If your fibroids cause moderate or severe symptoms, drugs or surgery can be used to remove or shrink them. Gonadotropin releasing hormone agonists, or GnRHa, is used to shrink the fibroids. It stops the ovaries from producing hormones, which causes a "medical menopause" and normal menopausal symptoms such as hot flashes, decreased sex drive, depression, insomnia, and joint pain. Another drug option is an anti-hormonal agent, such as mifepristone, which can stop or slow the growth of fibroids. However, they provide only a temporary relief; once you stop the treatment, the fibroids often grow back.
One surgical method of dealing with fibroids is a myomectomy, which removes the fibroids without taking the healthy uterine tissue. It can be performed either through an abdominal incision or vaginally. This is the preferred method if you are planning to have children in the future; however it is considered more dangerous than a hysterectomy. An endometrial ablation destroys the uterine lining. This method controls heavy bleeding, but you cannot have children afterwards. Myolysis involves inserting an electrical needle into the uterus through a small incision in the abdomen to destroy the blood vessels that feed the fibroids. A hysterectomy is the removal of the entire uterus and is the only way to permanently cure uterine fibroids. This method is recommended for women who have large fibroids or experience heavy bleeding and are near or past menopause, or do not want children.
Uterine Fibroid Embolization, or UFE, is a minimally invasive method of blocking the arteries that supply blood to the fibroids. A catheter is inserted into the arteries that supply the fibroids with blood, and small particles are then injected to block the flow of blood and essentially starve the fibroids. There is a small, but definite, risk that UFE will cause early menopause.
One of the newest treatments is MRI-guided ultrasound. It uses MRI images to plan and guide focused ultrasound waves that destroy fibroid tissue. The procedure is non-invasive and can be done as an outpatient procedure.
If a fibroid outgrows its blood supply, it may undergo "red degeneration" when it bleeds into itself. This often happens during the second trimester of pregnancy and can be extremely painful, but usually resolves itself without requiring treatment. A fibroid may also undergo "white degeneration," when portions undergo cell death and liquefy or develop into a cyst. This can also cause pelvic and/or abdominal pain.
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