Tammy has been seeing her gynaecologist annually for the past 5 years. She has a large fibroid. Her gynaecologist has reassured her that no treatment is required since she has no symptoms. Tulsi, on the other hand, wants to have a child and has been investigated for the last 2 years to figure out why she has not conceived. She has a fibroid growing into the uterine cavity. She has been advised to have the fibroid removed.

The treatment options for uterine fibroids are varied. To decide what is best for a particular woman, certain questions need to be answered.

• What are the symptoms and how do they affect the quality of your life?
• Do you plan to have children in the future?
• Are there risks associated with the treatment chosen?
• What are the costs involved?

There are various situations that may be present in women with fibroids. Each scenario requires a different approach.

For women with no bothersome symptoms and who are not planning to become pregnant

These women can be watched expectantly. No intervention is required. Depending on the size of the fibroid, these women can see their gynaecologist every 6-12 months. As long as a woman is reassured that the large size of the fibroid is not going to interfere with her health, she will more often that not, choose to watch and wait.

For women with heavy bleeding but who are not planning a pregnancy

In these women, there are several options. Oral contraceptive pills may be used to control the flow as well as provide contraception. Women, who have fibroids and a normal size uterine cavity, may get relief from heavy bleeding by using a progestin-releasing intra-uterine device (IUD). The hormone in the IUD thins the uterine lining. The menstrual flow will progressively decrease and within 6 months there will be negligible bleeding during the periods.  One scientific study showed that by 3-6 months, 85% of women returned to normal bleeding.

For women with heavy bleeding but who are interested in future fertility

In these women, there are several options depending on the position of the fibroid. 

Tranexamic acid tablets taken during menstruation may help control the bleeding. In case the fibroid is distorting the uterine cavity, a myomectomy may be done to remove the fibroid alone.