If you have troublesome uterine fibroids and want to have children, you may think your options are limited.
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Generally, women in their childbearing years develop uterine fibroids, or benign tumors of muscle and connective tissue. Unfortunately, one common treatment, a hysterectomy, involves removing the uterus.
It’s important to note that fibroids are fairly common and often don’t require treatment. But if you have fibroids causing heavy bleeding, painful intercourse or difficulty getting pregnant, there is good news. Less invasive, non-surgical treatments are available.
In figuring out the best approach, it’s important that you work with your doctor as a team to match medication and treatment options with your reproductive health needs.
Medication can reduce pain, bleeding
No medication can cure uterine fibroids. But some medications can help reduce symptoms like bleeding and pain.
- Hormonal contraceptives, including vaginal ring, shots or birth control pills.
- Tranexamic acid, a nonhormonal medication taken during the menstrual cycle.
- Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen and naproxen.
- Leuprolide acetate, which reduces estrogen production, placing women in temporary menopause. This is used when other medications are not an option.
Contraceptives make sense for a younger, sexually active woman, while an older woman unconcerned about pregnancy may prefer a shorter-course, nonhormonal treatment.
Side effects of the medications are typically mild. Some women notice weight gain, stomach aches, mood changes or breast tenderness.
Doctors avoid using hormone therapy for smokers over the age of 35 or in patients with a history of heart attack, stroke, blood clots or breast cancer.
RELATED: Fibroids Treatment Guide
4 surgical options besides hysterectomy
If medication is not an option or doesn’t help, your doctor may turn to surgery to relieve your symptoms. Aside from a hysterectomy, here are three main procedures to treat uterine fibroids.
1. Myomectomy: In a myomectomy, a surgeon removes fibroids in the uterus or surrounding muscle. Depending on the size and number of fibroids, the physician may use traditional or laparoscopic surgery.
If this treatment is right for you, you will keep your uterus and may still be able to have children. In about 25 percent of patients, the fibroids return over time.
2. Hysteroscopic myomectomy: This is an option for women who have fibroids specifically located in the space of pregnancy. It is an outpatient procedure performed transvaginally that does not cause or require abdominal incisions. It is also a same-day operation.
3. Uterine fibroid embolization: This procedure, which has an 85 percent success rate, is for women who have an enlarged uterus because the fibroids are particularly large.
Doctors use imaging to identify blood vessels feeding the fibroids in the uterus. They then block the blood flow, starving and shrinking the fibroids.
Doctors prefer this procedure for women who no longer want to get pregnant. It increases the risk of pre-term birth, hemorrhage or scar tissue, and makes conception more difficult.
4. Endometrial ablation: Doctors recommend endometrial ablation, which destroys the lining of the uterus, for women with a normal-sized uterus and small fibroids in the muscle.
They choose this procedure for women 45 and older for two reasons:
- Pregnancy is no longer possible after this procedure. Menstrual tissue also eventually grows back, likely causing future problems with pain.
- Endometrial ablation increases the risk of hysterectomy for younger women. A 2009 study found that about 40 percent of women 40 or younger who underwent the procedure later had a hysterectomy. It is also not recommended for women with a high risk of endometrial cancer.
Patients have to be deliberate about what they want with their body. A hysterectomy is the easy choice — you take the uterus out and never have problems again. But this is about individualized patient care and physicians need to have an interest in offering alternatives while employing a team approach.