Welcome
This website is designed to help you learn more about uterine fibroids. Fibroids are growths of the muscle of the uterus. They can cause heavy periods and pain. They are benign (meaning they do not lead to cancer).
If you have been diagnosed with uterine fibroids, this interactive tool can help you learn more about treatment options. Always talk to your doctor before starting a new treatment.
Who should use it? You should use this tool if you have been diagnosed with uterine fibroids and want to learn more.
When should you use it? You can use this tool at any time. It may help you get ready to talk about your fibroids with a gynecologist.
How do you use it? To use this tool, click on the button below. The tool will ask you questions and give you information about different treatment options, based on your answers.
What is the output of the tool? The tool will give you a list of treatment options. You can use this list the next time you talk to your doctor.
Previous Answers:
Expectant Management
You have the option of not taking medicines or having surgeries to treat fibroids. This means watching and waiting for any changes in your symptoms.
If your fibroids are not bothering you, you may not need any treatment. Fibroids are very common, and many people do not need treatment. Common symptoms are heavy periods, pain, feeling pressure in your abdomen, and difficulty getting pregnant. If you are having any of these symptoms, you may want to talk with your healthcare provider to see if there is a treatment option that works for you.
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Surgical Treatments
Myomectomy
A myomectomy is a surgery to remove the fibroids without removing the uterus. This procedure is usually done for women interested in pregnancy in the future. Depending on the size and location of the fibroids, the surgery can be done through the abdomen or through the vagina.
This is a surgery to remove fibroids without removing the uterus. A myomectomy can be done in different ways depending on how many fibroids you have and where they are. The different types of myomectomy procedures are laparoscopic myomectomy, abdominal myomectomy, and hysteroscopic myomectomy.
A myomectomy may be the best option for people who would like to get pregnant in the future. Fibroids can grow back after they have been removed in about 20 percent of cases (1 in 5 people).
Please talk to your doctor to see if myomectomy is a good option for you.
Laparoscopic myomectomy: Small (1 cm or less) incisions (cuts) are made on your abdomen (belly). The surgeon uses a small camera to see inside your abdomen to remove the fibroids. You may have some pain around the surgical area and some stomach cramping after the procedure. You may also have some vaginal bleeding. The recovery time is two to four weeks.
Open (abdominal) myomectomy: An incision is usually made on the bikini line (lower abdomen) to remove the fibroids. This is similar to a C-section incision. This method is used for patients whose fibroids are very large, or who have too many fibroids to remove using the camera. You should also expect some pain around the surgical area and some stomach cramping after the procedure. You may also have some vaginal bleeding. Sometimes the skin may be numb around the incision for a short time. An abdominal myomectomy has a longer recovery time (six to eight weeks).
General anesthesia is used for these surgeries. Possible risks include infection, bleeding, and injury to organs like the intestines, bladder, ureters, ovaries, uterus, or blood vessels. If your fibroid was deep in the uterus muscle, you may need to have a cesarean delivery in future pregnancies.
Hysteroscopic myomectomy: This surgery can be performed on patients with fibroids found in the inner lining of the uterine wall (submucosal). The surgery is done through the vagina instead of the abdomen. A hysteroscopic myomectomy has a faster recovery time (two-four days) and you do not need to stay in the hospital overnight. Monitored anesthesia care or general anesthesia is used for the surgery. Some side effects may include bleeding, cramping, and a possible need for a second procedure.
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Hysterectomy
Surgery to remove your uterus along with the fibroids. Hysterectomy is usually recommended for women who are not interested in having children in the future.
This is a surgery to remove your uterus (womb) and fallopian tubes. If you have this procedure, you won’t have your period anymore. If you have a hysterectomy, there is no chance that the fibroids will return in the future. You can’t get pregnant after a hysterectomy.
During a hysterectomy, the ovaries are usually not removed. If the ovaries are not removed, you will not have symptoms of menopause like hot flashes, and your moods and sex drive should be normal for you.
Different types of hysterectomies include laparoscopic, abdominal, and vaginal hysterectomy.
Laparoscopic hysterectomy: The surgeon makes three to four small (5mm to 1cm) incisions on the abdomen. A camera is used during the surgery to help remove the uterus. The general recovery time is two to four weeks. In addition, you cannot lift more than 10 pounds for 8 weeks. Also you cannot put anything in the vagina for 8 weeks.
Open abdominal hysterectomy: An incision is usually made on the bikini line (lower abdomen) to remove the fibroids. This is similar to a C-section incision. This is usually done for very large fibroids or patients who have had surgeries before. Usually, the whole uterus is removed. Sometimes, people decide to keep the bottom part of the uterus (cervix). The recovery time is six to eight weeks.
Vaginal hysterectomy: The uterus is removed through the vagina without any incisions or scars on the abdomen. This procedure may not be possible for women with a large uterus or who have had surgeries in their abdomen in the past. The general recovery time is two to four weeks. In addition, you cannot lift more than 10 pounds for 8 weeks. Also you cannot put anything in the vagina for 8 weeks
You should expect some pain around the surgical area and some stomach cramping after the procedure. You may also have some vaginal bleeding. Possible risks with hysterectomy are infection, bleeding, injury to organs like the intestines, bladder, ureters, ovaries, or blood vessels.
Please talk to your doctor to see if hysterectomy is a good option for you.
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Uterine Fibroid Embolization (UFE)
Non-invasive surgery where a special material is injected in the blood vessels supplying the fibroids. This shrinks fibroids by reducing their blood supply.
A doctor called an interventional radiologist puts a catheter (tube) through a vein in your arm or leg. Small particles are placed through the tube to block the blood supply to the fibroids. This can shrink the fibroids and can reduce discomfort, pain, or bleeding. Patients are usually sedated during the procedure but do not require general anesthesia. You’ll also need an MRI and sampling of the tissue in the lining of the uterus (“endometrial biopsy”) before this procedure. Because no incisions are made, recovery from this procedure is very short – about one week. You may stay in the hospital for one night to get help managing pain, which is the worst in the first few hours after the procedure.
You should also expect some pain in the arm or leg where the catheter was put in, and some pain in your uterus. You may also have some vaginal bleeding. Possible risks include infection and severe pain.
In some cases, the procedure may not work and you’ll still have symptoms. Sometimes the fibroids grow back in a few years after the procedure. Pregnancy may not be safe after UFE, so you should not have this procedure if you think you might want children in the future. Please talk to your doctor to see if UFE is a good option for you.
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Endometrial Ablation (Novasure device)
This is a minor surgery. A special instrument is inserted into the uterus to remove, burn, or heat the lining inside the uterus. This can decrease or stop vaginal bleeding.
This is a minor surgery. You will be sedated (asleep) for this procedure, but most people do not need general anesthesia (a breathing tube). The doctor will place a camera through the vagina into the uterus. They will use a special device to cauterize (burn) the lining of the uterus. This decreases the amount of blood the uterus makes during your period. Some possible risks include infection, bleeding, pelvic pain, and injury to organs like the intestines, bladder, uterus, or blood vessels.
Most women have either lighter periods or no periods after the procedure. Some women continue to have heavy periods. Some women have improvement in their periods for a few years, but then have heavy periods again. This occurs more often if you are less than 45 years old. Endometrial ablation may not work as well in patients with fibroids or adenomyosis.
Pregnancy is not safe after endometrial ablation, so you should not have this procedure if you think you might want children in the future. Please talk to your doctor to see if endometrial ablation is a good option for you.
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Focused Ultrasound (US)
This is not a surgery. An MRI (a type of medical imaging) is used to deliver special ultrasound waves that destroy fibroids without having to remove the uterus.
This procedure uses ultrasound waves to destroy fibroid tissue. It is done using an MRI machine, so you do not have any incisions. This treatment usually has a quick recovery time. Some possible risks are temporary numbness or tingling, and pain in your abdomen, uterus, or skin. Long-term effects of this procedure are still being studied. This procedure is not offered at the Boston Medical Center (BMC). Please talk to your doctor to see if this is a good fit for you.
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Laparoscopic Radiofrequency Ablation (Lap-RFA) (Acessa procedure)
Surgery where instruments are inserted through small incisions in your abdomen, which helps your surgeon see your uterus and fibroids more easily. Special instruments are used to heat up and destroy fibroid tissue by making it smaller and softer.
For this surgery, small (1cm or less) incisions are made on your abdomen (belly). The surgeon uses a small camera to see inside your abdomen. Other small devices are placed through the incisions to locate the fibroids with an ultrasound and heat up the fibroids to cause them to shrink. General anesthesia is used for this surgery.
You should expect some pain around the surgical area and some stomach cramping after the procedure. The recovery time is about one week. Possible risks include infection, bleeding, and injury to organs like the intestines, bladder, ureters, ovaries, uterus, or blood vessels.
Sometimes fibroids can come back after this procedure. This is a new procedure, so we do not yet know if it is safe to become pregnant after the procedure. Please talk to your doctor to see if this procedure is a good option for you.
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Daily Pills
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Oral Contraceptive Pills (birth control pills)
Hormonal pills that help regulate the hormones that control your menstrual cycle to help decrease vaginal bleeding and pain.
Read moreBirth control pills, which prevent pregnancy, can help reduce bleeding caused by fibroids. They work by decreasing the amount of bleeding during your period. They do not change the size or location of the fibroids. Some birth control pills contain both estrogen and progesterone while others include just progesterone Many people do not have side effects with birth control pills. When side effects happen, they can be mild nausea, breast tenderness, mood changes, and changes to your periods. They can also increase the risk of blood clots in about three out of every 1000 people who take them.
Please talk to your doctor to see if birth control pills are a good option for you.
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Gonadotropin-releasing hormone (GnRH) antagonists (Elagolix or Orlissa tablets)
Hormonal medication taken as a pill to help improve bleeding and reduce fibroid size by decreasing the amount of female hormones your body makes. The pills cause a temporary menopause. Your body will start making hormones again when you stop the pills.
Read moreThese are pills you take every day. The medicine causes your ovaries to stop making hormones while you’re taking it. This causes your body to temporarily enter menopause. When you stop taking the medicine, your ovaries start making hormones again. While you are on these pills, you do not have periods. The fibroids shrink, and pain usually improves.
This type of medication can also be combined in 1 pill with estrogen (Estradiol) and progesterone (norethindrone) that is taken daily to treat fibroid symptoms. This pill is called Myfembree (relagolix / ethinyl estradiol / norethindrone acetate). This pill may have less menopausal side effects that relagolix or elagolix alone.
Common side effects are hot flashes and decrease in bone density. Your doctor can give you medicines to help with these side effects. These pills usually prevent pregnancy, but some people do become pregnant. Please talk to your doctor to see if these pills are a good option for you.
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Non-Daily Pills
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Tranexamic Acid (TXA)
Non-hormonal medication that can decrease heavy menstrual bleeding by helping your blood clot. It is taken on days when you have heavy bleeding. It is usually used up to five days per month as a short-term treatment.
Read moreThis medication can reduce heavy menstrual bleeding. This medicine is hormone-free and does not affect the size of fibroids. This medication is taken three times a day when menses start for up to five days. The medicine decreases bleeding during a period. It does not affect your chances of getting pregnant, and it takes effect within two to three hours of use. Some side effects may include muscle cramping, pain, and headaches. Please talk to your doctor to see if this medicine is a good option for you.
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Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
Non-hormonal, anti-inflammatory medications used to treat mild bleeding and pain caused by uterine fibroids. Examples include ibuprofen and naproxen.
Read moreThese medications can be used to reduce menstrual bleeding and pain. You can get them without a prescription. You can also take these medicines with some of the other treatments. However, they may not work as well as some of the other treatments.
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Injections
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Medroxyprogesterone acetate (Depo-Provera injection)
Hormonal medication that is injected every three months to help decrease vaginal bleeding from fibroids. Sometimes it helps reduce fibroids size.
Read moreDepo-Provera is a shot given every three months. This medicine keeps you from getting pregnant, and usually stops your periods after three to six months. The injection decreases bleeding, but does not change the size or location of your fibroids. When you stop taking the medicine, your periods come back. Some people do not have regular periods for several months after stopping Depo-Provera injections, so you may not want to choose this option if you are planning pregnancy within the next year. Common side effects are weight gain and headaches.
Please talk to your doctor to see if Depo-Provera is a good option for you.
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Gonadotropin-releasing hormone (GnRH) agonists (Lupron injection)
An injected hormonal medication that helps improve bleeding and reduce fibroid size by decreasing the amount of female hormones your body makes. It’s usually given before surgery.
Read moreLupron is an injection given every every 1 or 3 months depending on the dose prescribed. This medicine causes your ovaries to stop making hormones while you’re taking it. This causes you to temporarily go into menopause. While you are on Lupron, you do not have periods. The fibroids shrink, and pain usually improves.
Common side effects are hot flashes and decrease in bone density. Your doctor can give you medicines to help with these side effects. Lupron usually prevents pregnancy, but some people do become pregnant.
Lupron is usually used for just three to six months. When you stop taking the medicine, your ovaries start making hormones again. Your doctor may recommend Lupron to shrink fibroids before surgery. Lupron can also be used to stop bleeding if you have anemia. Some patients who are close to age 50 and who want to avoid surgery may use Lupron until they have natural menopause. Please talk to your doctor to see if Lupron is a good option for you.
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IUDs + Implants
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Hormonal Intrauterine device (IUD) (Mirena, Liletta, Kyleena, Skyla IUDs)
Device that is inserted inside the uterus that uses hormones to help decrease vaginal bleeding from fibroids.
Read moreHormonal IUDs can be used to decrease pain and stop heavy bleeding caused by fibroids. They are placed inside the uterus by a doctor or a nurse practitioner. IUDs prevent pregnancy and usually make your periods lighter after three to six months. When you remove the IUD, your periods will be the same as before.
The IUD can be used for up to seven years. The IUD decreases bleeding, but does not change the size or location of your fibroids. Common side effects are cramping and irregular bleeding. Please talk to your doctor to see if a hormone IUD is a good option for you.
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Etonogestrel Implant (Nexplanon)
Hormonal implant inserted under the skin of your upper arm that helps decrease bleeding from fibroids by preventing the lining of the uterus from growing.
Read moreThis is an implant that releases progesterone into the bloodstream to help decrease heavy menstrual bleeding caused by fibroids. It also prevents pregnancy. Nexplanon is usually implanted into the upper arm. The device can be used for up to five years. Some common side effects include irregular bleeding, headache, weight gain, mood swings, and acne. Please talk to your doctor to see if an implant is a good option for you.
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Below is a summary of your symptoms and the possible treatment options you selectedYour Answers
Next Steps
If you would like to save this information to discuss with your healthcare provider, please print or screenshot this page. For more information about the Fibroid Center, please visit https://www.bmc.org/fibroid-center. If you would like to schedule an appointment, please call 617.414.2000.
About Us: The content for this website was developed by researchers at Boston University in conjunction with the Fibroid Center at Boston Medical Center. Software was engineered by Aiden Taghinia. This website aims to help people without advanced understanding of medicine or medical terminology understand the options for management of fibroids. We developed this website because there are currently few resources available to help patients in this area. This website does not provide medical advice. For a complete evaluation, please see your healthcare provider. This website will be updated as new treatment options become available. Please email us at fibroidcenter@bmc.org for more information.