Most women with fibroids never need surgery. The right choice depends on your symptoms, the size and location of the fibroids, how close you are to menopause, and whether you want a future pregnancy. These are the options that avoid major surgery, from simply watching to a minimally invasive procedure that treats every fibroid at once.
Watchful waiting
Fibroids that cause no symptoms do not need treatment. They are benign, and they usually shrink after menopause. We recheck with an ultrasound when symptoms change, or at intervals if a fibroid is large.
Medications for bleeding and pain
Anti-inflammatory pain relievers (NSAIDs) and tranexamic acid, taken only during the period, reduce menstrual bleeding and cramping. Iron replaces what heavy bleeding takes away and treats the fatigue of anemia. These medicines relieve symptoms but do not shrink fibroids or help pressure, bloating or frequent urination caused by fibroid bulk.
Hormonal treatment
Birth control pills, the ring or patch, progestin injections and the levonorgestrel IUD can lighten periods, although an IUD is not suitable when fibroids distort the uterine cavity. Newer daily pills that block the hormone signal from the brain (GnRH antagonists combined with low-dose add-back hormones) reduce heavy bleeding substantially and can be used for up to two years. Injectable GnRH agonists shrink fibroids temporarily, often before surgery, but cause menopause-like side effects and cannot be used long term.
The limitation of every hormonal option is the same: fibroids generally grow back once treatment stops. For women close to menopause, that may be enough to bridge the gap; for younger women it often is not.
Uterine fibroid embolization (UFE)
UFE is performed by an interventional radiologist through a pinhole in the wrist or groin. Tiny particles are delivered into the arteries that feed the fibroids, which then shrink while the uterus is preserved. All fibroids are treated in one session, there is no incision, most women go home the same day and return to normal activity within one to two weeks, and the large majority report lasting relief of bleeding and bulk symptoms. Learn more about UFE.
Radiofrequency ablation
Radiofrequency energy delivered through the cervix (Sonata) or through small laparoscopic incisions (Acessa) heats and shrinks individual fibroids. It suits women with a limited number of fibroids of suitable size and location.
MRI-guided focused ultrasound
Focused ultrasound energy, guided by MRI, heats and destroys fibroid tissue without any incision. Sessions are long, only certain fibroids can be reached, and it is offered at relatively few centers.
Choosing among them
Because fibroids differ so much from one woman to the next, we start with imaging and a conversation about your goals, then lay out every option side by side, including how invasive each one is and how long its benefit lasts. You can compare these with surgical options such as myomectomy and hysterectomy before deciding.