Alternatives to surgery for fibroids

Fibroids are benign, small growths made up of muscle and fibrous tissue that grow inside or close to the womb

About 1 in 3 women will develop fibroids during their reproductive years (ages 16 to 50) as they appear to be linked to the female hormone oestrogen

Often you don’t realise you have them as there aren’t always symptoms. But for those who do suffer symptoms, this can disrupt your life, such as, painful or heavy periods, stomach or lower back pain, a constant need to empty your bladder, constipation, and discomfort during sex. In rare cases they can cause problems during pregnancy or infertility.  

Surgery in the form of a hysterectomy to remove the womb is the most conclusive way to ensure fibroids don’t ever return. However, this comes with the risks of major surgery, having a general anaesthetic, and the need for a long recovery time. 

There are other non-surgical options you may want to consider. 

Treating the symptoms of fibroids 

There are over the counter medicines and some prescribed by your GP, which can alleviate the symptoms of fibroids, like bleeding and cramps. 

This includes taking the progestogen hormone, either orally or as an injection. It has the effect of slowing down the growth of the womb lining, resulting in lighter periods. 

While tranexamic acid tablets help the blood to clot, and so reduce periods by about 50%. 

And non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen and mefenamic acid, reduce bleeding and help with the management of pain. 

Taking the oral contraceptive pill can also make periods lighter, and reduce pain. 

Shrinking fibroids

Fibroids tend to shrink after menopause as levels of oestrogen diminish. There are also medications that can be used to reduce the size of fibroids, which your GP may refer you to a gynaecologist to prescribe. 

Gonadotropin releasing hormone analogues (GnRHas)

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

By shrinking the fibroids, you relieve pressure on your tummy and symptoms like the need to urinate frequently and constipation. 

The downside is that side-effects are similar to going through the menopause, including hot flushes, increased sweating and vaginal dryness. And it can only be prescribed for 6 months, after which your fibroids may return. 

Ulipristal acetate 

Ulipristal acetate is taken in tablet form and is a new way of treating fibroids by stopping your periods for a few months, during which time your fibroids should shrink. 

It’s only recommended for women over 18, with moderate to severe symptoms. 

Alternatives to surgery

If you’ve tried medical treatments and you’re still suffering symptoms of fibroids, you may think your only option is major surgery, such as a hysterectomy to remove the womb, or a myomectomy where fibroids are surgically removed. But there are still non-surgical procedures to consider.  

Uterine artery embolisation (UAE)

Uterine artery embolisation (UAE) is a highly effective procedure that involves blocking the blood vessels that supply the fibroids, causing them to shrink. A radiologist, who is skilled at reading X-rays and scans, will inject a special solution through a small tube, which is guided by X-ray through a blood vessel in your leg. 

It’s usually carried out while you’re awake, under local anaesthetic, so the area is numbed. It involves a couple of days in hospital, and 1 to 2 weeks rest after you return home. 

This procedure is usually recommended for women with large fibroids. 

You can go on to have a successful pregnancy after this procedure, but the effects on fertility and pregnancy are not full known.

All private insurance companies now cover for UFE. MRI scans will usually be charged on top of the usually quoted figures. UFE is provided by highly trained medical specialists known as interventional radiologists such as by Dr Nigel Hacking.

Dr Hacking who is the founder and medical director of a number of fibroids patient groups says, "Women of African and Afro-Caribbean descent have an increased risk of developing fibroids".  To help give women in Africa and the West Indies access to this non-invasive fibroid treatment, and to help train young doctors and junior radiologists, Dr Hacking dedicates part of his time in these countries each year, carrying out procedures and spreading his knowledge of the technology.

Endometrial ablation

This is a minimally invasive procedure that involves removing the lining of the womb, rather than the whole womb, as with a hysterectomy.  

It's mainly used to help women with heavy periods, to reduce or stop bleeding.  But it can also be used to treat small fibroids in the womb lining.

The lining can be taken away by various techniques, including freezing, electricity, microwaves, radiofrequency (radio waves) or hot water. 

One innovative ablation technique is NovaSure, which uses radio frequency waves. It’s a quick treatment that uses a rapid delivery (Maximum 120 seconds) of controlled radio frequency energy with a measured scientific end point to ensure safe and reliable ablation. On average it takes 90 seconds, and doesn’t require pre-treatment or scheduling with the menstrual cycle.

The procedure has a very high satisfaction rate and can be performed under local anaesthetic. Patients recover for up to two hours afterwards, and leave with simple painkillers.  You will be able to return to your normal activities the next day. 

It may still be possible to get pregnant after this procedure, so a form of contraception is needed. And it’s not recommended for women wanting to have children because the risk of miscarriage is high. 

MRI-guided procedures

There are also two relatively new techniques for treating fibroids using a magnetic resonance imaging (MRI) scanner. This machine allows the doctor to see a very detailed picture inside your body. 

The scanner is used to guide small needles into the centre of the fibroid. Laser energy or ultrasound energy is then passed through the needles to destroy the fibroid. The procedures are called MRI-guided percutaneous laser ablation and MRI-guided transcutaneous focused ultrasound, respectively. 

Day surgery for fibroids 

A MyoSure procedure is minimally invasive, and doesn’t involve cuts or scars, and you can go home the same day.  

The area is numbed using local anaesthetic, and you’re awake while your gynaecologist is guided to the right spot using a hysteroscopy. This is where the lining of the womb can be accessed via a slim telescope (hysteroscope) that’s passed into the womb via the vagina, and images are fed back to a screen. Fibroids can be removed using small surgical instruments that can be passed down the hysteroscope. 

Complications are rare. It shouldn’t interfere with your fertility, should you want to get pregnant in the future. 

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A medication that reduces sensation. Full medical glossary
Any drug that suppresses inflammation Full medical glossary
A blood vessel that carries blood away from the heart. Apart from the pulmonary artery and umbilical artery, all arteries carry oxygenated blood. Full medical glossary
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A fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. Full medical glossary
Blood that has coagulated, that is, has moved from a liquid to a solid state. Full medical glossary
a common condition where stools are not passed as frequently as normal Full medical glossary
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A benign tumour, most often in the uterus. Full medical glossary
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An organ with the ability to make and secrete certain fluids. Full medical glossary
gonadotrophin-releasing hormone Full medical glossary
A substance produced by a gland in one part of the body and carried by the blood to the organs or tissues where it has an effect. Full medical glossary
The surgical removal of the uterus (womb). Full medical glossary
A tube equipped with a light source and either a small camera or an optical system, used to examine the inside of the uterus (womb). Full medical glossary
Examination of the inside of the uterus by endoscopy, using an instrument called a hysteroscope inserted through the vagina and cervix. Full medical glossary
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A medication that reduces sensation in a part of the body. Full medical glossary
A technique for imaging the body that uses electromagnetic waves and a strong magnetic field. Full medical glossary

The time of a woman’s life when her ovaries stop releasing an egg (ovum) on a monthly cycle, and her periods cease

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The monthly sequence by which a woman’s body prepares for potential fertilisation of an egg released from the ovaries, involving thickening of the uterus lining and then shedding of the lining when pregnancy does not occur. Full medical glossary
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An abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. Full medical glossary
Tissue made up of cells that can contract to bring about movement. Full medical glossary
Any test or technique that does not involve penetration of the skin. The term 'non-invasive' may also describe tumours that do not invade surrounding tissues. Full medical glossary
non-steroidal anti-inflammatory drug Full medical glossary

Non-steroidal anti-inflammatory drugs. A group of drugs that provide pain relief and reduce inflammation.

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A hormone involved in female sexual development, produced by the ovaries. Full medical glossary
Female reproductive organs situated one on either side of the uterus (womb). They produce egg cells (ova) and hormones in a monthly cycle. Full medical glossary
Usually related to medical procedures; entering the body through the skin. Full medical glossary
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the organ or the body where food is stored and broken down Full medical glossary
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The muscula passage, forming part of the femal reproductive system, between the cervix and the external genitalia. Full medical glossary
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A type of electromagnetic radiation used to produce images of the body. Full medical glossary