Treatment options for fibroids 

Treatment
Pros
Cons
No treatment

Treatment isn't always necessary if there are no or few symptoms. Symptoms often ease or disappear after the menopause

  • No need for medication with associated side effects
  • No need for surgery with associated risks
  • Painful symptoms left untreated
  • May be several years until the menopause
  • May need repeat scans to monitor fibroids

Medication to treat heavy periods

Levonorgestrel intrauterine system (LNG-IUS)

A small, t-shaped, plastic contraceptive device that's placed in your womb. It releases a hormone that prevents the womb lining thickening

  • Effective treatment for heavy periods
  • No need to take regular medication
  • Long-term treatment
  • Also acts as a contraceptive 
  • Risk of side effects such as irregular bleeding, acne, headaches and breast tenderness
  • May be difficult to insert with large fibroids
  • Also acts as a contraceptive
  • Has to be fitted and removed by a qualified health professional
Tranexamic acid

Tablets that help stop bleeding in the womb by up to 50%

  • Effective treatment for heavy periods if LNG-IUS isn't suitable
  • Available over the counter or on prescription from a GP
  • Doesn't act as a contraceptive 
  • Must be taken three or four times a day
  • Side effects include indigestion and diarrhoea
  • Doesn't act as a contraceptive
  • May not be effective for large fibroids
  • Not suitable for women with certain pre-existing conditions, such as kidney problems
Anti-inflammatory medicines

Tablets taken during your period that reduce production of a hormone linked to heavy periods

  • Effective treatment for heavy periods
  • Eases period pain
  • Available over the counter or on prescription from a GP 
  • Risk of side effects such as indigestion and diarrhoea
  • May not be effective with large fibroids
  • Doesn't act as a contraceptive
  • Shouldn't be used by women with bleeding or clotting disorders, or women with a high risk of stomach ulcers 
Contraceptive pill

A form of contraception that stops an egg from being released from the ovaries to prevent pregnancy

  • Effective treatment for heavy periods
  • Eases period pain
  • Available over the counter or on prescription from a GP
  • Also acts as a contraceptive  
  • Must be taken every day for 21 days before your period
  • Risk of side effects such as headaches, nausea, breast tenderness and mood swings
  • May not be effective for large fibroids 
  • Not suitable for women with certain pre-existing conditions, such as heart or liver disease
Oral progestogen

A man-made  version of the female hormone, progesterone, that prevents the womb lining growing quickly

  • Effective treatment for heavy periods 
  • Must be taken every day from days five to 26 of your menstrual cycle (counting the first day of your period as day one)
  • Possible side effects include weight gain, breast tenderness and short-term acne
  • Doesn't act as a contraceptive 
Injected progestogen

An injection of a type of progestogen that prevents the womb lining growing too quickly

  • Only one injection needed every 12 weeks
  • Also acts as a contraceptive
  • Possible side effects include weight gain, bloating and breast tenderness  
  • There may be a delay after you stop taking it before you're able to get pregnant

Medication to shrink fibroids

Gonadotrophin releasing hormone analogues (GnRHas)

An injection of hormones that affect the pituitary gland, causing it to stop the ovaries producing oestrogen which shrinks fibroids

  • Help to ease symptoms of fibroids
  • Can be used to shrink fibroids before surgery 
  • Fibroids may return to original size when treatment stops
  • May cause menopause-like side effects and thinning of the bones (osteoporosis)
  • Can only be used for a maximum of six months at a time because of side effects
  • Doesn't act as a contraceptive
Ulipristal acetate

A new method of treating fibroids with moderate to severe symptoms. One tablet is taken orally (by mouth) once a day, with a course of treatment lasting up to three months. A repeat course may be needed

  • Should stop bleeding and shrink fibroids
  • Avoids the need for surgery if treatment is successful
  • Only recommended for adult women over 18 years of age after menstruation (monthly periods) have started
  • Hormonal contraception, such as such as the progestogen-only pill, intrauterine device, or combined oral contraceptive pill, aren’t recommended while taking ulipristal acetate. Instead, use a barrier method, such as condoms

Surgery and procedures

Hysterectomy

A surgical procedure to remove the womb

 

  • Effective treatment for all symptoms of fibroids
  • Can be used to treat large fibroids
  • Not suitable for women who want to have more children
  • Possible side effects include early menopause and loss of libido (sex drive)
  • Requires general anaesthetic and a hospital stay of up to five days
  • Recovery can take six to eight weeks
  • Small risk of complications such as damage to the womb, and small risk of complications related to anaesthetic
Myomectomy

A surgical procedure to remove fibroids from the wall of the womb

  • Effective treatment for heavy periods
  • Can be used in women who still wish to have children 
  • May affect fertility
  • Can't be used to treat all types of fibroids
  • Fibroids may grow back and further treatment may be needed
  • Requires general anaesthetic and a hospital stay of up to five days
  • Recovery can take six to eight weeks
  • Small risk of complications such as damage to the womb, and small risk of complications related to anaesthetic
Hysteroscopic resection

A procedure that involves using a thin telescope called a hysteroscope and a number of small surgical instruments to remove fibroids through the vagina

  • Effective treatment for heavy periods
  • Can increase your chances of getting pregnant if you have difficulty conceiving because of fibroids in your womb
  • Can be used in women who still wish to have children
  • Short hospital stay
  • May only be suitable for treating small fibroids located in the womb
  • Risk of injury to the womb because hysteroscope is inserted a number of times 
  • Small risk of complications such as infection, and small risk of complications related to anaesthetic
Hysteroscopic morcellation

A new procedure to remove fibroids using a hysteroscope and small surgical instruments

 

  • Hysteroscope is only inserted into the womb once, reducing risk of injury to the womb
  • May have potential in cases where there are serious complications
  • Short hospital stay
  • Limited evidence as to safety and long-term effectiveness
  • Specialised technique that can only be carried out by a clinician with specific training
  • Small risk of complications such as infection, and small risk of complications related to anaesthetic
Endometrial ablation

A procedure that involves removing the lining of the womb using laser energy, a heated wire loop, or hot fluid in a balloon

  • Effective treatment for heavy periods
  • Can be used to treat small fibroids in the womb lining
  • Can't be used to treat all types of fibroids
  • Not recommended for women who wish to have more children because of possible pregnancy risks
  • You may experience vaginal bleeding and tummy cramps afterwards, which can last for a few days or weeks
  • Womb lining may grow back, so surgery may need to be repeated
  • Small risk of complications such as inflammation or damage to the womb, and small risk of complications related to anaesthetic
Uterine artery embolisation (UAE)

A procedure that shrinks fibroids by blocking the blood vessels that supply blood to them with a chemical injected into your leg

  • Effective treatment for heavy periods
  • May be used to treat large fibroids
  • Carried out under local anaesthetic with short hospital stay
  • May affect your ability to get pregnant in the future
  • Can't be used to treat all types of fibroids
  • Small risk of complications such as infection, and small risk of complications related to anaesthetic
  • Chance the fibroids may come back and further treatment may be required

MRI-guided procedures

MRI-guided percutaneous laser ablation

Small needles are put through the skin into the centre of the fibroid and laser energy is used to destroy the fibroid

  • Non-invasive procedure
  • Some evidence that it's an effective treatment for fibroids
  • Not suitable for all types of fibroids
  • Symptoms may return
  • Full risks and benefits not yet known
  • Not widely available
MRI-guided transcutaneous focused ultrasound

Small needles are put through the skin into the centre of the fibroid and ultrasound energy is used to destroy the fibroid

  • Non-invasive procedure
  • Some evidence that it's an effective treatment for fibroids
  • Not suitable for all types of fibroids
  • Symptoms may return
  • Full risks and benefits not yet known
  • Not widely available