Do uterine fibroids have to be removed?

No, uterine fibroids do not have to be removed in all cases. Uterine fibroids are only surgically removed in severe cases that do not respond to medication.

If you are experiencing common symptoms associated with fibroids — such as heavy or abnormal bleeding, pelvic pain or fullness, painful sex or frequent urination — your doctor may order imaging tests or perform one of the following diagnostic surgical procedures:

• Laparoscopy: A surgeon will make a small incision near your navel, then insert a long, thin, lighted instrument called a laparoscope that has a camera on the end to view your uterus and nearby structures, taking pictures as needed in order to detect fibroids.
• Hysteroscopy: A surgeon will insert a long, thin, lighted instrument called a hysteroscope into your vagina and through the cervix to look for fibroids. Sometimes, a camera is used to take pictures.

If fibroids are confirmed and medication does not work to relieve your symptoms, surgery may be considered, but the type of surgery you have depends on the location and size of the tumor, as well as your symptoms.

Options may include:

• Myolysis: Fibroids are destroyed via freezing or an electrical current with a needle that is guided into the tumors.
• Myomectomy is commonly performed to remove fibroids that are located inside the uterus; this surgery is a viable option if you are planning to become pregnant, but it will not prevent the growth of new fibroids. Once inside, an electrical wire loop resectoscope or morcellator blade cuts and breaks down the fibroid. The procedure can be performed surgically via an abdominal myomectomy or by laparoscopy or hysteroscopy. Of these, abdominal myomectomy is the most invasive procedure.
• Endometrial ablation is a surgical procedure to remove the lining of the uterus; in half of patients who have endometrial ablation, menstruation stops entirely. This works best if fibroids are small but cause heavy bleeding, but you will not be able to become pregnant after the procedure.
• Uterine artery embolization: If fibroids are large, a procedure to cut off the blood supply to the fibroids by blocking nearby blood vessels may be performed; this shrinks the fibroids and causes them to die. It is an option if you aren’t planning to have more children and you want to avoid surgery, but the procedure won’t stop the growth of new fibroids in the future.
• Hysterectomy: This surgery involves removal of the uterus entirely. It may be indicated if medication does not work to manage your symptoms and no other surgical options are available in your specific case. You will not be able to become pregnant after the procedure.

Medications

Before surgery is recommended, you may be prescribed medications to see if the fibroid will shrink.

If you are experiencing uncomfortable symptoms from fibroids, your doctor may first recommend medications such as:

• Levonorgestrel-releasing intrauterine system (LNG-IUS)
• Tranexamic acid
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Birth control pills
• Progesterone

These medications can significantly reduce blood loss.

If these medications are not successful at relieving your symptoms, medications to decrease hormone production — such as gonadotropin-releasing hormone (GnRH) analogues — may be used in order to shrink your fibroids. Sometimes, this therapy is used prior to surgery to remove fibroids.