There are oral medications that can be used to control fibroid symptoms such as combined estrogen/progesterone contraceptives, progesterone only pills, tranexamic acid and gonadotropin receptor antagonists (like Myfembree and Oriahnn). There are also injectable medicines including long acting progesterone (Depo Provera) and a long acting gonadotropin receptor agonist (Lupron). Finally, a progestin containing IUD (such as Mirena or Kyleena) or implant (Nexplanon) can also be helpful in managing bleeding associated with fibroids for some patients. These strategies are primarily aimed at reducing heavy bleeding associated with fibroids, but can also decrease fibroid size or at least slow their growth.
Uterine artery or uterine fibroid embolization is a procedure in which the blood flow to the uterus and/or fibroids is occluded or diminished. This procedure is accomplished by our interventional radiology colleagues who deploy material into the uterine arteries to block blood from feeding fibroids. This can lead to fibroid shrinkage and thereby improve fibroid related symptoms.
Sometimes fibroids are located mostly or entirely within the uterine cavity, when this is the case, operative hysteroscopy becomes a helpful management strategy. With operative hysteroscopy, a small camera is inserted into the uterus through the cervix to directly visualize intrauterine fibroids. A resection device (such as Myosure) can then be introduced and fibroids removed under direct visualization. Removing fibroids that involve the endometrial lining can be helpful to reduce fibroid related bleeding.
There are newer technologies coming onto the scene to treat fibroids with radio frequency ablation. One of these employs laparoscopic surgery and a needle array to ablate uterine fibroids with real-time ultrasound and laparoscopic visualization (Acessa). Another radio frequency ablation technique uses a device introduced into the uterine cavity hysteroscopically (through the cervix) to view and treat fibroids with ultrasound from that perspective (Sonata). Radiofrequency ablation decreases fibroid size over time, thereby reducing bleeding and/or bulk symptoms.
Myomectomy, or surgical fibroid removal, can be accomplished with either open surgery or minimally invasive surgery (laparoscopy or robotics). Fibroid size and location, as well as surgeon comfort and experience, are the key factors when selecting which approach to use. Myomectomy is generally done for patients who desire future childbearing and who are not good candidates for other less invasive approaches.
Definitive management of uterine fibroids is hysterectomy, surgical removal of the uterus. Hysterectomy can be performed via an open approach, laparoscopically or robotically, or vaginally. Again, the route of hysterectomy that is appropriate will depend on fibroid location and size, patient factors and surgeon preference.
Fibroid management is not “one size fits all” and often a combination of, or progression through, the above strategies is needed. Talk with your Kamm McKenzie provider about your fibroids and we can advise you about the best options for your unique situation!