Most fibroids do not require treatment unless they arecausing symptoms.

After me nopause fibroids shrink andit is unusual for fibroids to cause problems.Symptoma tic uterine fibroids can be treated by: medication to control symptoms medication aimed at shrinking tumours ultrasound fibroid destruction various surgically aided methods to reduce bloodsupply of fibroids myomectomy or radio frequency ablation hysterectomy Herbal treatment Most frequently used herbal treatments areVitex agnus-castus,YarrowandCapsella b ursa-pastoris. There is no clinical evidence supporting their use in the treatme nt of fibroids, however for Vitex [33] and Yarrow [ citation needed ] thereis evidence that they can reduce menstrual bleeding andPMS symptoms. Medication A number of medications are in use to control symptomscaused by fibroids. NSAIDs can be used to reducepainful menses. Oral contraceptive pills are prescribed to reduce uterine bleeding and cramps. [30] Anemia mayhave to be treated with iron supplementation.Levonorgestrel intrauteri ne devicesare highly effectivein limiting menstrual blood flow. Side effects are typically very moderate because thelevonorgestrel (a progestin) is released in l ow concentration locally. Whilemost Levongestrel-IUD studies concentrated ontrea tment of women without fibroids a few reported verygood results specifically for women with fibroidsincluding a substantial regression of fibroids. [34] Onereported problem is that women with large fibroids hadmore frequently spontan eous expulsion of the IUD,however many of those asked for reinsertion of thedevi ce indicating a high rate of satisfaction despite theexpulsion. [35][36] Danazolis an effective treatment to shrink fibroids andcontrol symptoms. Its use is limited by unpleasant sideeffects. Mechanism of action is thought to beantie strogenic effects. Recent experience indicates thatsafety and side effect profil e can be improved by morecautious dosing. [35] Dostinexin a moderate and well tolerated dosis hasbeen shown in 2 studies to shr ink fibroids effectively.Mechanism of action is completely unclear. [35][37] Gonadotropin-releasing hormone analogscausetemporary regression of fibroids by d ecreasing estrogenlevels. Because of the limitations and side effects of thismed ication it is rarely recommended other than forpreoperative use to shrink the si ze of the fibroids anduterus before surgery. Its is typically used for amaximum of 6 months or shorter because after longeruse they could causeosteoporosisand o ther typicallypostmenopausal complications. The main side effects aretransient p ostmenopausal symptoms. In many cases thefibroids will regrow after cessation of treatment,however significant benefits may persists for muchlonger time in some

cases. Several variations arepossible, such as GnRH agonists with add-back regi mensintended to decrease the adverse effects of estrogendeficiency. Several addback regimes are possible,tibolone, raloxifene, progestogensalone,estrogenalone, and combined estrogens and progestogens. [35] Aromatase inhibitorshave been used experimentally toreduce fibroids. The effect is believed to be due partiallyby lowering systemic estrogen levels and partiall y byinhibiting locally overexpressed aromatase in fibroids. [35] Experience from experimental aromatase inhibitortreatment of endometriosis indic ates that aromatase inhibitors might be particularly useful in combinationwith a progestogenic ovulation inhibitor.Progesteroneantagonists have been shown in sm allstudies to decrease the size of uterine fibroids.Mifepristonewas effective in a placebo-controlled pilotstudy. [38] [39] Selective progesterone receptor modulators , such asProgenta, have been under investigation.The selective progesterone receptor modulator Asoprisnil is curre ntly tested with very promising results as apossible use as a treatment for fibr oids - the hope isthat it will provide the advantages of progesteroneantangonits t without their adverse effects. [35] The long term safety of progesterone antagonists as wellas selective progesteron e receptor modulators has yet tobe established. [40][41] Magnetic Resonance-Guided Focused Ultrasound Magnetic Resonance guided Focused Ultrasound (MRgFUS), is a non-invasive interve ntion (requiring noincision) that uses high intensity focused ultrasound( HIFU ) waves to ablate (destroy) tissue in combinationwith Magnetic Resonance Imaging (MRI), which guidesand monitors the treatment. This technique wasapproved by th e FDA in 2004. Ultrasound is a form of energy that passes through skin, muscle, fat and othersoft tissue. High intensity focused ultrasound energy,focused on a small target volume (tumor), provides atherapeutic effect by raising the tissue temperature of the target (tumor) high enough to destroy it. This issimilar to t he manner in which sunlight focused by amagnifying glass can create sufficient h eat to start afire. The use of heat to destroy tissue is called thermalablation. Treatments consist of multiple exoposures of focused energy or sonications. MRg FUS uses a MagneticResonance Imaging (MRI) scanner to identify tissues inthe bod y and plan the treatment. During the procedure,delivery of focused ultrasound en ergy is guided andcontrolled using MR thermal imaging. MR imagingprovides a thre e-dimensional view of the target tissue,allowing for precise focusing of ultraso und energy withina desired volume. Additionally, the MR imagingprovides quantita tive, real-time, thermal images of thetreated area. This allows the physician to ensure thatthe temperature generated during each cycle of ultrasound energy is sufficient to cause thermal ablationwithin the desired tissue and if not, to ada pt theparameters. The advantage and value of MR guidanceensures safe and accurat e treatment. [42] Patients whohave symptomatic fibroids, who desire a non-invasivetreatment option and who do not have contraindictionsfor MRI are candidates for MRgFUS. About 60 % of patients qualify. It is an outpatient procedure and takesone to three hours depending on the size of the fibroids.It is safe and effective. [43] For patients who have a totalfibroid volume of more than 500cc, they may bepretr eated for 3 months with a gonadotropin-releasinghormone (GnRH) analogue (e.g. le uprorelin) to reduceleiomyoma size and subsequently, improve thermalablation eff icacy. [44]

Fibroid characteristics (T2hypointensity, smaller size, intramural location, few er number) are important predictor of treatment success. [45][46][47][48] Symptomatic improvement is sustained fortwo plus years. [49] Need for additional treatment variesfrom 16-20% and is largely dependent on the amount of fibroid that can be safely ablated; the higher the ablatedvolume, the lower the re-treatment rate. [50] Incomparison to available treatment options, the costeffectiveness of MRgFUS in the U.S. and U.K. has beenfound to be reasonable and comparable to alternativetr eatments (hysterectomy, pharmacotherapy, uterineartery embolization). [51][52] The largest hurdle forpatients who desire MRgFUS is insurance coverage. Mostinsu rers will not cover MRgFUS even though there is alarge body of evidence to suppo rt its efficacy and safety.The most likely reason is because there are norandomi zed trial between MRgFUS and UAE. A multi-center trial is underway to investigat e the efficacy of MRgFUS vs. UAE. Uterine artery embolizationUterine artery embolization (UAE): Usinginterventional radiologytechniques, the interventionalradiologist oc cludes both uterine arteries, thus reducingblood supply to the fibroid. [53] A small catheter (1 mm indiameter) is inserted into the femoral artery at the le velof the groin underlocal anesthesia.Under imaging guidance, the interventional radiologist will enterselectively into both uterine arteries and inject small(5 00 m) particles that will block the blood supply to thefibroids. A patient will u sually recover from theprocedure within a few days. The UAE procedure shouldresu lt in limited blood supply to the fibroids whichshould prevent them from further growth, heavybleeding and possibly shrink them.A retrospective cohort study sho wed that UAE has muchfewer serious adverse effects than hysterectomy (oddsratio0 .25) and similar rates of satisfaction. In thisstudy, 86% of women treated with UAE wouldrecommend the treatment to a friend compared to 70%of those treated by hysterectomy. [54] Uterine artery ligationUterine artery ligation , sometimes also laparoscopicocclusion of uterine arteries are minimaly invasivemethods to limit blood supply of the uterus by a smallsurge ry that can be performed transvaginally orlaparoscopically. The principal mechan ism of action maybe similar like in UAE. This is a relatively new methodwhich de monstrated similar efficacy similar like UAE butis easier to perform and for thi s reason fewer sideeffects are expected. [55][56][57] UAE currently appearsmuch more effective than this method in directcomparison. Cite error: Invalid <ref> tag; invalidnames, e.g. too many; see thehelp pageRadi o frequency ablationRadiofrequency ablation : One of the newestminimally invasive treatments for fibroids isradiofrequency a blation. [58] In this technique the fibroidis shrunk by inserting a needle-like device into th efibroid through the abdomen and heating it with radio-frequency (RF) electrical energy to causenecrosisof cells. The treatment is a potential option for women whohave fibroids, have completed child-bearing and want toavoid a hysterectomy. Surgery It is possible to remove multiple fibroids during amyomectomy. Although a myomec tomy cannot preventthe recurrence of fibroids at a later date, such surgery isin creasingly recommended, especially in the case of women who have not completed b earing children or whoexpress an explicit desire to retain the uterus. There are

three different types of myomectomy: In a hysteroscopic myomectomy, the fibroid isremoved by the use of a resectoscope, anendoscopicinst rument that can use high-frequency electrical energy to cut tissue.Hysteroscopic myomectomies can be done as anoutpatient procedure, with either local or genera lanesthesia used. Hysteroscopic myomectomy ismost often recommended for submucos alfibroids. A French study collected results from235 patients suffering from sub mucous myomaswho were treated with hysteroscopicmyomectomies; in none of these c ases was thefibroid greater than 5 cm. [59] A laparoscopic myomectomy requires a smallincision near the navel. The physician theninserts a laparoscope into the uterus and usessurgical instruments to remove the fibroids. Studies have suggested that laparoscopicmyomectomy leads to lowermorbidityrates andfaster recovery than does laparotomicmyomectomy. [60] As with hysteroscopicmyomectomy, laparoscopic myomectomy is notgenerally used on very large fibroids. A study of laparoscopic myomectomies conducted betweenJanu ary 1990 and October 1998 examined 106cases of laparoscopic myomectomy, in which thefibroids were intramural or subserous andranged in size from 3 to 10 cm. [61] A laparotomic myomectomy (also known as an open or abdominal myomectomy) is the mostinvasive surgical procedure to remove fibroids.The physic ian makes an incision in theabdominal wall and removes the fibroid from theuteru s. A particularly extensive laparotomicprocedure may necessitate that any future birthsbe conducted by Caesarean section. [30] Recoverytime from a laparatomic procedure is generallyexpected to be four to six weeks.Hysterectomyis the classical method of treating fibroids.Although it is n ow recommended only as last option it isstill the leading cause of hysterectomie s in the US. Endometrial ablationEndometrial ablation can be used if the fibroids areonly within the uterus and not intramural and re lativelysmall. High failure and recurrence rates are expected inthe presence of larger or intramural fibroids. Other The use of vitex herbal medicine lacks supporting evidence. Malignancy About 1 out of 1000 lesions [30] are or become malignant,typically as aleiomyosarcomaon histology. A sign that a lesion may be malignant is growth after menopause. [30] There is no consensus among pathologists regarding thetransformation of Leiomyom a into a sarcoma. Mostpathologists believe that a Leiomyosarcoma is a de novo disease [ citation needed ]

. Metastasis There are a number of rare conditions in which fibroidsmetastasize. They still g row in a benign fashion, but canbe dangerous depending on their location. [62] In leiomyoma with vascular invasion , anordinary-appearing fibroid invades into a vesselbut there is no risk of recu rrence. In Intravenous leiomyomatosis ,leiomyomatagrow in veins with uterine fibroids as theirsource. Cardiac involvem ent can be fatal. In benign metastasizing leiomyoma ,leiomyomata grow in more distant sites such asthe lungs and lymph nodes. The so urce is notentirely clear. Pulmonary involvement can befatal. In disseminated intraperitonealleiomyomatosis , leiomyomata grow diffuselyon the peritoneal and omental surfaces, withuterine fibroids as their source. This cansimulate a malignant tumor but behavesbenignly . What are Commonsymptoms of uterine myoma (fibroids)? Pain in the back of the legs Pelvic pain or pressure Very heavy and prolonged menstrual periods Pressure on the bowel which may lead toconstipation and/or bloating An enlarged abdomen (this may be mistakenfor weight gain or pregnancy) Pain during sexual intercourse Pressure on the bladder which results in: aperpetual need to urinate, incontinen ce, or theinability to empty the bladder