Treatments for Fibroids

If you consult a mainstream doctor for fibroids, the first thing you typically receive is a pregnancy test to rule out the possibility that you’re carrying a fetus, and not a fibroid.

The next step is usually an endometrial biopsy, to check for uterine cancer.

Once those two possibilities have been eliminated, you may also have an ultrasound exam and possibly other test to confirm your diagnosis, and to show where there are in your uterus.

Mainstream medicine offers three treatment options: watchful waiting, drugs, or surgery. “Fibroids often grow during your perimenopausal years,” Dr. Simons explains, “and then shrink as you become menopausal. If your fibroids are not causing much discomfort, you might decide to just live with them until menopause shrinks them naturally. If you have heavy periods, you can take an iron supplement.”

Drug treatment for fibroids is aimed at suppressing the estrogen that makes them grow. Two popular drugs are leuprolide (Lupron) and nafarelin (Synarel), both of which reduce estrogen by increasing secretion of gonadotropin-releasing hormone (GnRH). Recent studies show that they can shrink fibroids by up to 50 percent, according to Samantha Pfeifer, M.D., an assistant professor of obstetrics and gynecology at the University of Pennsylvania School of Medicine in Philadelphia. The problem is that these drugs cause menopausal symptoms–hot flashes, vaginal dryness, and possibly insomnia and pain on intercourse–not to mention that they cost more than $300 a month. A chearper option is the female sex hormone, progesterone, which can shrink fibroids up to 25 percent.

For fibroids that cause severe symptoms, surgery is your last resort. The conservative approach, myomectomy, removes just your fibroids and leaves your uterus intact. A number of different procedures have been developed, some vaginal, some abdominal. But myomectomy may not be possible if you have lots of fibroids or if they are hard to reach. Furthermore, if you have a myomectomy, there’s a 25 percent chance your fibroids will recur. Scientists aren’t sure if recurrences are new fibroids or growth of small ones that were there all along, but missed during your myomectomy. Ether way, if your fibroids return, you might need more surgery.

The other surgical alternative is hysterectomy. It’s more radical, but there’s no risk of fibroid regrowth because you no longer have your uterus. Fibroids account for about one-third of the 550,000 hysterectomies performed in the U.S. each year. If you have your ovaries removed, you may suffer a loss of libido afterward because your ovaries make hormones (androgens, notably testosterone) that fuel women’s sex drive. Supplemental androgens can treat this problem.

“There’s rarely any urgency to treating fibroids,” Dr. Simons says. “Get several opinions, and don’t rush into surgery.”

Red Flags

If you have fibroids, beware of sudden sharp pelvic pain. It might mean that one of your fibroids has become twisted enough to cut off its own blood supply. That’s a potential medical emergency. Call your doctor right away. You may need immediate surgery to remove the strangled fibroid.