If you have uterine fibroids, you may or may not need treatment. Treatment may not be necessary if you have fibroids but do not have any symptoms, or if you only have minor symptoms that are not significantly affecting your everyday activities. Fibroids often shrink after the menopause, and your symptoms will usually either ease or disappear completely.
If you have fibroids that need treatment, a GP may recommend medicine to help relieve your symptoms. But you may need to see a gynecologist (a specialist in the female reproductive system) for further medicine or surgery if these are ineffective. Keep in mind that although there are several options available for treating fibroids, a recent study shows that among the three more commonly chosen option none can be considered as a best course of action.
What Medicines Help with Fibroids?
You can take pain relievers, such as ibuprofen. But be sure to follow the instructions on the label so you don’t accidentally take too much. If you and your doctor decide you need to take something for your fibroids, you may want to consider these other options:
. Hormone therapy. To help prevent more growth of the fibroid, your doctor may recommend that you stop taking birth control pills or hormone replacement therapy. But in some cases, your doctor may prescribe birth control pills to help control the bleeding and anemia from fibroids, even though the hormones may cause fibroids to grow.
. GnRH antagonists. GnRH is a hormone your body naturally makes. GnRH antagonists put your body in menopause as long as you take them by surpressing the estrogen which stimulate the growth of uterine fibroids.These drugs are expensive. You shouldn’t take them for more than 6 months because they can make you more likely to get osteoporosis, which makes your bones too frail. Your doctor may also prescribe a low dose of progestin, or a low dose combination estrogen/progestin pill, to make osteoporosis less likely.
. GnRH agonists. Your doctor may prescribe one to shrink fibroids and reduce anemia. They carry the same precautions as GnRH antagonists. And as with GnRH antagonists, when you stop taking a GnRH agonist, your fibroids can grow back. Still another possible option is a medication which combines all three, an GnRH antagonist, estrogen and progesterone.
. SERMs. SERMs are a type of medicine that works on your estrogen levels. (SERMs stands for selective estrogen receptor modulators.) They may be able to shrink fibroids without causing menopause symptoms. But researchers aren’t yet sure how well they work for this purpose.
Will an IUD Help?
An IUD is a birth control device. Some also release the hormone progestin. It won’t shrink your fibroids. But it can control the bleeding and cramping that they cause.
Fibroids Surgical Treatment
Surgery to remove your fibroids may be considered if your symptoms are particularly severe and medicine has been ineffective. Several different procedures can be used to treat fibroids. A GP will refer you to a specialist, who'll discuss the options with you, including benefits and any associated risks. The main surgical procedures used to treat fibroids are outlined below.
A hysterectomy is a surgical procedure to remove the womb. It's the most effective way of preventing fibroids coming back. A hysterectomy may be recommended if you have large fibroids or severe bleeding and do not wish to have any more children.
There are a number of different ways a hysterectomy can be carried out, including through the vagina or through a number of small cuts (incisions) in your tummy (abdomen). Depending on the technique used, a hysterectomy can be carried out using a spinal or epidural anesthetic, where the lower parts of the body are numbed.
Sometimes a general anesthetic may be used, where you'll be asleep during the procedure. You'll usually need to stay in hospital for a few days after having a hysterectomy. It takes about 6 to 8 weeks to fully recover, during which time you should rest as much as possible. Side effects of a hysterectomy can include early menopause and a loss of libido (sex drive). This usually only occurs if the ovaries have been removed.
A myomectomy is surgery to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy if you'd still like to have children. But a myomectomy is not suitable for all types of fibroid. Your gynecologist can tell you whether the procedure is suitable for you based on factors such as the size, number and position of your fibroids.
Depending on the size and position of your fibroids, a myomectomy may involve making either a number of small incisions in your tummy (keyhole surgery) or a single larger incision (open surgery). Myomectomies are carried out under general anesthetic and you'll usually need to stay in hospital for a few days afterwards. You'll be advised to rest for several weeks while you recover. Myomectomies are usually an effective treatment for fibroids, although there's a chance the fibroids will grow back and further surgery will be needed.
Hysteroscopic resection of fibroids
A hysteroscopic resection of fibroids is a procedure where a thin telescope (hysteroscope) and small surgical instruments are used to remove fibroids. The procedure can be used to remove fibroids from inside the womb (submucosal fibroids) and is suitable for women who want to have children in the future.
No incisions are needed because the hysteroscope is inserted through the vagina and into the womb through the entrance to the womb (cervix). A number of insertions are needed to ensure as much fibroid tissue as possible is removed.
The procedure is often carried out under general anesthetic, although local anesthetic may be used instead. You can usually go home on the same day as the procedure. After the procedure you may experience stomach cramps, but they should only last a few hours. There may also be a small amount of vaginal bleeding, which should stop within a few weeks.
Hysteroscopic morcellation of fibroids
Hysteroscopic morcellation of fibroids is a new procedure where a clinician who's received specialist training uses a hysteroscope and small surgical instruments to remove fibroids. The hysteroscope is inserted into the womb through the cervix and a specially designed instrument called a morcellator is used to cut away and remove the fibroid tissue.
The procedure is carried out under a general or spinal anesthetic. You'll usually be able to go home on the same day. The main benefit of hysteroscopic morcellation compared with hysteroscopic resection is that the hysteroscope is only inserted once, rather than a number of times, reducing the risk of injury to the womb. The procedure may be an option in cases where there are serious complications. But because hysteroscopic morcellation is a new technique, evidence about its overall safety and long-term effectiveness is limited.
Which Treatment Is Right for You?
While there are many treatment options for uterine fibroids, there is no clear winner. That means you and your doctor can choose a treatment based on your preferences and reproductive plans along with other medical considerations.
As you decide, ask your doctor:
. Which treatment gives me the best chances of having a healthy pregnancy?
. Which treatment is most likely to offer permanent removal of fibroids?
. What are my personal risks and benefits of medical versus surgical treatment options?
Let your doctor know:
. whether you plan to have more children
. if you’d prefer to keep your uterus, even if your childbearing days are over
. which symptoms you find most bothersome and how they affect your quality of life.
There may be no “best” treatment for uterine fibroids. But there is a best treatment for you.
About Iranian Surgery
Iranian surgery is an online medical tourism platform where you can find the best gynecologists and fertility specialists in Iran. The price of Fibroid Treatment in Iran can vary according to each individual’s case and will be determined by an in-person assessment with the doctor.
For more information about the cost of Fibroid Treatment in Iran and to schedule an appointment in advance, you can contact Iranian Surgery consultants via WhatsApp number 0098 901 929 0946. This service is completely free.