Most uterine fibroids are harmless, do not cause symptoms, and shrink with menopause. But some fibroids are painful, press on other internal organs, bleed and cause anemia, or cause pregnancy problems. If you have a fibroid problem, there are several treatments to consider. Fibroids can be surgically removed, the blood supply to fibroids can be cut off, the entire uterus can be removed, or medicine can temporarily shrink fibroids. Your choice will depend on whether you have severe symptoms and whether you want to preserve your fertility.

Watchful waiting for minimal fibroid symptoms or when nearing menopause

If you have uterine fibroids but you have few or no symptoms, you do not need treatment. Instead, your health professional will recommend watchful waiting. This means that you will have regular pelvic exams to check on fibroid growth and symptoms. Talk with your health professional about how often you will need a checkup.

If you are nearing menopause, watchful waiting may be an option for you, depending on how tolerable your symptoms are. After menopause, your estrogen and progesterone levels will drop, which causes most fibroids to shrink and symptoms to subside.

For heavy menstrual bleeding or pain

If you have pain or heavy menstrual bleeding, it may be from a bleeding uterine fibroid. But it may also be linked to a simple menstrual cycle problem or other problems. (For more information, see the topic Dysfunctional Uterine Bleeding.) The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods, but they do not shrink fibroids:

• Nonsteroidal anti-inflammatory drug (NSAID) therapy improves menstrual cramping and reduces bleeding for many women. But there is no evidence that NSAIDs relieve pain or bleeding specifically caused by fibroids. ⁴
• Birth control hormones (pill, patch, or ring) lighten menstrual bleeding and pain while preventing pregnancy.
• An intrauterine device that releases small amounts of a certain hormone into the uterus may reduce heavy menstrual bleeding.
• A progestin shot (Depo-Provera) every 3 months may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may improve fibroids or may make them grow. ^{5, 2} This might be different for each woman.
• Iron supplements, available without a prescription, are an important part of correcting anemia caused by fibroid blood loss.

For infertility and pregnancy problems

If you have fibroids, there is no way of knowing for certain whether they are affecting your fertility. Fibroids are the cause of infertility only 2% to 3% of the time. Many women with fibroids have no trouble getting pregnant.

If a fibroid distorts the wall of the uterus, it can prevent a fertilized egg from implanting in the uterus. This may make an in vitro fertilization less likely to be successful, if the fertilized egg doesn't implant after it is transferred to the uterus. ⁶