If You’re Considering Surgery for Fibroids, Try These Options First

The decision to undergo any procedure for uterine fibroids is personal because it is based on your symptoms, including one of the most common symptoms: heavy bleeding during your menstrual cycle. “The average woman’s bleeding should not saturate through pads,” advises Linda Bradley, M.D., the director of the Fibroid Center at Cleveland Clinic in Ohio. Some women with fibroids experience extreme bleeding during their cycles, Dr. Bradley says, although it can vary greatly from a light flow to a gushing like Niagara Falls. If a heavy cycle is disrupting your life, you should check in with your physician.

Aside from heavy bleeding, pain and bloating are the primary symptoms women experience. “Some women speak of passing blood clots that look like liver, and when they pass it can cause cramping and back pain,” says Dr. Bradley. “These growths make the uterus so enlarged that it can cosmetically make women look like they are pregnant; their stomach sticks out and they can feel a mass.” If you’re wondering how those little fibroids could possibly affect the shape of your belly, the answer is: They’re not so little. The largest of fibroids can grow to be about40 poundsor the size of the watermelon.

“The cure [to fibroids] will always be a hysterectomy,” says Dr. Bradley. “If you take out the uterus, you won’t have periods (or period pain). But for people who want to have children, that is not the right answer.” Reports show that 20% to 80% of women will get fibroids before they reach the age of 50, when they are still in their reproductive years. So, making a permanent decision to get a hysterectomy requires weighing your desire for a family against your immediate health needs.

如果你正在经历的症状和好的under the knife, a laparoscopic myomectomy is another option. Here, a doctor will make small incisions in your belly and use a lighted tube with a miniature camera on the end to guide them as they remove the fibroids. This method is recommended for women who want to become pregnant (some women with fibroids struggle with conceiving). One study found about80%of women were able to get pregnant within a year of the procedure. A laparoscopic myomectomy may remove fibroids long enough for you to get pregnant, but they will likely eventually come back.

If surgery’s not your thing, uterine artery embolization (UAE) is another option. During this procedure, a radiologist uses a catheter to enter the femoral artery (one of the main blood vessels in the thigh) and adds a material that cuts off the blood supply to the fibroids which causes them to shrink. “You would need to go to a radiology department that could do this procedure,” says Linda Fan M.D., an assistant professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine in New Haven, CT. “This is a good option for bleeding but not bulk symptoms.”

You can also go the hormonal route. A progestin-releasing IUD can help reduce bleeding and pain caused by uterine fibroids, but keep in mind this treatment does not remove the fibroids, it simply treats the symptoms. Another daily oral medication combines relugolix, estradiol, and norethindrone acetate to reduce heavy bleeding. Neither treatment should be used by women who want to get pregnant.

Gonadotropin-releasing hormone analogues (GnRH-a) are also an option. This group of medications can shrink fibroids but puts your body in a menopause-like state, so it’s not ideal for the long term. (Also, if you stop taking the meds the fibroids can grow back.)

We all have that friend or relative who insists a change in diet or exercise helped them shrink their fibroids. It’s possible, but experts and science are not yet convinced. “There isn’t any research on that,” says Dr. Fan. She adds that because there is no evidence of diet and exercise truly making a difference in fibroid symptoms, it could be a placebo effect. Still, there’s no downside to a healthy diet and regular exercise, so if you believe the Mediterranean or anti-inflammatory diet is working for your fibroid pain, Dr. Fan says, “Keep it up!”

Managing uterine fibroids is a specialty that all physicians aren’t well versed in, and not all doctors keep up with the latest research and technology. If your doctor isn’t comfortable with discussing treatment options for your fibroids, or is pushing you to have surgery and not presenting other options, it’s time to find a new doc. “Patients should know that there are different options out there and they should ask about them,” says Dr. Fan. “I also think they should go to facilities that can offer these options or at the very least talk to them about it.”

Always remember that your health is your priority. Consider keeping a journal of past medicines and procedures so if you see a new physician, you save time and money by not trying something that failed in the past. “Know your body, know yourself, and know what you’ve done before,” says Dr. Bradley, who recommends saving your lab results. Then, if you change insurance and switch doctors, you’ll still have your old tests to refer to. And if your current treatment isn’t working, don’t give up: Keeping working with your doctor until eventually, something clicks.