Uterine fibroids, also known as leiomyomas, are non-cancerous growths of the uterus that can affect women at various stages of life. While they may be asymptomatic in some, others experience significant symptoms like heavy menstrual bleeding, pelvic pain, and fertility challenges. As an obstetrician, gynecologist, and fertility expert, I often encounter patients seeking clarity on the best approach to managing fibroids. Here, we delve deeper into modern solutions and approaches to fibroid management, offering insight into when and how to intervene.

Not all fibroids require treatment. The decision largely depends on their size, location, and the symptoms they cause.

• Symptomatic Fibroids: Fibroids causing heavy menstrual bleeding, anemia, severe pelvic pain, frequent urination, or constipation should be addressed.
• Fibroids Impacting Fertility: Submucosal fibroids or those distorting the uterine cavity can interfere with implantation or pregnancy and often need removal.
• Rapidly Growing Fibroids: Any fibroid that grows rapidly in a short period raises concerns and warrants further evaluation.
• Asymptomatic Large Fibroids: Fibroids over 5 cm, even without symptoms, may require observation or treatment if there’s potential for complications like compression of nearby organs.

• Women with Reproductive Goals: For women planning pregnancies, fibroids affecting the uterine cavity (submucosal or large intramural fibroids) should be prioritized for treatment.
• Women Nearing Menopause: For peri-menopausal women, a wait-and-watch approach may be suitable unless symptoms significantly impact their quality of life.
• Postmenopausal Women: New or enlarging fibroids or postmenopausal bleeding related to fibroids requires immediate investigation to rule out malignancy.
• Chronic Symptomatic Patients: Women experiencing persistent symptoms that disrupt daily life should be considered for intervention, regardless of reproductive plans.

The best treatment depends on the individual’s symptoms, age, reproductive goals, and overall health.

1. Medications
   • Hormonal Therapy: Medications like gonadotropin-releasing hormone (GnRH) agonists shrink fibroids temporarily and are often used pre-surgery to reduce size.
   • Progestin-based Therapies: These can help control heavy bleeding but don’t shrink fibroids.
   • Selective Progesterone Receptor Modulators (SPRMs): Newer medications like ulipristal acetate offer targeted management of symptoms with fewer side effects.
2. Non-Surgical Interventions
   • Uterine Artery Embolization (UAE): A minimally invasive procedure that blocks the blood supply to fibroids, causing them to shrink. Ideal for women who have completed childbearing.
   • MRI-guided Focused Ultrasound Surgery (MRgFUS): A non-invasive technique using high-intensity ultrasound waves to ablate fibroids. Best for smaller, symptomatic fibroids.
3. Surgical Options
   • Hysteroscopic Myomectomy: Removes submucosal fibroids via the vaginal route, preserving fertility.
   • Laparoscopic or Robotic Myomectomy: Minimally invasive techniques to remove fibroids while maintaining the uterus.

• • Hysterectomy: Complete removal of the uterus is the only definitive cure for fibroids but is typically reserved for women who have completed childbearing and have severe symptoms.

While there is no guaranteed method to prevent fibroid growth, adopting a proactive approach can help:

• Lifestyle Modifications: Maintain a healthy weight, as obesity is linked to fibroid growth. A diet rich in fruits, vegetables, and whole grains, and low in red meat and processed foods, is beneficial.
• Control Hormonal Levels: Manage estrogen levels through hormonal contraception or medication, as fibroids thrive in high-estrogen environments.
• Regular Monitoring: Routine ultrasounds and check-ups can help track fibroid size and growth patterns.

A hysterectomy is the only permanent solution for fibroids, ensuring they do not recur. However, this is a major decision that requires thorough discussion about the patient’s reproductive goals and overall health.

For those wishing to retain their uterus, myomectomy or minimally invasive interventions like UAE or MRgFUS offer long-term relief but may not prevent recurrence.