Treatment Options for Fibroids
Why This Matters
Being diagnosed with fibroids can feel overwhelming, particularly if your symptoms are affecting your daily life.
You may have been told you need treatment—or perhaps you've been offered several different options and aren't sure which is right for you.
Some women worry they'll immediately need surgery or lose their uterus. Others wonder whether they should simply wait and see what happens.
The good news is that there isn't one single treatment for fibroids. Instead, treatment is tailored to your symptoms, the size and location of your fibroids, your age and, importantly, whether you hope to have children in the future.
Understanding your options can help you feel more confident when discussing treatment with your healthcare team.
Quick Summary
Not all fibroids need treatment.
Treatment depends on your symptoms and personal circumstances.
Many women only require regular monitoring.
Medication can help control symptoms but usually doesn't remove fibroids.
Several minimally invasive procedures are available.
Surgery may be recommended for larger fibroids or fertility problems.
Your future pregnancy plans are an important part of choosing the right treatment.
Do All Fibroids Need Treatment?
No.
Many fibroids are discovered by chance during an ultrasound or pelvic examination.
If your fibroids:
aren't causing symptoms
are small
aren't affecting fertility
your doctor may simply recommend watchful waiting.
This usually involves monitoring your symptoms and, occasionally, repeat scans to check whether the fibroids are changing.
Many women never need treatment.
Choosing the Right Treatment
Several factors help determine which treatment is most suitable.
These include:
your age
the severity of your symptoms
the size of the fibroids
where the fibroids are located
whether you want children in the future
how close you are to menopause
your overall health
There is rarely one "best" treatment for everyone.
Medication
Medication does not usually remove fibroids permanently, but it can help control symptoms.
Pain Relief
Simple painkillers such as paracetamol or anti-inflammatory medicines (NSAIDs), for example ibuprofen, may help reduce period pain.
Medicines to Reduce Heavy Bleeding
Several medications can reduce menstrual blood loss.
These include:
tranexamic acid
NSAIDs
hormonal contraception (such as the combined pill or progesterone-only methods)
the hormonal intrauterine system (Mirena®), if the shape of the uterus allows it
These treatments improve symptoms but do not remove fibroids.
Hormone Treatments
Some medications temporarily reduce hormone levels and can shrink fibroids.
Examples include GnRH agonists and GnRH antagonists.
These medicines are often used:
before surgery
to reduce fibroid size
to improve anaemia caused by heavy bleeding
Because lowering oestrogen can cause menopausal-type side effects such as hot flushes and bone loss, these treatments are usually prescribed for a limited period.
Uterine Artery Embolisation (UAE)
Uterine artery embolisation is a minimally invasive procedure performed by an interventional radiologist.
Tiny particles are injected into the arteries supplying the fibroids.
This reduces their blood supply, causing the fibroids to shrink over time.
Advantages
avoids major surgery
shorter recovery
uterus remains in place
Things to Consider
Although many women have successful pregnancies afterwards, there is still some uncertainty about fertility outcomes compared with surgery. Women wishing to have children should discuss this carefully with their specialist.
MRI-Guided Focused Ultrasound
Some hospitals offer MRI-guided focused ultrasound treatment.
This uses high-energy ultrasound waves to heat and destroy fibroid tissue without making surgical cuts.
It is not suitable for every type of fibroid and is not available everywhere.
Myomectomy
A myomectomy is an operation that removes fibroids while leaving the uterus in place.
This is often the preferred surgical option for women who hope to become pregnant.
Depending on the fibroids, it may be performed:
through the cervix (hysteroscopic)
using keyhole surgery (laparoscopic or robotic)
through open abdominal surgery
Although myomectomy can improve symptoms and fertility in some women, fibroids may develop again in the future.
Hysterectomy
A hysterectomy removes the uterus completely.
This is the only treatment that permanently prevents fibroids from returning.
It may be recommended when:
symptoms are severe
other treatments have failed
pregnancy is no longer desired
fibroids are very large
A hysterectomy is major surgery and is a significant personal decision.
Which Treatment Is Best If I Want Children?
If you're hoping to become pregnant, preserving fertility is usually an important part of treatment planning.
Your specialist may recommend:
monitoring only
medication to improve symptoms while planning pregnancy
myomectomy if fibroids are affecting fertility
IVF in some circumstances
The best option depends on your individual situation.
Will Fibroids Come Back?
Unfortunately, they can.
Fibroids that are removed during a myomectomy may be replaced by new fibroids developing later.
After menopause, however, fibroids usually stop growing and often become smaller.
What Does This Mean for You?
Not every woman with fibroids needs treatment, and not every woman needs surgery.
The right approach depends on your symptoms, your future plans and how your fibroids are affecting your life.
For some women, simple monitoring is all that's required.
Others may benefit from medication, minimally invasive procedures or surgery.
Understanding your options allows you to have informed conversations with your healthcare team and choose the treatment that best fits your individual needs and priorities.
You Are Not Alone
If you've been offered treatment for fibroids, it's normal to feel uncertain or even frightened.
You may be worried about surgery, anxious about your fertility or unsure whether you're making the right decision.
Remember that there is rarely a need to rush. In most cases, you'll have time to ask questions, explore your options and, if you wish, seek a second opinion.
The best treatment is the one that takes into account not only your fibroids, but also your goals, your lifestyle and what matters most to you.
Key Takeaways
Many fibroids require no treatment.
Treatment depends on symptoms, size, location and future pregnancy plans.
Medication mainly helps control symptoms rather than remove fibroids.
Uterine artery embolisation and focused ultrasound offer less invasive alternatives for some women.
Myomectomy removes fibroids while preserving the uterus.
Hysterectomy permanently removes fibroids but also ends the ability to carry a pregnancy.
Treatment decisions should always be individualised.
Frequently Asked Questions
Do all fibroids need to be removed?
No. Many fibroids never require treatment and can simply be monitored.
Can medication cure fibroids?
Medication can reduce symptoms and sometimes shrink fibroids temporarily, but it does not usually remove them permanently.
Which operation is best if I want children?
A myomectomy is often considered when surgery is needed and future pregnancy is desired, although the best treatment depends on your individual circumstances.
Will my fibroids come back after surgery?
They can. Myomectomy removes existing fibroids, but new fibroids may develop over time.
Is a hysterectomy the only permanent cure?
Yes. Removing the uterus permanently prevents fibroids from returning, but it also means you will no longer be able to carry a pregnancy.
References
National Institute for Health and Care Excellence (NICE). Heavy menstrual bleeding: assessment and management (NG88).
Royal College of Obstetricians and Gynaecologists (RCOG). Fibroids: Information for You.
American College of Obstetricians and Gynecologists (ACOG). Management of Symptomatic Uterine Leiomyomas.
European Society of Human Reproduction and Embryology (ESHRE). Guidance on fertility and fibroids.
Stewart EA, et al. Uterine Fibroids. Nature Reviews Disease Primers.
Bulun SE. Uterine Fibroids. New England Journal of Medicine.