Uterine Fibroids Treatment: Options, Surgery & Remedies

What is Uterine Fibroids?

Uterine fibroids are the non-cancerous growths of the uterus that develop from its muscular tissues and are medically known as leiomyomas. These growths can develop in any part of the uterus, influencing the symptoms the patient experiences. These symptoms may include heavy and/or prolonged periods, pain in the lower abdomen, frequent urination, and even fertility issues. Essentially, their location in the uterus also divides it into its major types, which include:

• Intramural fibroids; these develop inside the wall of the uterus.
• Submucosal fibroids; these grow into the cavity of the uterus, which is where a pregnancy is developed.
• Subserosal fibroids; these often grow on the outer surface of the uterus

Interestingly, uterine fibroids are mostly asymptomatic for a large population of women experiencing this condition. This makes routine pelvic exams or imaging tests a necessity to diagnose uterine fibroids. Moreover, the exact cause of uterine fibroids remains unclear. However, it is assumed that they often develop from the hormonal activity of estrogen and progesterone.

How to Treat Uterine Fibroids with Medications?

Medications are usually the first line of defence against uterine fibroids, but only in their early or mild stages. These treatments mainly focus on managing symptoms and temporarily shrinking fibroids by interfering with the body's hormonal system. Medications generally used may include:

• Oral Contraceptive Pills: Over-the-counter oral contraceptives can help manage heavy bleeding and pelvic pain during the monthly cycle.
• Iron Supplements: If you are experiencing anaemia-like symptoms due to heavy bleeding during periods, your healthcare provider may suggest you take some iron supplements to cope with iron deficiency.
• Gonadotropin-releasing hormone (GnRH) agonists: These are used because the growth of fibroids is mainly controlled by the amounts of estrogen and progesterone in the body. These agonists work by lowering or reducing hormone levels, which can help shrink fibroids. This treatment is often used before surgery.
• Gonadotropin-releasing hormone (GnRH) antagonists: GnRH antagonists are used to manage heavy menstrual bleeding for those who haven’t gone through menopause yet. However, unlike agonists, these do not shrink the fibroid.
• Progestin-releasing intrauterine device (IUD): High-dose progestin IUDs can also be prescribed when the goal is to control abnormal menstrual bleeding due to fibroids. However, note that this device can prevent pregnancy and is not able to shrink or permanently cure uterine fibroids.

What Are Minimally Invasive Treatments for Fibroids?

Minimally invasive treatments are those that do not require large cuts or incisions to access the area being treated. These treatments are used when medications do not work enough to control symptoms or shrink uterine fibroids. One of the benefits of these procedures is their faster recovery times. This group of treatments include:

• Uterine Artery Embolisation: The procedure works on the principle of blocking the blood supply that uterine fibroids need to grow and thrive. It is done by injecting tiny particles into the arteries leading to fibroids. That is, fibroids need proper blood flow to grow. Therefore, blocking blood flow can help cut off their nutrient supply, eventually causing them to shrink.
• MRI-guided focused ultrasound surgery (FUS): FUS is more of a non-invasive procedure than a minimally invasive one. It works by using high-intensity ultrasound waves to heat and eventually destroy fibroid tissue without harming the surrounding healthy tissue. It is MRI-guided, helping doctors target the precise site of fibroids.
• Radiofrequency ablation: In this procedure, doctors use thermal energy from radiofrequency to destroy fibroids and their supporting blood vessels. It is done by making two small cuts on the abdominal area and using a laparoscopic camera to find the exact location of the fibroid and then destroying it with small, specialised needles.
• Laparoscopic myomectomy: Laparoscopy is used to remove fibroids without hurting the uterus itself. The procedure involves using a laparoscope, a device with a camera, and inserting it into the area of the fibroids through a small incision in the abdomen. Note that if the fibroid is too large, another pre-procedure may be advised to break it into smaller pieces.
• Hysteroscopic myomectomy: This procedure is specifically used when the fibroid is inside the uterus. In hysteroscopic myomectomy, a hysteroscope is inserted into the location of the fibroid via the vaginal opening and cervix.
• Endometrial Ablation: This procedure is used for women with very heavy menstrual bleeding. It includes destroying the endometrial lining of the uterus, completely stopping the menstrual flow. However, women who wish to get pregnant in the near future must not opt for this procedure.

When Is Surgery Needed to Treat Uterine Fibroids?

A conventional surgery may be needed when the uterine fibroids become very large, cause severe symptoms and do not get better with other treatments. These surgeries are recommended only when fibroids become extremely large, causing persistent lower pain, heavy bleeding, pressurising other organs, and worst of all, affecting fertility. There are two options in traditional open surgeries, which include:

• Myomectomy: This is an open surgery procedure in which fertility is preserved by preserving the uterus itself. However, it includes a large incision on the abdomen to cut open the uterus and directly remove the fibroids. This preserves the prospect of women getting pregnant.
• Hysterectomy: Though every treatment is very effective in treating fibroids, hysterectomy is considered the only effective treatment for the condition all along. This procedure involves removing the whole uterus, along with sometimes the ovaries, which completely eliminates the possibility of fibroids returning. However, this procedure completely nulls the possibility of getting pregnant for women; therefore, it is only recommended for women who do not wish to get pregnant in future.

Can Home Remedies Help Manage Uterine Fibroids?

Uterine fibroids generally do not show any symptoms, never interfere with pregnancy, and tend not to grow and shrink after menopause on their own. Therefore, careful monitoring is recommended before proceeding with any treatment option. So, if it's not bothering you much, then leave it be and watch them disappear on their own when the time comes.

Till then, you can use the following strategies to deal with the pain and discomfort it may cause:

• Take a Balanced Diet: A balanced diet of whole grains, lean proteins, fruits, and vegetables may help you maintain balanced hormones and promote good health.
• Working on maintaining a healthy weight: If you have too much body fat, then you have increased amounts of estrogen, which might be the cause of your fibroids growing. Maintaining a healthy weight through healthy eating habits and regular exercise can benefit you.
• Regular exercise: It can help regulate your hormones, improve blood flow, & support overall reproductive health.
• Reducing stress: Studies have found that yoga, meditation, and relaxation techniques might help reduce stress and hormone levels.
• Heat Therapy: Placing a heating pad on your lower abdomen may help reduce pelvic pain and/or menstrual cramps caused by uterine fibroids.

Note that these remedies are only means of giving you comfort from heavy bleeding and pelvic pain and do not remove or shrink fibroids.

Are there any risks of fibroid treatment?

Long story short: Yes, just like any other medical treatment, uterine fibroid treatment procedures also carry certain risks and/or side effects. These risks largely depend on the treatment method used, the size and location of fibroids, and, of course, the patient's own health. These may include:

• Medication Side Effects: Hormone therapy can lead to many unintended side effects, like hot flashes, mood changes, headaches, and decreases in bone density if used long-term.
• Recurrence of Fibroids: Fibroids often recur after a myomectomy, particularly in younger women.
• Risk of Surgery: All surgeries are risky; however, hysterectomy and myomectomy carry typical surgical risks, such as infection, haemorrhage, and reaction to anaesthesia.
• Impact on Fertility: Fertility or future pregnancy outcome may be impacted based on the type of treatment a woman pursues. Hence, the decision for any treatment option is often made based on whether the woman desires to have children, either now or later.
• Procedure-Related Complications: A minimally invasive procedure, such as Uterine Artery Embolisation, may cause temporary discomfort during the postoperative recovery period.

These risks do not mean that these treatments are unsafe or ineffective; in hindsight, they have significantly improved the quality of life for many women.

Are there any risks of fibroid treatment?

Long story short: Yes, just like any other medical treatment, uterine fibroid treatment procedures also carry certain risks and/or side effects. These risks largely depend on the treatment method used, the size and location of fibroids, and, of course, the patient's own health. These may include:

• Medication Side Effects: Hormone therapy can lead to many unintended side effects, like hot flashes, mood changes, headaches, and decreases in bone density if used long-term.
• Recurrence of Fibroids: Fibroids often recur after a myomectomy, particularly in younger women.
• Risk of Surgery: All surgeries are risky; however, hysterectomy and myomectomy carry typical surgical risks, such as infection, haemorrhage, and reaction to anaesthesia.
• Impact on Fertility: Fertility or future pregnancy outcome may be impacted based on the type of treatment a woman pursues. Hence, the decision for any treatment option is often made based on whether the woman desires to have children, either now or later.
• Procedure-Related Complications: A minimally invasive procedure, such as Uterine Artery Embolisation, may cause temporary discomfort during the postoperative recovery period.

These risks do not mean that these treatments are unsafe or ineffective; in hindsight, they have significantly improved the quality of life for many women.

When to Consult Your Doctor

Uterine fibroid treatments work best when given early in the phase. Therefore, understanding your signs is a major call to determining the success of your treatment. This means you need to seek medical help and consult your doctor when you experience the following signs:

• Heavy and longer than usual bleeding, which is interfering with your daily activities and causing fatigue.
• Constant pain or pressure in the lower abdomen.
• Difficulty in urinating or having to go to the loo in a short interval.
• Abdominal swelling without any usual cause.
• Unbearable cramps which are not relieved by regular menstrual medications.
• Sudden change in your monthly cycle.

Conclusion

Finally, we can conclude that uterine fibroids are a very common gynaecological condition worldwide, making it important to understand how to treat and manage them effectively. In this article, we have learned that a large number of treatments are available in medical science; however, the one best suited to an individual makes them successful. That is, medications can help regulate and manage uterine fibroids symptoms, minimally invasive surgeries can help shrink them, whereas major surgeries are used for severe or large fibroids. Lastly, we have learned that this condition often resolves on its own without intervention; therefore, watchful monitoring is generally considered the first step in treating uterine fibroids.