove them.
Intrauterine systems – Devices placed in the womb slowly release hormones that stop the womb lining from growing quickly. With thinner lining, bleeding becomes lighter. This system also works as a contraceptive device but the ability to conceive is restored once the device is removed.
If symptoms are severe and if medicines have been ineffective in controlling the symptoms, surgery may be considered to remove the fibroids. There are several different procedures that can be adopted to remove fibroids. A urologist specialist can recommend the options including benefits and any associated risks. Some of the main surgical procedures used to treat fibroids are:
Hysterectomy – The surgical procedure removes the womb as the most effective way of preventing fibroids from coming back. It is recommended in women with large fibroids or severe bleeding and who do not wish to have any more children. There are many techniques to carry out the procedure.
Myomectomy – In women who wish to still have children, this is an alternative surgery to hysterectomy where only the fibroids are removed from the wall of the womb. An urologist specialist can tell whether the procedure may be suitable based on factors such as the size, number and position of your fibroids.
Hysteroscopic resection of fibroids – A hysteroscope is inserted through the vagina and into the womb to remove the fibroids. Multiple insertions are needed to remove as much of fibroid tissues as possible.
Hysteroscopic morcellation of fibroids – An urogynecologist with specialist training uses a hysteroscope and small surgical instruments to be inserted only once to remove fibroids and thus avoid chances of injury to the womb.
Minimal invasive procedures
These treatment methods can be safely used to treat all types of fibroids with high long-term benefits and minimal risks but may not be suitable to women who wish to save their fertility.
Uterine artery embolization – involves blocking the blood vessels that supply the fibroids, causing them to shrink.
Endometrial ablation – is a minor procedure that removes the lining of the womb by using laser energy, a heated wire loop or hot fluid in a balloon.
MRI-guided focused ultrasound surgery is to safely and effectively remove uterine fibroids and preserves the uterus, which requires no incision and is done on an outpatient basis.
Prior to the treatment plan for fibroids, a complete fertility evaluation and assessment of risks and benefits of various procedures is recommended.
Discuss the risks and benefits with you so you can make an informed decision.