Treatment - Fibroids

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 gynaecologist (a specialist in the female reproductive system) for further medicine or surgery if these are ineffective.

See a GP to discuss the best treatment plan for you.

Medicine for symptoms

Medicines are available that can be used to reduce heavy periods, but they can be less effective the larger your fibroids are.

These medicines are described below.

Levonorgestrel intrauterine system (LNG-IUS)

The levonorgestrel intrauterine system (LNG-IUS) is a small, plastic T-shaped device placed in your womb that slowly releases the progestogen hormone levonorgestrel.

It stops your womb lining growing quickly, so it's thinner and your bleeding becomes lighter.

Side effects associated with LNG-IUS include:

• irregular bleeding that may last for 3 to 6 months
• acne
• headaches
• breast tenderness
• in some cases, no periods at all (absent periods)

LNG-IUS also acts as a contraceptive, but does not affect your chances of getting pregnant after you stop using it. 

Tranexamic acid

If LNG-IUS is unsuitable (for example, if contraception is not desired) tranexamic acid tablets may be considered.

They work by helping your blood to clot, reducing blood loss.

Tranexamic acid tablets are taken 3 or 4 times a day during your period for up to 4 days.

Tranexamic acid tablets are not a form of contraception and will not affect your chances of becoming pregnant.

Feeling sick, being sick or diarrhoea are possible side effects of tranexamic acid tablets. 

Anti-inflammatory medicines

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, can be taken 3 times a day from the first day of your period until bleeding stops or reduces to manageable levels.

NSAIDs work by reducing your body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods.

Anti-inflammatory medicines are also painkillers, but they are not a form of contraception.

Indigestion and diarrhoea are common side effects of NSAIDs.

The contraceptive pill

The contraceptive pill is a popular method of contraception that stops an egg being released from the ovaries to prevent pregnancy.

As well as making bleeding lighter, some contraceptive pills can help reduce period pain.

A GP can provide you with further advice about contraception and the contraceptive pill.

Oral progestogen

Oral progestogen is synthetic (man-made) progesterone (one of the female sex hormones) that can help reduce heavy periods.

It's usually taken as a daily tablet from days 5 to 26 of your menstrual cycle, counting the first day of your period as day 1.

Oral progestogen works by preventing the womb lining growing quickly. It's not a form of contraception, but can reduce your chances of conceiving while you're taking it.

The side effects of oral progestogen can be unpleasant and include weight gain, breast tenderness and short-term acne.

Injected progestogen

Progestogen is also available as an injection to treat heavy periods. It works by preventing the lining of your womb growing quickly.

This form of progestogen can be injected once every 13 weeks for as long as treatment is required.

Common side effects of injected progestogen include:

• weight gain
• irregular bleeding
• absent periods

Injected progestogen also acts as a contraceptive. It does not prevent you becoming pregnant after you stop using it, although there may be a significant delay (up to 12 months) after you stop taking it before you're able to get pregnant.

Medicine to shrink fibroids

Gonadotropin releasing hormone analogues (GnRHas)

If you're still experiencing symptoms related to fibroids despite treatment with the above medicines, a GP can refer you to a gynaecologist.

They may prescribe medicine called gonadotropin releasing hormone analogues (GnRHas) to help shrink your fibroids.

GnRHas, such as goserelin acetate, are hormones given by injection. They work by affecting the pituitary gland, which stops the ovaries producing oestrogen.

The pituitary gland is a small, pea-sized gland located at the bottom of the brain. It controls a number of important hormone glands within the body.

GnRHas stop your menstrual cycle (period), but are not a form of contraception. They do not affect your chances of becoming pregnant after you stop using them.

If you're prescribed GnRHas, they can help ease heavy periods and any pressure you feel on your stomach. They also help improve symptoms of frequent urination and constipation.

GnRHas are sometimes also used to shrink fibroids prior to surgery to remove them.

GnRHas can cause a number of menopause-like side effects, including:

• hot flushes
• increased sweating
• muscle stiffness
• vaginal dryness

Sometimes a combination of GnRHas and low doses of hormone replacement therapy (HRT) may be recommended to prevent these side effects.

Osteoporosis (thinning of the bones) is an occasional side effect of taking GnRHas.

A GP can give you more information about this, and may prescribe additional medicine to minimise thinning of your bones.

GnRHas is only prescribed on a short-term basis (a maximum of 6 months at a time). Your fibroids may grow back to their original size after treatment is stopped.

You may be offered a type of GnRHas that also contains oestrogen and progestogen. It's taken as a tablet and can be taken for as long as you need it.

Ulipristal acetate

Ulipristal acetate (Esmya) is a medicine that can be used to treat fibroids. However, it should only be prescribed for occasional use if:

• you have moderate to severe symptoms
• you're an adult and you've not reached the menopause
• surgery and non-surgical procedures are not suitable, have not worked or you decide not to have them

This is because there is a risk of serious liver damage and liver failure.

If your doctor thinks ulipristal acetate may be suitable for you, they should discuss the risks and benefits with you so you can make an informed decision.

If you decide to try ulipristal acetate, your liver function will be closely monitored using liver function tests before, during and after treatment.

Ask for an urgent GP appointment or call 111 if you develop symptoms of liver damage, such as:

• tummy pain
• yellowing of the skin or eyes (jaundice)
• dark pee
• tiredness
• loss of appetite
• nausea and vomiting

You may get these symptoms even after you stop taking ulipristal acetate.

There are currently no concerns with the emergency contraceptive pill ellaOne, which also contains ulipristal acetate.

Surgery

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.

Hysterectomy

A hysterectomy is a surgical procedure to remove the womb.

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 anaesthetic, where the lower parts of the body are numbed.

Sometimes a general anaesthetic 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 low sex drive (loss of libido). This usually only occurs if the ovaries have been removed.

Myomectomy

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 gynaecologist 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 anaesthetic 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 anaesthetic, although local anaesthetic may be used instead. You can usually go home on the same day as the procedure.

After the procedure you may experience stomach cramps. 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 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 local anaesthetic. 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.

Read the National Institute for Health and Care Excellence (NICE) guidance about hysteroscopic morcellation for uterine fibroids

Non-surgical procedures

As well as traditional surgical techniques to treat fibroids, non-surgical treatments are also available.

Uterine artery embolisation (UAE)

Uterine artery embolisation (UAE) is an alternative procedure to a hysterectomy or myomectomy for treating fibroids. It may be recommended for women with large fibroids.

UAE is carried out by a radiologist, a specialist doctor who interprets X-rays and scans. It involves blocking the blood vessels that supply the fibroids, causing them to shrink.

During the procedure, a special solution is injected through a small tube (catheter), which is guided by X-ray through a blood vessel in your leg.

It's carried out under local anaesthetic, so you'll be awake but the area being treated will be numbed.

You'll usually need to stay in hospital a day or two after having UAE. When you leave hospital, you'll be advised to rest for 1 to 2 weeks.

Although it's possible to have a successful pregnancy after having UAE, the overall effects of the procedure on fertility and pregnancy are uncertain.

It should therefore only be carried out after you have discussed the potential risks, benefits and uncertainties with your doctor.

Endometrial ablation

Endometrial ablation is a relatively minor procedure that involves removing the lining of the womb.

It's mainly used to reduce heavy bleeding in women without fibroids, but it can also be used to treat small fibroids in the womb lining.

The affected womb lining can be removed in a number of ways – for example, by using laser energy, a heated wire loop, or hot fluid in a balloon.

The procedure can be carried out either under local anaesthetic or general anaesthetic.

It's fairly quick to perform, taking around 20 minutes, and you can usually go home the same day.

You may experience some vaginal bleeding and tummy cramps for a few days afterwards, although some women have bloody discharge for 3 or 4 weeks.

Some women have reported experiencing more severe or prolonged pain after having endometrial ablation.

In this case, you should speak to a GP or a member of your hospital care team, who may be able to prescribe a stronger painkiller.

It may still be possible to get pregnant after having endometrial ablation, but the procedure is not recommended for women who want to have more children because the risk of serious problems, such as miscarriage, is high.

The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information about endometrial ablation

MRI-guided procedures

There are also 2 relatively new techniques for treating fibroids that use MRI.

They are:

• MRI-guided percutaneous laser ablation
• MRI-guided transcutaneous focused ultrasound

These techniques use MRI to guide laser energy or ultrasound energy to destroy the fibroid.

These treatment methods cannot be used to treat all types of fibroids, and the long-term benefits and risks are unknown.

Research is still being carried out, but there's some evidence to suggest that these non-invasive procedures have short- to medium-term benefits when performed by an experienced clinician.

But the effects on pregnancy and women who want to have a baby in the future are not fully known, so this should be taken into consideration.

Find out more about:

• MRI-guided percutaneous laser ablation for uterine fibroids on National Institute for Health and Care Excellence (NICE)
• MRI-guided transcutaneous focused ultrasound for uterine fibroids on National Institute for Health and Care Excellence (NICE)

Ultrasound-guided procedures

Transcervical ultrasound-guided radiofrequency ablation is a new procedure that uses heat to shrink fibroids.

Before the procedure you’ll be given a general or local anaesthetic, so you will not feel any pain.

A long, thin device that has an ultrasound probe at the end is passed into your vagina, through your cervix and into your womb.

The ultrasound probe sends images to a screen which helps your doctor see the fibroid. Heat is then applied to the fibroid to shrink it.

Because transcervical ultrasound-guided radiofrequency ablation is a new treatment, evidence about its safety and long-term effectiveness is limited.

Your doctor should explain the possible risks and benefits before you agree to have the procedure.