Women's Health

Fibroid Zen: 8 Ways to Shrink Them

By Devin Namaky MD

TriHealth Advanced Gynecologic Surgery

Your clothes don't fit like they used to. Your belly may even start to look a little lumpy, not to mention that constant urge to urinate. Getting asked "how far along are you?" might be the last straw.

How do you deal with your fibroids? Because let's face it. You can't exactly head down to your local evil villain supply shop and get your hands on a shrink ray and we don't have a time machine to reverse the growth of fibroids. There are things you just can't change. There's always the option of a hysterectomy, but what if you don't want to have a hysterectomy just yet?

Here are eight ways you may be able to shrink those fibroids, potentially avoiding hysterectomy.

1. Do nothing (Watchful Waiting)

We’re traditionally taught that fibroids shrink around menopause, although that’s not always the case. If your symptoms aren’t making you an anxious mess, or if they aren’t life threatening, this may be a reasonable option.

What about those of you who aren’t approaching menopause? You might be thinking “If I was interested in doing nothing I wouldn’t be reading this article in the first place!” But did you know about seven percent of fibroids seem to shrink on their own?

Now for the reality check: In the same women the overall growth rate was a nine percent increase in size. Even though some fibroids shrink, most women using watchful waiting actually get worse.

You may especially want to consider other options if you are young and nowhere near menopause.

2. Have a baby

There are many factors you consider before having children (e.g. the presence of a stable loving relationship, parenting skills, financial means, etc.)

Then there are the minor details of wanting and managing to get pregnant and making it through nine months of potential misery as fibroids tend to temporarily grow during pregnancy. You also have to consider the challenges of the postpartum period as well as raising a child.

All of that said, pregnancy can improve fibroids. Some will shrink or even disappear postpartum, so if you were already considering having a child, a reasonable option might be to go ahead and have one.

3. Mifepristone

Mifepristone has been shown to reduce the size of fibroids, and decrease fibroid symptoms. It may be hard to get the right dose. For some, having a pharmacy compound Mifepristone is an option.

4. Ulipristal

Ulipristal decreases fibroid size by about 20 percent and controls bleeding. Typically, small doses are used. Unfortunately, in the United States only larger doses are available, which limits its use.

5. Leuprolide

Leuprolide is sometimes used before fibroid surgery, decreasing fibroid size and symptoms.

A drawback is that myomectomy (i.e. fibroid removal) may be more difficult. Its main pre-operative use is to make hysterectomy easier and enable a minimally invasive procedure.

Side effects of leuprolide can be significant. Essentially, you’re put in an induced menopause. Symptoms of menopause are common on this medication, and if taken long-term your bone health can also be affected.

6. Myolysis

Myolysis is an outpatient laparoscopic approach to destroy (not remove) fibroids. Various technologies can be used to perform myolysis, the most promising of which is radiofrequency (RFA). Recent information on RFA myolysis shows size reductions of up to 45 percent.

There is still a lack of information on myolysis. It isn’t well known how it affects future pregnancies. It hasn’t been compared to many other treatments, and there is little information on how often you might need another surgery. Myolysis is still considered investigational.

7. Uterine artery embolization (UAE)

Uterine artery embolization has been around for more than 10 years. A Cochrane review showed a 30 to 45 percent reduction in fibroid size for UAE, the main benefit being faster recovery than major surgery.

UAE is not without its drawbacks, however, and readmission is sometimes required. Some fibroids are not amenable to treatment with UAE, and UAE may have a detrimental effect on future pregnancies. Many patients will still need an invasive procedure.

8. Focused ultrasound (FUS)

FUS is used to heat fibroids. Only certain sizes and numbers of fibroids are treatable with FUS, and many centers restrict who they are willing to treat. It requires spending quite a bit of time laying in an MRI machine.

Further complicating things, FUS was compared with placebo (i.e. they essentially faked FUS on some patients for comparison) and the results were disappointing. Regarding fibroid symptoms, women who received FUS fared no better than women who received the fake treatment.

FUS is probably not ready for regular use.

What doesn’t shrink fibroids?

Diet, “natural”, and non-prescription therapies don’t shrink fibroids. Some reduce the risk of developing fibroids, but there is no information to suggest diet or herbal therapies shrink fibroids or are effective treatments for fibroids.

Even when you feel desperate, overcome with anxiety, fed up with bloating, pain or bleeding, don’t fall victim to “natural” or “herbal” remedies. They are not regulated for safety and are not tested for efficacy (i.e. they aren't tested to see if they work). Don’t hurt yourself, or prolong your own suffering with the false sense of hope they provide.

Take care of your body. Stay informed. Ask your doctor.

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