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.) Since the only proven medicine for shrinking fibroids has troublesome side effects and should only be used short-term, consider first trying one or both of the following for menstrual pain or heavy bleeding. Combining the two is most likely to relieve pain and lighten bleeding:⁷

• Nonsteroidal anti-inflammatory drug (NSAID) therapy improves menstrual cramping and reduces bleeding for many women.⁷ But there is no evidence that NSAIDs relieve pain or bleeding specifically caused by fibroids.⁶
• Birth control hormones (pill, patch, or ring) lighten menstrual bleeding and pain while preventing pregnancy.⁸

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.^{9, 5} This might be different for each woman.

Iron supplement therapy and an iron-rich diet improve anemia caused by blood loss.

NSAID use during conception or early pregnancy may cause miscarriage.¹⁰ If you are trying to get pregnant, talk to your health professional about whether you can use NSAID therapy.

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. Other women with fibroids have fertility problems because of some other reason.⁵