Hormones may be given in several forms. The female hormone progesterone, that counteracts excess oestrogen, may be given by tablet, injection, implant or intrauterine device.

More commonly drugs called gonadotrophin-releasing hormone agonists (GnRHa) are injected on a monthly or three monthly basis. GnRHa create a temporary menopause by switching off oestrogen production and causing the fibroids to shrink. They can also cause temporary menopause symptoms like hot flushes and tiredness.

GnRHa are generally used as a temporary measure over three to six months to:

• help correct anaemia from heavy blood loss,
• shrink fibroids before surgery to make the surgery easier or
• shrink the womb enough so that “keyhole” robotic or conventional keyhole surgery can be used.

Other medications like painkillers may be tried to reduce discomfort. Tranexamic acid or low dose birth control pills may reduce bleeding problems without causing the fibroids to grow.

UAE is a procedure carried out by specialist x-ray doctors. From the groin, they can inject microscopic particles to block the blood vessels supplying the fibroids. This can cause them to shrink by more than half in many cases. As a result, the symptoms caused by the fibroids improve or disappear.

UAE is a well-proven, low-risk alternative to removing fibroids for women who do not wish to have surgery. There have also been many successful pregnancies following UAE. However, for women who wish to retain their fertility, use of UAE needs to be carefully discussed with a gynaecologist experienced in the management of fibroids.

MRI focussed ultrasound shrinkage of fibroids has a similar effect to UAE but is not offered in many centres at present.

All forms of removal or shrinkage carry a significant risk that fibroids will recur at a later date unless the natural menopause occurs soon after treatment.

• How many fibroids do I have?
• What size are my fibroids?
• Where are my fibroids located (outer, middle, inner surface of the womb)?
• Can I expect the fibroids to grow larger?
• How rapidly have they grown (if their existence was already known)?
• How will I know if the fibroids are growing larger?
• What problems can the fibroids cause?
• What tests or imaging are best for keeping track of the growth of my fibroids?
• What are my treatment options if my fibroids become a problem?

Fibroids often exist without any symptoms and, once diagnosed, may not require any treatment. However if you have significant symptoms, seeing a gynaecologist early may give you more treatment options. Ultimately, hysterectomy is the only complete cure for fibroids.

Ref: S13