Medical Management

Hormonal manipulation, Non Steroidal Anti-inflammatory medication and drugs to shrink fibroids in the short time are often used.
If medical therapy fails to control symptoms an interventional treatment. Fibroid Embolisation or Traditional surgery is often required. View webpage

Surgical Management

Hysterectomy
Over 60,000 hysterectomies are performed each year in the UK. over 600,000 are performed in the USA. The majority are for benign disease with fibroids being the commonest diagnosis. Whilst hysterectomy will give a permanent cure for fibroid disease it carries a significantly higher complication rate than Fibroid Embolisation. View webpage
Recovery times after abdominal hysterectomy varies but typically women return to work after 6-12 weeks. If work is demanding or physical this can take longer. View webpage
Laparoscopically assisted hysterectomy can lead to faster recovery times.

Myomectomy
This is usually reserved for women wanting to preserve fertility.
Abdominal myomectomy is most commonly performed if fibroids are large and multiple. Complications and Recovery times are similar to open hysterectomy. Subsequent pregnancy and childbirth if it occurs are typically managed by Caesarean section.
Hysteroscopic myomectomy is useful for small (less than 3cm) intracavity sub-mucosal fibroids. It can be used in combination with fibroid embolisation to manage multiple fibroids or larger intracavity fibroids. Recovery after hysteroscopic myomectomy is usually very quick.
Laparoscopic Myomectomy is useful for sub serosal fibroids no larger than 9cm and usually single or few in number. It can be combined with Fibroid Embolisation where fibroids are multiple.

The combination of Fibroid Embolisation and Myomectomy is a very useful management option. The embolisation should deal with all the fibroids and the myomectomy can effectively debulk the largest fibroids.

Recurrence rates after Myomectomy depends largely on the number of fibroids at time of presentation. When solitary fibroid recurrence rates are low. When multiple recurrence of fibroids should be expected after myomectomy and this is more likely than after embolisation.