Fibroid Treatment Options
If you’ve gotten a fibroid diagnosis, it’s important to know that you have options. Educate yourself to fully understand what kinds of fibroid treatments are available, and advocate for yourself to get the care you need. Ask your doctor if these options might be right for you. And if your doctor isn’t taking you seriously, don’t be afraid to seek out other options.
I had to educate myself, ask smart questions about my treatment options, ask my doctor to explain why they weren’t suggesting less invasive options, and advocate for the care I wanted and needed. My HMO was pushing me to get a hysterectomy, when that really wasn’t necessary. I’m glad that I took the time to fully learn what my options were, and to instead seek a treatment that was less invasive, far less intense, and that dramatically improved my life. For some people, though, a hysterectomy is the right choice. I saw it as a last resort and wanted to avoid it at all costs.
Remember that your body belongs to you. It’s your body, and you get to make the choice about what happens to it.
Keep reading to learn:
When is treatment necessary for fibroids?
Around 25%¹ of people in the United States with uterine fibroids have symptoms so bad that it requires treatment.
Not everyone needs or chooses to have their fibroids treated. If you’re one of the lucky ones who have small, painless fibroids that aren’t growing and aren’t interfering with the rest of your body’s joyful functioning—congratulations. You probably don’t need to do anything about your fibroids beyond having your doctor monitor them and keep an eye on things over time. That’s referred to as “watchful waiting.”
But if you’re like me, and have fibroids that are wreaking havoc on your period, and making life painful, uncomfortable, or worse in some other way, you’ll probably want to do something about it. You might have a collection of different symptoms that make life bothersome in a variety of ways.
Here’s one real life TMI example (don’t read these two paragraphs if you’re squeamish!):
“In my case, my fibroids were so big and numerous that they made my stomach swell out—my pants didn’t fit anymore and I had this constantly heavy feeling in my lower abdomen. I was waddling around like I was carrying a 8-lb barbell inside my lower belly. They’d made my uterus as big as 3-4 months pregnancy. Because some of my fibroids were also pressing against my bladder, it made me constantly feel like I had to pee. Like 24/7. And when I went pee, I couldn’t even get total relief. One or two of the fibroids was blocking my bladder from emptying fully, so even after I peed, I still felt like I had to pee. The other fibroids putting pressure on my bladder gave me that have to pee all the time feeling. I couldn’t sleep through the night because I had to get up and pee numerous times. I was exhausted.
And have I mentioned the pain? Once my period started, all bets were off. The pain descended in my belly like a dragon tearing my uterus apart. Sometimes it felt like labor contractions, coming in excrutiating waves. Sometimes it felt like twisting searing agony. Sometimes it felt like a droning ache with spontaneous stabs. I could barely walk, and I was bleeding round the clock like the red sea for 8-10 days. Most of the time I was unable to work, and had to use a lot of sick days. At its worst, I was going through a super-size tampon in an hour, while using a heavy pad as backup. My period week also messed up my digestion (acid reflux, indigestion, upset stomach, constipation, diarrhea, the whole nine yards). So my fibroids basically made being human suck for 25% of the year. In my case, things got progressively worse until I couldn’t take it anymore.”
Treatment for fibroids is necessary when they cause significant symptoms that affect daily life. You decide what’s tolerable for you.
Common reasons for seeking treatment include symptoms like:
Heavy or prolonged periods leading to anemia and fatigue.
Severe pelvic pain or pressure affecting movement and comfort.
Frequent urination or difficulty emptying the bladder due to fibroid pressure.
Infertility or pregnancy complications linked to fibroid location.
Rapid fibroid growth or suspected unusual changes.
Not all fibroids require treatment. If they’re small, asymptomatic, or not growing, doctors may recommend a "watchful waiting" approach with regular checkups. For those near menopause, symptoms may naturally improve as your estrogen levels decline.
Keep reading to learn about the various medical, minimally invasive, or surgical treatments that are available to help manage your fibroids.
1) https://pmc.ncbi.nlm.nih.gov/articles/PMC8432600/ - Uterine Fibroids: Assessing Unmet Needs from Bench to Bedside
What are the different treatment options for fibroids?
How you treat fibroids can depend on a variety of factors. Treatment options consider: symptom severity, fibroid size, fibroid location, and reproductive goals.
I’ll explain all of these treatments in greater detail below, but here’s a quick overview.
The main fibroid treatment options are:
Pain medicine: Over-the-counter pills to mask or minimize pain. e.g. NSAIDs like ibuprofen, naproxen
Medications: Used to shrink fibroids or manage symptoms. Keep scrolling to read more about this below.
Non-Surgical Treatment include:
Radiofrequency ablation (RFA) uses heat to destroy the fibroid; the heat is delivered at the end of a special needle. The fibroid will die, wither, and its cells will be either reabsorbed by your body or expelled, kind of like what happens when a scab heals. This treatment works best for smaller fibroids. With medium-large fibroids, it may not wither away completely. RFA may not be effective or suitable for extremely large fibroids. Learn more
Uterine artery embolization (UAE) kills the fibroid by cutting off its blood supply. This is done by isolating the blood vessel(s) that deliver blood to the fibrod, and then blocking them by injecting microbeads into the artery/vein(s). These stop blood from flowing to the fibroid, so it dies and shrinks. Learn more
High-intensity focused ultrasound (HIFU) uses highly focused soundwaves to generate heat at the precise location of the fibroid, destroying the targeted fibroid and causing it to shrink. Learn more
Myomectomy: A minimally invasive surgery called myomectomy physically removes fibroids while leaving the rest of the uterus intact. If this is done through a cut in your belly, it’s called an abdominal myomectomy. If this is done by going into the uterus through your cervix, this is called a hysteroscopic myomectomy. Learn more
Hysterectomy: The removal of the uterus, or part of the uterus. No fibroids can grow in a uterus that isn’t there, so this is a permanent solution for severe cases. The ovaries and fallopian tubes may or may not be removed with the uterus in a hysterectomy. Learn more
Total hysterectomy removes the entire uterus and the cervix. This is the most frequent type of hysterectomy.
Partial hysterectomy (also called supracervical hysterectomy) removes only the uterus, leaving behind the cervix.
Radical hysterectomy removes the most: the uterus, cervix and upper part of the vagina. This is usually only done for cancer treatment.
The best treatment depends on your individual needs and preferences, including future pregnancy plans and symptom severity. Talk to your doctor to determine the best approach for you.
What medications are available to manage fibroids?
If you want to avoid a physical intervention like the treatment options above, you might be thinking of trying medication to reduce or eliminate your fibroid symptoms.
Medications can help you deal with the problematic symptoms, but they will not make your fibroids go away.
These medications are commonly used to manage fibroid symptoms:
Hormonal birth control e.g. pills, patches, IUDs¹: Might reduce heavy bleeding but doesn’t shrink fibroids. For me personally, I was deeply skeptical about taking more hormones since elevated hormones are implicated in causing fibroids in the first place. It gets pretty complicated quickly:
👍🏾 On one hand, hormonal birth control is often prescribed to minimize heavy bleeding and make your period lighter. And “the use of hormonal contraceptives such as birth control pills or intrauterine devices (IUDs) has been shown to reduce the risk of UFs.”³…BUT…
👎🏾 …but on the other hand: hormonal birth control can sometimes cause fibroids to grow larger.² So, to me, this option seemed entirely counter-intuitive. Why would I take a pill that makes my fibroids bigger, when my fibroids are the reason my period was so agonizing in the first place?
IUDs can create some challenging scenarios too. Intrauterine devices (IUDs) deliver hormonal birth control directly into the uterus, and can cause two kinds of complications with fibroids:
A) Fibroids might block the entry path into the uterus which can interfere or impede the placement of the IUD
B) Fibroids might grow around the IUD and prevent the IUD from being easily removed later on. IUDs are not recommended if you have large fibroids that block or fill up the uterine cavity.
GnRH agonists e.g., Lupron³: Gonadotropin-releasing hormone agonists suppress your hormones which can temporarily shrink fibroids, but it gives you menopause symptoms and can weaken your bones.
Selective progesterone receptor modulators (SPRMs)³: Used in some countries to shrink fibroids and reduce bleeding.
Tranexamic acid⁴: A non-hormonal medication that reduces menstrual bleeding. You take these pills 3-4 times a day for up to four days.
NSAIDs e.g. ibuprofen, naproxen: Who hasn’t tried taking an Advil to deal with period cramps, amirite? These over-the-counter medications might help relieve pain, but won’t shrink your fibroids or make them go away.
Medications are often a temporary solution, or are used before surgery to shrink fibroids and make procedures easier.
1) https://www.nichd.nih.gov/health/topics/uterine/conditioninfo/treatments/medical-treatments - Medication-Related Treatments for Fibroids
2) https://www.nichd.nih.gov/health/topics/factsheets/uterine - Uterine Fibroids
3) https://pmc.ncbi.nlm.nih.gov/articles/PMC10975324/ - Empowering Strategies for Lifestyle Interventions, Diet Modifications, and Environmental Practices for Uterine Fibroid Prevention; Unveiling the LIFE UP Awareness
4) https://www.nhs.uk/conditions/fibroids/treatment/ - Treatment, Fibroids
Are there any non-surgical treatments for fibroids?
Yes! You don’t have to get a huge incision in your abdomen to treat your fibroids. These non-surgical options might still involve going under anesthesia, but the good news is, they can shrink fibroids or kill them completely, and relieve your symptoms without physically cutting the fibroids out.
A non-surgical fibroid treatment might be right for you if:
→ You want to keep your uterus
→ You want to try to get pregnant in the future
→ You don’t want a big surgery
Each of these treatment options can only treat your existing fibroids. None of these treatments can stop new fibroids from growing. But you’d be in a good position if you treat your existing fibroids, then adopt lifestyle changes that minimize your chance of growing more fibroids in the future.
Radiofrequency ablation (RFA): Uses heat to kill fibroids, which shrinks them or eradicates them.
Uterine artery embolization (UAE): Cuts off blood supply to fibroids by permanently blocking the veins that feed blood into the fibroid, which causes the fibroids to shrink.
High-intensity focused ultrasound (HIFU): Uses ultrasound waves to break down fibroids.
Hormonal therapy: Medications like GnRH agonists can shrink fibroids temporarily.
These options are ideal for people who want to avoid surgery or preserve fertility. The best treatment choice depends on fibroid size, location, severity of symptoms, and what you want to do with your body
Keep reading for more details about all of these treatment options.
What is radiofrequency ablation for fibroids?
Radiofrequency ablation (RFA) is a minimally invasive procedure that uses heat to kill and/or shrink fibroids. A very thin needle, inserted via laparoscopy or through the vagina, is inserted into the fibroid, and then the tip of the needle heats up to deliver radiofrequency waves which destroy fibroid tissue. This effectively “kills” the fibroid, stops it from growing, and shrinks it over time. This will lead to the relief of symptoms like pain, heavy bleeding, and pressure.
RFA is a quick outpatient procedure. Only two small incisions measuring 1.0 and 0.5 cm are made — one on your tummy and one hidden in your belly button. Recovery is fast, only about a week, and any pain can be easily managed with over-the-counter anti-inflammatories.
RFA can successfully treat multiple fibroids in single procedure, however RFA may not be suitable for extremely large fibroids.
RFA preserves the uterus, making it an option for people who want to avoid major surgery, or who want to get pregnant in the future.
The two methods of RFA: RFA is commonly referred to as either Acessa¹ or Sonata². The main difference between Acessa and Sonata is their point of entry. Acessa uses a tiny incision to enter your body through a laparoscope on your tummy, and it can treat all four types of fibroids: intramural, submucosal, subserosal, and pedunculated. Sonata has no incision because it enters your body through the vagina and cervix, and it can only treat the three types of fibroids that can be reached from inside the uterus.
Unlike myomectomy which cuts out each fibroid, RFA does not physically take the fibroids out of your body. Very small fibroids are likely to be entirely killed right on the spot by the RFA process. The destroyed fibroid cells are then expelled or reabsorbed by your body, so those fibroids go away completely. Larger fibroids will stop growing, will shrink, and their symptoms will either be greatly reduced or will stop showing symptoms completely.
RFA can only treat your existing fibroids; it can’t stop new fibroids from growing.
1) https://bruceleemd.com/about-acessa/ - Fibroid Radiofrequency Ablation | Inventor of Acessa
2) https://sonatatreatment.com/why-sonata/ - Sonata Treatment | Inventor of Sonata
What is high-intensity focused ultrasound (HIFU)?
High-intensity focused ultrasound (HIFU) is a non-invasive, non-surgical treatment that uses ultrasound waves to heat and break down fibroids without surgery. The ultrasound waves go through your abdomen.
The procedure is performed under MRI guidance, allowing doctors to precisely target fibroid tissue while avoiding damage to surrounding areas.
HIFU is outpatient, requires no incisions, and has a short recovery time. Fibroids shrink gradually after treatment, reducing pain, heavy bleeding, and pressure symptoms. However, HIFU may not be suitable for large or multiple fibroids, and not all medical centers offer it.
This treatment is a good option for those who want to avoid surgery, but its long-term effectiveness varies, and fibroids may regrow.
HIFU can only treat your existing fibroids; it can’t stop new fibroids from growing.
What is uterine artery embolization (UAE)?
Uterine artery embolization (UAE) is a minimally invasive procedure that blocks blood flow to fibroids, causing them to shrink. A radiologist inserts a small catheter into the uterine arteries and injects tiny microbead particles to block the flow of blood and cut off the fibroid’s blood supply. Over the following weeks and months, fibroids shrink, reducing pain, heavy periods, and pressure symptoms.
UAE is an effective alternative to surgery, with minimal recovery time, and it preserves the uterus.
However, UAE is not recommended for people planning to become pregnant in the future, because it may affect blood flow to the uterus. UAE is a permanent treatment (because the microbead particles that are placed in your veins are there to stay) but this treatment doesn’t remove fibroids completely, so some may grow back over time.
UAE can only treat your existing fibroids; it can’t stop new fibroids from growing.
What is a myomectomy?
A myomectomy is a surgical procedure to physically remove fibroids while keeping your uterus.
There are three main types of myomectomy:
Hysteroscopic myomectomy: Removes fibroids inside the uterine cavity by using a vaginal approach and going through the cervix (no abdominal incisions).
Laparoscopic myomectomy: Uses small incisions in the abdomen to enter the uterus, and a camera is inserted to help the surgeon see. Fibroids are removed through that incision.
Open myomectomy: Requires a larger incision in the abdomen. Often for bigger fibroids or multiple fibroids.
Recovery time varies according to the treatment method:
Laparoscopic procedures have the shortest recovery, 1–2 weeks.
Open surgery has the longest recovery time, requiring up to 6 weeks.
Myomectomy can only treat your existing fibroids; it can’t stop new fibroids from growing.
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus and is the only permanent way to prevent getting future uterine fibroids. After a hysterectomy, you won’t have a uterus, so you can’t get any uterine fibroids and you won’t have any other fibroid symptoms.
The ovaries and fallopian tubes may or may not be removed with the uterus in a hysterectomy.
There are different types of hysterectomy:
Total hysterectomy: Removes the uterus and cervix.
Subtotal hysterectomy: Removes the uterus but keeps the cervix intact.
Radical hysterectomy: Removes the uterus, cervix, and parts of surrounding tissue. This is used for cancer.
A hysterectomy can be performed vaginally, laparoscopically, or through open surgery, with varying recovery times.
While hysterectomy permanently eliminates fibroid symptoms, it also means no future pregnancies can occur. It can also lead to menopausal symptoms if the ovaries are removed.
Hysterectomy is a major surgery—it’s removing an organ from your body— and it comes with the risk of additional side effects or complications including: excessive bleeding during healing; infection; blood clots; damage to surrounding organs during the surgery; urinary problems; constipation; menopause-like symptoms including hot flashes, vaginal dryness and insomnia. Future complications may include pelvic organ prolapse (when other organs fall into the vaginal cavity), depression, mood changes, and coronary heart disease.
Hysterectomy is typically recommended for severe fibroid cases or when other treatments have failed.