Battling uterine fibroids: surgery or medication?

With around two in three women developing at least one fibroid in their lifetime, what treatments can help tackle this condition? By Kiays Khalil.

Credit: HenadziPechan/shutterstock

July marked uterine fibroids awareness month and with new technologies and medication emerging in the market we now have a greater understanding of how to best treat this condition on an individual basis. 

The non-cancerous growths in the uterus, affect millions of women worldwide at childbearing age and can impact fertility in various ways. The benign tumours can cause a range of symptoms, including heavy menstrual bleeding, pelvic pain, lower back pain, constipation, pains during intercourse and fertility issues. Although the exact cause of growths is unknown, they have been correlated to high levels of oestrogen. 

Despite the number of symptoms, a patient can experience, many women are still going undiagnosed for uterine fibroids. According to the UK National Health Service (NHS) the condition is more prevalent in women between the ages of 30 and 50 and women of African-Caribbean origin are more at risk of developing fibroids. Another factor that can exacerbate the development of fibroids is body mass as the production of oestrogen increases in fat cells. 

As awareness about uterine fibroids continues to grow, women are presented with two primary treatment options medication and medical devices used in diagnosing and surgery. 

Minimally invasive surgical tools and non-surgical treatments have gained popularity in recent years as alternative solutions to traditional surgery. These devices aim to preserve the uterus and its reproductive potential while providing symptomatic relief. 

Lidia Chesnokova, vice president of PatientPartner, a platform that connects patients to physicians, argues that advancements in medical devices is revolutionising the way we diagnose and treat patients with uterine fibroids. 

“Modern imaging technologies provide precise visualisation of fibroids, aiding in informed treatment decisions. Innovative procedures like uterine artery embolization (UAE) and the Acessa procedure offer less invasive alternatives, reducing recovery times and preserving fertility,” says Chesnokova. “These advancements enhance treatment options and improve quality of life for patients. Continued technological progress promises even more significant breakthroughs, transforming fibroid diagnosis and treatment worldwide.” 

Diagnosing of uterine fibroids most commonly happens during a routine check from the gynaecologist and from pelvic examinations. But if the patient is suffering from symptoms the doctor will refer them for further testing. 

Such tests include abdominal and transvaginal ultrasound scans and a laparoscope exam, which uses a small camera to give the clinician a view inside the patient’s abdomen and pelvic area and aids them in identifying fibroids. Hysteroscopes, a small telescope which is used in hysteroscopy examinations and gives the doctor an inside view of the womb and aids them preforming a biopsy which examines small tissue samples.  

A GlobalData report outlines the hysteroscopes market in North America in 2015 was valued it at $44.3 million and expect it to grow by $31.4 million to $75.7 million in 2025. The report also indicates unit sales will grow from 5,705 to 11,214 in the same time frame. 

One notable medical device making waves in the field is the magnetic resonance-guided focused ultrasound (MRgFUS). Using high-intensity sound waves, MRgFUS targets fibroids by precisely, causing them to shrink or dissolve entirely. This outpatient procedure is performed without any incisions, allowing for a quicker recovery time compared to surgery. Additionally, MRgFUS offers women the advantage of avoiding potential complications associated with surgery, such as scarring and infection. 

Brian Hicks, a GlobalData senior analyst specialising in the medical devices industry said: “I think there is a growing emphasis on developing non-surgical treatment modalities, as there’s no doubt that surgical treatments always remain the last option if possible. This is especially true for uterine fibroids if fertility preservation is one of the key goals for the patient.” 

Another promising technology highlighted by Chesnokova is UAE, a minimally invasive procedure that blocks the blood supply to fibroids, causing them to shrink. With UAE, women can experience relief from fibroid symptoms while preserving fertility potential. 

Despite the potential for a speedy recovery, there are still risks. “For embolization particles, there’s a risk of infection after embolization, even if an antibiotic is given, and embolic agents can lodge in the wrong place and deprive normal tissue of oxygen supply,” said Hicks. 

According to a GlobalData report, the number of Embolization Particle Procedures to treat Uterine Fibroids in the United States was 18,736 in 2022 and it is forecast to drop to 14,694 in 2030. This drop could possibly be attributed to the emergence of new devices that offer non invasive treatments. 

The Acessa procedure is another none invasive treatment which has become more favourable among patients allowing them to return to daily life quicker. Chesnokova believes the benefits from this treatment make it stand out compared to other treatment modalities. She said: “Unlike traditional surgical approaches like hysterectomy, Acessa is a minimally invasive procedure that targets and destroys fibroid tissue while preserving the uterus. This key advantage makes it an excellent option for women who wish to retain their fertility. Additionally, Acessa offers a quicker recovery time compared to more invasive procedures, allowing women to resume their daily activities sooner. With its precise radiofrequency energy application, Acessa effectively reduces fibroid symptoms.” 

Although there are various treatments available, hysterectomy is the most effective in eliminating fibroids, but it is invasive and not suitable for fertility preservation. 

Hicks suggests that the surgical treatment market for uterine fibroids is growing. “Most of these devices aren’t seeing rapid growth like we see in some emerging markets, but they remain an important tool for uterine fibroids treatment and as such we will likely not see any significant decline in market value.” 

The medication route 

Medication remains a viable treatment option for women seeking to manage uterine fibroids. George Kramb, CEO of PatientPartner listed several drugs used in the treatment of uterine fibroids to reduce symptoms. They include over the counter medications like ibuprofen, naproxen and non-steroidal anti-inflammatory drugs (NSAIDs) which provide temporary relief from fibroid-related pain. 

Oral contraceptives, can help regulate the menstrual cycle, reduce heavy bleeding, and alleviate symptoms. Gonadotropin-releasing hormone (GnRH) agonists, though temporary in their effects, can shrink fibroids by inducing a state like menopause. GnRH agonists are normally used in combination with surgery reducing the size of fibroids before the operation. Even with the temporary relief there are side effects that patients should be aware of. Hormonal therapies can cause mood swings, weight gain, and hot flashes, while GnRH agonists can lead to bone density loss if used for an extended period. 

In August 2022 the US Food and Drug Administration (FDA) granted approval for a new drug called Myfembree, which falls into the same category of other GnRH therapies.  Kramb said: “This is the first and only FDA-approved once-daily pill proven to notably reduce heavy periods from uterine fibroids in premenopausal women. Myfembree has been shown to reduce menstrual pain and non-menstrual pelvic pain in premenopausal women with endometriosis.” 

He added: “Although pharmaceuticals are widely used by women diagnosed with uterine fibroids, it’s important to note that medication is typically used for managing symptoms or as a temporary measure. Drugs do not eliminate fibroids; they provide relief by reducing symptoms, such as heavy bleeding and pain.” 

Despite the availability of surgical options and medication, there is still a need for increased awareness about uterine fibroids and the potential treatment options. Many women continue to suffer in silence, unaware of the alternatives available to them. Organisations dedicated to women’s health and medical professionals are working to bridge this knowledge gap, emphasising the importance of early detection and intervention. 

In comparison to pharmaceutical treatments Hicks said surgical options are more favourable for severe cases of uterine fibroids, as the medications may not always sufficiently reduce the fibroids or simply over induce the side effects. 

Kramb said: “The choice of medication or treatment depends on various factors, including the patient’s specific symptoms, desired fertility, and overall health. It is always best to consult with a healthcare professional to determine the most appropriate treatment approach for individual cases.” 

By raising awareness, promoting research, and providing comprehensive support, women can be empowered to make informed decisions and improve their quality of life in the face of uterine fibroids.