Uterine Fibroids

We may do an ultrasound, diagnostic hysteroscopy, saline infusion sonography or MRI to get a clear picture of your pelvic health before creating a treatment plan.

Ultrasound

This non-invasive test creates a picture of your pelvic organs using sound waves. Ultrasound is often the first test done to confirm that you have uterine fibroids and check for abnormalities in your pelvis.

Hysteroscopy

A diagnostic hysteroscopy is a quick procedure that can be performed right in the doctor’s office. Our team has performed more than 10,000 in-office hysteroscopies, which means we have extensive experience with this technique.

During a diagnostic hysteroscopy, we insert a thin, flexible lighted tube, or hysteroscope, through the vagina to examine the uterus. We often utilize a “no-touch” technique that eliminates the need for a speculum or additional instruments. A hysteroscopy helps us determine the size and extent of your fibroids. We can also make sure you don’t have other conditions affecting the uterus and cervix, such as polyps or an infection.

Saline infusion sonography

A saline infusion sonography, also called a water sonogram, is a type of ultrasound. We use saltwater to gently expand the uterus. Your doctor inserts an imaging tool through the vagina, which allows us to see a 3D image of fibroids and other abnormalities in the uterus.

MRI

We may do an MRI if your uterus is enlarged. This imaging test helps us determine the size, number and location of your uterine fibroids.

You have a range of options when it comes to uterine fibroid treatment. Before creating a treatment plan, we take the time to listen to your needs. We review your symptoms and discuss your goals for fertility preservation.

Uterine fibroid medications

We offer a wide range of medications to reduce pelvic pain, relieve heavy bleeding during periods and prevent anemia (a lack of iron in the blood). We may recommend:

• Birth control pills: Estrogen helps shorten periods and reduce heavy bleeding.
• Progestin-releasing intrauterine device (IUD): This hormone can reduce blood flow during periods, though an IUD may not be recommended for women with bulk fibroids.
• Tranexamic acid (Lysteda®): We give this nonhormonal medication during your period to reduce blood loss. We may recommend it for women who can’t have hormonal therapy.
• Elagolix (Oriahnn™): This pill lowers estrogen levels in the body. It reduces heavy bleeding and may stop your periods completely while used, up to 24 months.
• Leuprolide acetate (Lupron Depot®): This medication is administered as a shot and lowers estrogen levels in the body. It reduces heavy bleeding and may stop your periods completely.
• Relugolix, Estradiol, Norethindrone acetate (Myfembree®): This pill contains a combination of medications that can help decrease heavy bleeding due to fibroids and minimize side effects.

Fibroid surgery options at Cleveland Clinic

Sometimes fibroid surgery is necessary. We’ll choose a procedure that fits your fertility goals and personal preferences. Be sure to let us know what’s important to you. We offer bloodless surgery for women who don’t want a blood transfusion or blood products during surgery.

Uterine artery embolization

During this procedure, we collaborate with interventional radiologists to place a small catheter into an artery in your groin or wrist. We inject particles through the catheter into your uterine arteries to cut off blood supply to the fibroids. This causes them to shrink over the span of a few months.

Endometrial ablation

Your surgeon uses heat to destroy the lining of the uterus. This treatment may burn small fibroids near the uterine lining, but it’s primarily done to reduce heavy bleeding during periods. Endometrial ablation affects fertility, so we would not recommend this procedure if you’re planning on having children.

Myomectomy

We may recommend a myomectomy if you plan on having children. During this procedure, we remove the uterine fibroids and keep your uterus intact. Our surgeons can perform most myomectomies hysteroscopically or laparoscopically.

Hysteroscopic myomectomy

We can remove small fibroids in the uterine cavity using a hysteroscope. This is a thin, lighted tube used to look inside the vagina, cervix and uterus. We attach surgical tools to the hysteroscope to take the fibroids out through the vagina. Without the need for any incisions, this is a quick, outpatient procedure. Most women can return to normal activities within a few days.

Laparoscopic and robotic-assisted myomectomy

We use this procedure to remove larger uterine fibroids while preserving the uterus. However, it requires small incisions in the abdomen, often measuring 5-10mm. In some cases, a surgeon may use the assistance of a robot depending on the surgeon’s preference.

For most women, laparoscopic myomectomy is a same-day procedure. Recovery time is usually two to four weeks. The procedure offers several advantages over a traditional open myomectomy, including:

• Less blood loss.
• Quicker recovery.
• Reduced pain after surgery.
• Smaller incision.

Laparoscopic hysterectomy

By the age of 60, one in three women will have had a hysterectomy (a surgery to remove the uterus). The majority of hysterectomies are done to treat fibroids.

Many women assume they’ll need an open hysterectomy (laparotomy), which would involve a large incision and an extensive recovery. However, we can almost always perform a vaginal or laparoscopic hysterectomy, which only requires small incisions in the abdomen.

It’s important to note that we typically don’t remove the ovaries during a hysterectomy if you are premenopausal. This means you won’t go into early menopause or need hormone therapy after the procedure. Most women can go home the same day as their surgery. The typical recovery period is two to four weeks.

Radiofrequency ablation (RFA)

This minimally invasive procedure applies heat directly into the fibroids. This causes the fibroids to shrink over time and reduces symptoms. RFA may be done vaginally or laparoscopically depending on the size, number and location of the fibroids.

Taking the Next Step

Whether it’s miserable periods or pain, fibroids can pull you away from your active life. The good news? You can work with our team of experts to create a treatment plan that’ll work for you. With treatment, comes relief from symptoms that get in the way of the life you want to live.