This article was created in partnership with sanoLiving clinicians for trusted, accurate information.
If you've been diagnosed with uterine fibroids, you're not alone. These benign tumors affect up to 70% of women by age 50, yet many women suffer in silence: bleeding through tampons, canceling social plans due to exhaustion, or simply accepting this as "just part of being a woman."
It doesn't have to be this way. Understanding your treatment options is the first step toward reclaiming your life.
What Are Fibroids?
Uterine fibroids (also called leiomyomas or myomas) are non-cancerous growths that develop in or on the uterus. They can range from as small as a seed to as large as a melon, and you might have just one or dozens.
The confusing part? Some women with large fibroids have no symptoms at all, while others with small ones experience debilitating problems. Location matters as much as size. Submucosal fibroids that protrude into the uterine cavity and those close to it can more frequently provoke heavy menstrual bleeding with subsequent anemia, which can be life-threatening.
Fibroids can grow in several locations:
- Intramural: Within the muscular uterine wall
- Submucosal: Protruding into the uterine cavity (these cause the heaviest bleeding)
- Subserosal: On the outside of the uterus (these can press on other organs)
- Pedunculated: Attached by a stalk
The Hidden Toll: Beyond Heavy Periods
Most discussions about fibroids focus on heavy menstrual bleeding, but these growths steal more than just your comfort during your period.
Iron Deficiency Anemia and Crushing Fatigue
If you're bleeding heavily month after month, you're likely developing anemia, a condition where your blood can't carry enough oxygen throughout your body. Approximately 30% of women who suffer from heavy bleeding as a side effect of fibroids experience anemia.
Cases of severe iron deficiency anemia complicated with uterine fibroids are not rare, and hemoglobin levels can drop to life-threatening levels below 2.0 g/dl in extreme cases. When your red blood cells are depleted through blood loss, your body starts "stealing" iron from your storage centers, leading to a cascade of symptoms: chronic fatigue, compromised immune function, brittle nails, headaches, cognitive difficulties, hair loss, and even unusual cravings for ice or chalk (a condition called pica).
The fatigue isn't "just being tired." It's the kind of exhaustion where getting out of bed feels like climbing a mountain.
Impact on Sexual Health and Intimacy
Fibroids can profoundly affect your sex life, though this is rarely discussed in doctor's offices. Depending on their size and location, fibroids can cause:
- Pelvic pressure that makes intimacy uncomfortable
- Heavy bleeding that impacts spontaneity and confidence
- Fatigue and low energy that diminishes desire
The emotional toll of these symptoms, combined with the physical discomfort, can strain even the strongest relationships.
Hormonal Treatment Options
Current treatment strategies range from routine monitoring in asymptomatic cases to surgical procedures, with an increasing trend toward uterus-preserving or non-surgical alternatives. Let's explore what's available.
GnRH Antagonists: A New Generation of Treatment
One of the most exciting developments in fibroid treatment is the approval of oral gonadotropin-releasing hormone (GnRH) antagonists. Eleven randomized clinical trials with a total of 4,164 patients evaluated GnRH antagonists including Relugolix, Elagolix, Linzagolix and Cetrorelix against placebo or GnRH agonists in premenopausal women with uterine fibroids and heavy menstrual bleeding.
These medications work by blocking the hormone signals that stimulate fibroid growth. The results showed that patients treated with GnRH antagonists had significantly better control of uterine bleeding compared to placebo, with a relative risk of 5.09. This means that the group was 5x more likely to have bleeding controlled.
The newer oral GnRH antagonists have a major advantage over older injectable versions: they're combined with low-dose hormone "add-back" therapy. Once-daily GnRH antagonist combination therapy results in a significant reduction in menstrual bleeding compared with placebo, and preserves bone mineral density.
Currently available options include:
- Relugolix combination therapy (Myfembree)
- Elagolix combination therapy (Oriahnn)
- Linzagolix (in clinical trials)
These are typically prescribed for women who want to avoid surgery or are preparing for a procedure. The FDA advises limiting treatment to 24 months, though research continues on longer-term use.
Other Hormonal Options
Birth control pills and hormonal IUDs can help manage bleeding in some women, though they don't shrink fibroids. The levonorgestrel-releasing intrauterine system primarily affects the endometrium, the lining of the uterus, rather than directly targeting the uterine fibroids.
Aromatase inhibitors typically used for other gynecological conditions, have shown promise. Studies indicate that these inhibitors can reduce uterine fibroid size and symptoms in selected patients, although common adverse effects include hot flushes, mood swings, bone loss, and vaginal dryness. More research is needed for this category of drugs to be used for fibroids.
Uterine Artery Embolization (UAE): Cutting Off the Blood Supply
Imagine if you could starve your fibroids without surgery. That's essentially what uterine fibroid embolization does.
How It Works
During UAE, an interventional radiologist makes a tiny incision in your groin or wrist and threads a catheter through your blood vessels to the arteries feeding your fibroids. They then inject tiny particles (about the size of grains of sand) that block blood flow to the fibroids, causing them to shrink over time.
The Evidence
The procedure has substantial research backing it. The FIBROID Registry, the largest study evaluating UAE outcomes, enrolled over 3,000 patients. Data showed sustainable fibroid symptom relief with patients reporting improvement in health-related quality of life.
Considerations
UAE had a higher reintervention rate and hysterectomy rate compared to myomectomy at four-year follow-up, meaning some women may eventually need additional treatment. However, for women wanting to avoid surgery initially, it offers significant symptom relief with minimal recovery time.
The procedure can be performed via your groin (transfemoral) or wrist (transradial). Transradial and transfemoral UAE have similar technical and clinical outcomes, with similar rates of uterine volume reduction and low access site complications.
Radiofrequency Ablation: Targeted Heat Therapy
Radiofrequency ablation (RFA) represents one of the newest minimally invasive options for treating fibroids. Think of it as using controlled heat to destroy fibroid tissue from the inside, one fibroid at a time.
Two Approaches
Laparoscopic RFA (Acessa Procedure):
The FDA cleared the Acessa System for ablation of soft tissue including treatment of symptomatic uterine fibroids under direct ultrasound guidance. The procedure uses tiny incisions in your abdomen. A laparoscopic ultrasound probe helps your surgeon see all your fibroids—even tiny ones as small as 2mm—and then treat each one with radiofrequency energy delivered through a needle array.
Transcervical RFA (Sonata System):
This approach goes through your vagina and cervix instead, meaning no abdominal incisions at all. It's particularly good for certain types of fibroids.
Recovery and Lifestyle
Most women go home the same day. Typically, patients can begin work and mild activity in a few days and recover fully within two weeks. Most patients notice significant relief in their symptoms about three months after the ablation.
Important Considerations
The effects of RFA on future pregnancy are still being studied. If you're hoping to get pregnant, discuss this carefully with your doctor. This technique was approved in the United States in 2012, so there is limited long-term data, especially about pregnancy and pregnancy outcomes.
Surgical Options: Myomectomy and Hysterectomy
Myomectomy: Removing Fibroids, Keeping the Uterus
Myomectomy removes fibroids while preserving your uterus, making it the preferred choice for women who want to maintain their fertility. Minimally invasive treatments for uterine smooth-muscle tumors are designed with the aim to preserve the fertility of women.
The procedure can be done through:
- Hysteroscopy (through the vagina and cervix) for submucosal fibroids
- Laparoscopy (small abdominal incisions) for subserosal and some intramural fibroids
- Laparotomy (open surgery) for large or numerous fibroids
The main challenge with myomectomy is that the likelihood of re-intervention is a recognized challenge with conservative approaches, as new fibroids can grow or existing ones can return.
Hysterectomy: Definitive Treatment
Hysterectomy is the most common treatment, but safer options such as localized ablation and oral GnRH antagonist therapies are underused. While hysterectomy permanently solves the problem, it's major surgery with a longer recovery period and means you can no longer become pregnant.
For many women, especially those whose families are complete and who have severe symptoms not responding to other treatments, hysterectomy offers definitive relief and peace of mind.
Making Your Decision: What to Consider
The decision on which procedure to choose should be made based on individual preferences and the physician's expertise. Here are key factors to discuss with your healthcare team:
Your priorities:
- Do you want to preserve your fertility?
- How severe are your symptoms?
- How quickly do you need relief?
- What's your tolerance for the possibility of needing retreatment?
- What does recovery time mean for your work and family life?
Fibroid characteristics matter:
- Size, number, and location of your fibroids
- Whether they're causing heavy bleeding, bulk symptoms, or both
- Results of your imaging studies
Your overall health:
- Severity of anemia, if present
- Other medical conditions
- Age and proximity to menopause
Addressing Anemia: A Critical First Step
Regardless of which treatment you choose for your fibroids, addressing anemia is often the first priority. Anemia caused by fibroids can be treated and cured through iron supplementation and comprehensive uterine fibroid treatment.
Your doctor may recommend:
- Oral iron supplements to rebuild your iron stores
- Intravenous iron infusions for moderate anemia
- Blood transfusions in severe cases
- Dietary changes including iron-rich foods like red meat, beans, leafy greens, and fortified cereals
Once the underlying cause has been treated and iron levels increase, the anemia should go away and your menstrual cycle should become more normal.
The Bottom Line
You have more options than ever before for treating symptomatic fibroids. Current treatment strategies range from routine monitoring in asymptomatic cases to surgical procedures, with an increasing trend toward uterus-preserving or non-surgical alternatives.
The "best" treatment isn't the same for everyone. It depends on your symptoms, your plans for pregnancy, the characteristics of your fibroids, and what matters most to you in terms of recovery time and long-term outcomes.
Don't settle for suffering. Work with a healthcare team that listens to your concerns and presents all available options. Whether you choose watchful waiting, medication, a minimally invasive procedure, or surgery, the goal is the same: helping you reclaim your energy, your comfort, and your life.
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