Most individuals can be followed closely by their physician, without treatment, if fibroids are small and do not cause symptoms.

However, women who have pain, abnormal bleeding (heavy menstrual bleeding or bleeding between periods),particularly if anemia/a low blood count is present, rapid fibroid growth as determined on follow-up exams, infertility (can't become pregnant), multiple miscarriages, or fibroids that increase in size after menopause should be treated.

Removal of the uterus and therefore the fibroids gets rid of the problems of pain and heavy menstrual flow that can occur in women who have them. A hysterectomy eliminates the possibility of having a later pregnancy.

A hysterectomy is surgery under general anesthesia and can have complications including pain and infection. The uterus can be removed through the abdomen or the vagina, but whatever method is used, there is a signifant (4-6 week) recovery period. Other types of surgery and procedures that are less invasive are being used, especially in women who want to avoid major surgery or who wish to become pregnant in the future (see "myomectomy" below).

Approximately 2-3% of those who have a hysterectomy later develop a problem called a "small bowel obstruction" (blockage of the bowel) which may require emergency surgery.

During a myomectomy, the fibroids are removed from the uterus, but the uterus remains. A myomectomy can be performed through a large incision (cut) made in the abdomen or with an instrument called a hysteroscope which requires a much smaller incision. Both approaches are effective for decreasing pain and bleeding from fibroids, and are the treatments of choice for individuals with infertility that may be due to fibroids.

A myomectomy requires special skill and training on the part of the surgeon. Some surgeons are more comfortable performing one of the surgical approaches over the other (abdominal versus hysteroscopic myomectomy). The experience of the surgeon is very important in choosing the surgical approach.

Fibroids can recur. Sometimes a uterus may have several small fibroids, which may grow after removal of the larger ones. In some cases, not all fibroids can be removed without damaging the uterus.

These drugs are the first choice for patients who cannot undergo surgery or general anesthesia, and for those who are close to, or beginning menopause. They work by lowering estrogen (female hormone) which simulates menopause. They are effective for shrinking fibroids, but can only be used for up to 6 months. Fibroids tend to grow again after these medications are stopped.

The temporary reduction in fibroid size can be enough to avoid surgery for women who are nearing menopause. During menopause, the decrease in estrogen often helps fibroids to shrink permanently.

Some physicians also use these drugs prior to surgery to shrink the fibroids. Smaller fibroids are easier to surgically remove and bleed less during the operation.

These drugs are expensive.

This type of IUD appears to work by decreasing heavy blood loss that can occur during periods in those with fibroids. This treatment provides a good option for women with fibroids who may want to become pregnant at some later time. Some women have symptoms (cramps, spotting) related to the IUD.

With this procedure, one of the major arteries that supplies blood to the uterus is effectively closed off (embolized). As blood suppy to the fibroid decreases, the fibroid tends to shrink. The procedure is effective for decreasing heavy menstrual bleeding.

Satisfaction with this procedure was high in a number of studies even though as many as one in five women eventually had to have another procedure, such as a hysterectomy.

The decrease in heavy flow was the same for uterine artery embolization as for hysterectomy in one study, but hysterectomy improved pelvic pain (which can sometimes occur with fibroids) more than embolization. Embolization has fewer side effects than hysterectomy.

Most experts believe uterine artery embolization should not be used in women who want to become pregnant later because of risks of pregnancy complications (such as weakening of the wall of the uterus).

Progestins are sometimes used to reduce the size of large fibroids in women who are close to menopause, in an attempt to avoid surgery. Once menopause begins, fibroids tend to naturally shrink on their own.

Fibroids often return to their original size within a few menstrual cycles after stopping the drugs. So, these drugs work best if a woman is nearing menopause.

Progestins are not the drug of choice for this purpose - newer drugs called "gonadotropin-releasing hormone" are now more commonly used.