Uterine Fibroids – Diagnosis and Treatment
Diagnosis
Doctors usually find fibroids during a routine pelvic exam. During this check-up, the doctor feels the uterus to check its size and shape.
If the uterus feels bigger than normal or a bit lumpy, fibroids might be the cause.
Imaging Tests to Check for Fibroids
Ultrasound is the main way doctors spot fibroids. This test uses sound waves to make images of the uterus, showing how many fibroids are there and how big they are.
Doctors do ultrasounds in two main ways:
- Transabdominal Ultrasound: The doctor moves the device over your belly.
- Transvaginal Ultrasound: The device goes inside the vagina, giving clearer pictures.
These tests can show different types of fibroids, like subserosal, intramural, submucosal, and pedunculated ones. If you have unusual bleeding, doctors might order blood tests.
A complete blood count (CBC) checks for anemia, and other tests can find bleeding problems or check your thyroid.
More Ways To Get Detailed Images
If ultrasound doesnât give enough answers, doctors might order more detailed tests.
Some of the options are:
| Imaging Test | How Itâs Done | What It Shows | When Itâs Used |
|---|---|---|---|
| Magnetic Resonance Imaging (MRI) | Uses magnets and radio waves to make detailed images. | Shows size, type, and location of fibroids. | Often used for large uterus or before treatment. |
| Sonohysterography (Saline Infusion Sonogram) | Saline fills the uterus to help show inside walls during ultrasound. | Picks up small submucosal fibroids and lining. | If pregnancy problems or heavy bleeding occur. |
| Hysterosalpingography | Dye is put in the uterus and tubes, then x-rays are taken. | Shows open or blocked fallopian tubes, submucosal fibroids. | If fertility is a concern. |
| Hysteroscopy | A small camera (hysteroscope) goes through the cervix into the uterus, with saline to expand it. | Doctor checks lining and tube openings. | For a closer look at the uterus walls. |
These tests let doctors see more about each fibroidâs size, type, and exact spot.
Treatment
Careful Monitoring Without Immediate Treatment
Some people with fibroids donât have symptoms, or their symptoms are so mild they donât really notice.
In these cases, doctors often just keep an eye on things with regular check-ups. Fibroids tend to grow slowly, stay the same, or even shrink after menopause, since hormones drop.
Fibroids arenât cancer, and they rarely mess with fertility. If you donât have strong symptoms or health risks, just waiting and watching can make sense.
Medications to Relieve Symptoms
Some medicines help control heavy bleeding and pain from fibroids. Most of these target hormones tied to the menstrual cycle, but they donât get rid of the fibroids.
Hereâs a quick rundown:
- GnRH Agonists: GnRH agonists lower estrogen and progesterone, which stops periods and shrinks fibroids for a while. Theyâre handy before surgery or for short-term relief. Hot flashes are common, and using them too long can weaken bones. Because of this, doctors usually prescribe them for up to six months, sometimes with a little hormone add-back to ease side effects.
GnRH Antagonists: These medications cut down heavy bleeding in people who havenât reached menopause, and side effects are milder with low-dose hormones. Bleeding drops, but fibroids donât shrink. Treatment is generally safe for up to two years.
Progestin-Releasing Intrauterine Device (IUD): An IUD can reduce heavy periods but wonât shrink or remove fibroids. It also works as birth control.
Antifribronolytic: This non-hormonal pill is taken only on heavy bleeding days to cut down blood loss.
Birth Control Pills: Low-dose pills can make periods lighter and more regular, but they donât shrink fibroids.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Ibuprofen and naproxen help with pain, but donât shrink fibroids or reduce bleeding.
Supplements: If bleeding causes anemia, iron or vitamin supplements might be needed.
The best medicine depends on your symptoms, plans for pregnancy, and what you want from treatment.
Medicine Options Table
| Medicine Type | Main Purpose | Effects on Fibroid Size | Common Use Duration | Other Notes |
|---|---|---|---|---|
| GnRH Agonists | Stops periods, shrinks | Yes | Up to 6-12 months | Temporary menopause symptoms |
| GnRH Antagonists | Reduces bleeding | No | Up to 2 years | Add-back therapy lowers side effects |
| Progestin-IUD | Less bleeding | No | Long-term | Also prevents pregnancy |
| Antifibronolytic | Eases heavy periods | No | Short-term | Taken only during heavy bleeding |
| Low-Dose Birth Control | Controls cycle, bleeding | No | Long-term | Does not shrink fibroid |
| NSAIDs | Reduces pain | No | As needed | No effect on bleeding |
| Iron/Vitamins | Treats anemia | N/A | As needed | Supports low iron from bleeding |
Treatments With No Surgery
MRI-guided focused ultrasound (FUS) is a non-surgical way to treat fibroids. Doctors use strong sound waves to heat and break down small fibroid areas while the patient is inside an MRI scanner.
This lets the doctor target the fibroid exactly, without any cuts. FUS keeps the uterus in place and doesnât need a hospital stay.
Itâs still a newer option, but research says itâs safe and works for many. Still, some people donât get as much relief as with certain minimally invasive surgeries.
Less Invasive Surgeries
Some treatments use tiny cuts or even no cuts, which means you can recover faster and face fewer risks than with open surgery.
Here are the main ones:
Uterine Artery Embolization (UAE): The doctor injects tiny particles into the arteries that feed the uterus, blocking blood flow to fibroids. This makes them shrink and symptoms improve. Rarely, it can affect blood flow to the ovaries or other organs, but serious problems donât happen often.
-
Radiofrequency Ablation: Doctors use heat to destroy fibroid tissue and shrink the blood vessels feeding it. They can do this through:
- The abdomen (laparoscopy), using small cuts and a camera.
- The vagina or cervix (transcervical), guided by ultrasound.
- Both methods usually mean a quick recoveryâmost people are back to their routine in days.
Laparoscopic or Robotic Myomectomy: Surgeons remove fibroids through small belly cuts with special tools. Robotic systems give a 3D view and let doctors work with great precision. Sometimes they use a device to break up big fibroids (morcellation) so they fit through tiny incisions.
Hysteroscopic Myomectomy: If fibroids are inside the uterus, doctors can remove them through the vagina and cervix, with no skin cuts. Tools go into the uterus to take out the fibroids directly.
Endometrial Ablation: This destroys the lining of the uterus to reduce heavy bleeding. It doesnât remove fibroids but can help if theyâre small and not deep in the muscle.
Minimally Invasive Treatments Comparison
| Procedure | How It’s Done | Cuts Needed | Recovery Time | Removes Uterus? |
|---|---|---|---|---|
| Uterine Artery Embolization | Embolic agents in artery | No | Short | No |
| Radiofrequency Ablation | Heat through laparoscopy or vagina | Small/none | Fast | No |
| Laparoscopic/Robotic Myomectomy | Small cuts, precise removal | Small | Fast | No |
| Hysteroscopic Myomectomy | Through vagina/cervix | None | Quick | No |
| Endometrial Ablation | Destroys uterine lining | None | Fast | No |
Classic Surgeries
Doctors might recommend major surgery for people with big fibroids, lots of fibroids, or really tough symptoms that donât get better with other treatments.
These surgeries are more involved and need more time to heal.
Traditional Myomectomy: Surgeons make a bigger cut in the lower belly to reach and remove fibroids from the uterus.
Hysterectomy: The whole uterus is removed. This is the only permanent solution for fibroids. After this, pregnancy isnât possible.
Both surgeries work well, but you usually stay in the hospital longer and need more time to recover than with less invasive methods.
Breaking Up Fibroids During Removal
When doctors need to remove large fibroids, they sometimes break them into smaller piecesâa process called morcellation.
This lets them take the fibroid out through a small cut or with minimally invasive surgery.
To lower the risk of spreading hidden cancer cells, doctors can do âcontained morcellationâ inside a protective bag. This extra step helps if unexpected cancer shows up in the fibroid.
Fertility and Future Pregnancy
If you want to have kids now or later, talk through your treatment choices with your doctor.
The best option for keeping fertility is âmyomectomy,â which removes only the fibroids and keeps the uterus healthy for pregnancy. Hysterectomy doesnât work for anyone who wants children, since it removes the uterus.
Some treatments, like uterine artery embolization or endometrial ablation, might lower your chances of getting pregnant or may not be good if you want kids.
Hormone treatments are usually temporary and donât block pregnancy after you stop them.
Fertility Goals and Best Treatments
| Fertility Goal | Better Options | Not Advised |
|---|---|---|
| Want to become pregnant | Myomectomy | Hysterectomy, endometrial ablation |
| Family complete | Any option | Based on health needs |
Possibility of New Fibroids Forming
Even after treatment, new fibroids can grow. The risk depends on what treatment you choose. Myomectomy takes out the fibroids you have, but it canât stop new ones from showing up later.
Medicines only help while youâre taking themâonce you stop, fibroids and symptoms may come back.
Only hysterectomy truly prevents new fibroids, but itâs permanent and not for anyone who wants to have children.
Regular check-ups after treatment matter, so your doctor can catch new symptoms or signs of fibroids early. You and your care team should pick the best plan for your health and future goals.
Other Treatment Choices
Lots of people look for alternative ways to deal with uterine fibroids.
Some try changing their diet, using magnet therapy, herbal supplements like black cohosh, or homeopathic remedies. So far, research hasnât shown that these methods really work.
A few small studies do suggest acupuncture might help with symptoms if you add it to regular treatments. With acupuncture, a trained expert puts thin needles in certain spots on your body.
Getting Ready for Your Doctor Visit
Steps You Can Take Before the Appointment
Getting ready ahead of time really helps you make the most of your visit with the doctor.
Here are some tips you might find handy:
List All Symptoms: Jot down every problem youâve noticed, like heavy bleeding, anemia, or any strange discomfort. Add in all the details, even if youâre not sure they matter.
- Record All Medicines and Supplements: Make a list of every prescription, over-the-counter medicine, herb, and vitamin youâre taking. Note the names, doses, and how often you use them.
Bring Support: If youâre feeling anxious or worried about forgetting things, ask a friend or family member to come with you.
Take Notes: Bring a notebook, or just use your phone or tablet, so you can write down anything important during the appointment.
Write Down Questions: Before you go, think about what you want to askâmaybe questions about your symptoms, abnormal uterine bleeding, treatment options, or worries about future pregnancy.
Hereâs a table of sample questions you might want to bring along:
| Topic | Example Question |
|---|---|
| Number and size | How many fibroids, and how large are they? |
| Location | Where are the fibroids located? |
| Treatment | What medicines or options are available? |
| Surgery | When do you recommend surgery, if at all? |
| Pregnancy | Can fibroids or treatment affect having children? |
| Side effects | What side effects might come with treatment? |
| Medicines | Will medicine be needed before or after surgery? |
You might want to mark which questions feel most important to you, so you remember to ask them first. If something the doctor says doesnât make sense, donât be shyâask them to explain it again.
Questions the Doctor May Ask
Doctors usually ask questions to get a clear picture of your symptoms and figure out if you might have uterine fibroids. They’ll probably want to know when you first noticed things like abnormal bleeding or pain.
You might need to talk about how often you deal with heavy bleeding or anemia. Doctors often ask if your symptoms get worse at certain times, like during your period.
They’ll also want to know what helps or makes things worse. Family history comes up too, so be ready to mention if anyone else has had similar health issues.
If you answer honestly, your doctor can understand your situation better. It helps to think about these things before your appointmentâit just makes everything go a bit smoother.
