Treatment of uterine fibroids

Revised 2016


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Do all fibroids require treatment?

Not usually, because most patients with fibroids do not have symptoms. However, women with fibroids should have regular checkups to see if the fibroids are changing in size, to discuss any symptoms with their doctor, or if they are planning to get pregnant.

Is surgery the only treatment?

Some fibroids are affected by levels of the hormone estrogen and can be managed with the use of medicine. These medicines may temporarily preclude fertility and have undesirable side effects. For instance, gonadotropin-releasing hormone (GnRH) analog injections can cause hot flashes, vaginal dryness, mood changes, and bone thinning. Birth control pills can cause breast tenderness and blood clots. Progestins can cause bloating and abnormal bleeding from the uterus. Other, nonsurgical treatments are less common and include uterine artery embolization (UAE) and high-intensity focused ultrasound (HiFU) which are reserved for women finished having children. Herbal and homeopathic therapies have not been shown to improve symptoms caused by fibroids.

When is surgery considered?

Surgery is considered when fibroids cause significant symptoms. Surgery should not be considered to treat infertility until other factors that could be causing infertility have been thoroughly evaluated.

What kind of surgery?

For women who wish to get pregnant, surgical removal of the fibroids (myomectomy) is often the best option.

How is myomectomy done? Is there a minimally invasive approach?

There are different types of myomectomies that can be done. The type used depends on the location and size of the fibroids All surgery on the uterus carries the risk of scarring and adhesions which can affect future fertility. Each also carries the risk of excessive bleeding, which may require blood transfusions or, when life-threatening, a hysterectomy (surgical removal of the uterus).

Abdominal myomectomy (Laparotomy)

With this method, the surgeon makes an incision (surgical cut) in the abdomen. The cut can be 3-5 inches long or more. It is usually used to remove tumors on the outer surface of the uterus and surrounding organs. This surgery may require a short hospital stay and up to 4-6 weeks of recovery at home.

Laparoscopic myomectomy

The surgeon places a lighted telescope (laparoscope) into the abdomen through a small cut (usually less than ½ an inch) near the belly button. He/she uses surgical instruments placed through other small incisions in the abdomen to remove the fibroids. Women can be sent home from the hospital the day of the procedure or within 24 hours. Recovery time is usually 2-7 days.

Hysteroscopic myomectomy

This procedure is used for fibroids found in the inside of the uterus. The doctor inserts a lighted telescope (hysteroscope) into the uterus through the vagina. He/she fills the uterus with fluid to inflate the uterus. Surgical instruments are inserted through a sheath in the hysteroscope to remove the fibroids. Generally, women are sent home the day of surgery and can return to their normal activities within a few days. Serious complications are rare and include damage or scarring to the inside cavity of the uterus, electrolyte imbalance (changes in the minerals in the blood system), puncturing the uterus, and bleeding.

Robotic assisted myomectomy

During a robotic procedure, a doctor places a telescope into the abdomen at or above the navel. Up to five other small incisions are made to hold the instruments to remove the fibroids. The instruments are controlled using robotic instruments. For more information about robotic surgery, please see the ASRM fact sheet titled Robotic surgery. Women usually go home the same day or within 24 hours. Recovery time is between a few days and a week.

When can I start trying to get pregnant after a myomectomy?

Although recovery time varies with the type of surgery and typically is short, the uterus needs time to heal and it may be 1-6 months before you are given the green light to attempt pregnancy.

What is the chance that the fibroids will return after surgery?

This risk of new fibroids growing back after surgery is about 30% over 10 years. Women with more than one fibroid are more likely to have fibroids return than women with a single fibroid.

Are there other treatment options if I don’t want to get pregnant?

Myolysis:

Another laparoscopic technique called myolysis involves burning the fibroids through heat and cold energy via needles or lasers.

MrgFUS:

A method which does not involve an incision is called MRIguided focused ultrasonic treatment (MrgFUS). As this is a relatively new technology, there is limited information about long-term outcomes. At this time, MrgFUS cannot be recommended for women hoping to maintain or improve their fertility.

Uterine artery embolization:

Uterine artery embolization is performed by a radiologist. It involves injecting small particles into the uterine blood vessels to clog the small blood vessels that supply the fibroids. This cuts off the blood supply and causes the fibroids to shrink. Women generally experience several days of pain after the procedure. Fibroid volume shrinks by 40-50%, and most women experience relief from their symptoms. At this time, it is not recommended for women wanting to get pregnant in the future.

Hysterectomy:

About half of all hysterectomies (surgical removal of the uterus) are done to treat uterine fibroids. Hysterectomy is most appropriate for women with symptoms who don’t wish to get pregnant later.

Hysterectomy can be done through the abdomen, the vagina, or using a laparoscope. Recovery time is usually 2-6 weeks. Hysterectomy can have consequences on sexuality, psychological wellbeing, and health. It is important to discuss these potential issues with your healthcare professional.

Fibroids or Myomas or Leiomyomas

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SART Fertility Experts - Fibroids and Fertility

Fibroids and their impact on fertility are discussed in this episode featuring Dr. Elizabeth Stewart, interviewed by host Dr. Brooke Rossi.  Listen to the Episode
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Fibroid Tumors

An educational video that answers patient questions about the causes, symptoms, diagnosis and management of uterine fibroids. Watch Video
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Fibroids and Fertility

Uterine fibroids are benign (noncancerous) tumors of muscle tissue in the uterus. They are also called myomas or leiomyomas. View the Fact Sheet
Patient Ed Icon

What are fibroids?

Uterine fibroids (also called myomas or leiomyomas) are benign (noncancerous) tumors of muscle tissue found in the uterus. View the fact sheet
Videos Icon

Causes of Female Infertility

Dr. Roger Lobo, of the American Society for Reproductive Medicine explains the causes of female infertility. Watch Video
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Fibroids or Myomas or Leiomyomas Infographics

ASRM has prepared infographics to illustrate the subject of Fibroids better. View the infographics

Surgery (reproductive)

Podcast Icon

SART Fertility Experts - What is an REI?

These experts in infertility lead IVF programs, perform reproductive surgery, and perform research to enhance the field of reproductive medicine. Listen to the Episode
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SART Fertility Experts - Tubal Surgery in the IVF Era

In this episode of SART Fertility Experts, Dr. Brad Hurst and Dr. Mark Trolice, to review the indications for tubal surgery. Listen to the Episode
Patient Ed Icon

Infertility: an Overview (booklet)

Infertility is typically defined as the inability to achieve pregnancy after one year of unprotected intercourse. View the booklet
Patient Ed Icon

Laparoscopy and Hysteroscopy

Laparoscopy and hysteroscopy can be used for both diagnostic (looking only) and operative (looking and treating) purposes. View the booklet
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Intrauterine adhesions: what are they?

The inside of the uterus is like a balloon with the front and back
walls flat against each other. View the fact sheet
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Dilation and Curettage (D&C)

“Dilation and curettage” (D&C) is a short surgical procedure that removes tissue from your uterus (womb). You may need this procedure if you have unexplained or abnormal bleeding or if you have delivered a baby and placental tissue remains in your womb. View the Fact Sheet
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Minimally invasive surgery

Surgery is termed “minimally invasive” if it uses small or no incisions (cuts). View the fact sheet
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Robotic Surgery

Robotic surgery is a form of laparoscopy. View the fact sheet
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Varicocele

A varicocele is a variation of normal anatomy in which veins in the scrotum (the sac that holds the testicles) become enlarged and sometimes even visible. View the fact sheet
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Conditions Treated with Adnexal Surgery

Surgery can be used to treat problems with your ovaries or fallopian tubes such as cysts, endometriosis or infections. Adnexal surgery involves any of the organs that are on the sides of (“next to”) the uterus (womb), such as the fallopian tubes and ovaries.

  View the Fact Sheet
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Nonhormonal Contraception

Despite a large number of contraceptive options available to couples, it is still thought that 50% of pregnancies in the United States are unintended. View the fact sheet

Fact Sheets/Booklets

View more fact sheets and booklets written by the ASRM Patient Education Committee.
Patient Booklet teaser

Assisted Reproductive Technologies (booklet)

This booklet will help you understand in vitro fertilization (IVF) and other assisted reproductive technology (ART) that have become accepted medical treatments for infertility.
Patient Factsheet teaser

Hormonal Contraception

Hormonal contraceptives contain a progestin (progesterone medicine) with or without an estrogen.
Patient Factsheet teaser

What do I need to know about Zika virus and trying to have a baby?

Common symptoms include fever, rash, joint pain, conjunctivitis (red eyes), muscle pain, and headache.
Patient Booklet teaser

Third-Party Reproduction

The phrase “third-party reproduction” refers to involving someone other than the individual or couple that plans to raise the child (intended parent[s]) in the process of reproduction.

Resources For You

The American Society for Reproductive Medicine (ASRM) is committed to providing patients with the highest quality information about reproductive care.

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