Treating Fibroids While Preserving the Uterus

12 Dec Treating Fibroids While Preserving the Uterus

Fibroids are the commonest benign tumours of the uterus, affecting up to 70% of women by the age of 50. When they cause heavy bleeding, pain or fertility issues, many women want treatment options that allow them to preserve their uterus. A range of effective uterus-sparing treatments are now available, from medication to minimally invasive surgery. If you are exploring conservative options before considering a hysterectomy, it may help to read more about the causes and management of fibroids on the main Fibroid Treatment page.

Key Takeaway

• Several effective treatments can reduce fibroid symptoms while preserving the uterus.
• Myomectomy remains the gold standard uterus-sparing surgical option for suitable patients.
• Medications and radiological procedures can help manage symptoms without removing the uterus.
• Treatment choice depends on fibroid size, number, location and future fertility goals.
• A gynaecologist can help determine which minimally invasive or conservative option is most appropriate.

Understanding Fibroids and Why Uterine Preservation Matters

Fibroids, also known as leiomyomas, are non-cancerous growths that develop in the muscular wall of the uterus. They vary widely in size and number, and not all require treatment. However, when fibroids cause symptoms such as heavy bleeding, pelvic pressure or difficulties conceiving, many women prefer options that preserve their uterus, particularly if future fertility is important.

Uterine-sparing treatments aim to reduce symptoms without removing the uterus itself. These options can be highly effective, especially when tailored to the individual’s health history and reproductive goals.

Medical Treatments That Preserve the Uterus

For women with mild to moderate symptoms, medical therapy may be the first step. These options do not remove fibroids, but they can reduce heavy bleeding or pain.

Non-hormonal medication

• Tranexamic acid
• NSAIDs (non-steroidal anti-inflammatory drugs)

These help with painful or heavy periods but do not shrink fibroids.

Hormonal options

• Oral contraceptive pills
• Progesterone tablets
• Hormonal IUD such as the Mirena
• Progesterone injections or implants

These can reduce bleeding, though some may not be suitable for fibroids that distort the uterine cavity.

GnRH analogues

These medications can temporarily shrink fibroids and are sometimes used before surgery to reduce size. They are not a long-term solution due to menopausal side effects.

Myomectomy: The Gold Standard for Removing Fibroids While Keeping the Uterus

A myomectomy removes fibroids but leaves the uterus intact, making it one of the most effective uterus-preserving procedures. There are several approaches, depending on fibroid type and size:

Hysteroscopic myomectomy

• Removes submucosal fibroids inside the uterine cavity
• No abdominal incisions required
• Performed through the cervix

Laparoscopic myomectomy

• Keyhole approach
• Small incisions
• Shorter recovery time

Robotic-assisted myomectomy

For appropriately selected patients, robotic surgery provides enhanced precision, vision and dexterity. If you are considering this advanced minimally invasive approach, you may find it helpful to explore the robotic surgery overview.

Open myomectomy (laparotomy)

Used for very large or numerous fibroids when minimally invasive options are not suitable.

Myomectomy is particularly beneficial for patients who want to maintain or improve fertility. However, fibroids can grow back over time, and some women may require further treatment.

Radiological Treatments That Preserve the Uterus

Some women prefer non-surgical options, especially if surgery is not recommended due to other medical conditions.

Uterine Artery Embolisation (UAE)

A radiologist blocks the fibroid’s blood supply, causing it to shrink. It is effective for symptom control but generally not recommended for women planning pregnancy.

Choosing the Right Uterus-Preserving Treatment

The best treatment depends on several factors:

• The size, number and location of fibroids
• Your age and fertility plans
• Severity of symptoms
• Medical history and preferences
• Whether minimally invasive surgery is suitable
• Personal circumstances and preference 

A gynaecologist will consider all of these factors before recommending the most appropriate option.

When Uterus-Preserving Treatment May Not Be Suitable

In some cases, a hysterectomy may be recommended, such as:

• Severe symptoms unresponsive to other treatments
• Multiple large fibroids that distort the uterus
• Co-existing gynaecological conditions
• Suspicion of malignancy
• When fertility is no longer desired and symptoms are significantly impacting quality of life

If you would like to understand more about the procedure, visit the Hysterectomy page.

Considering Treatment for Fibroids?

Preserving the uterus is possible for many women, and modern treatment options are safer and more effective than ever. To explore your individual situation and receive tailored advice, you can contact the clinic through the General Enquiries page.