Most uterine fibroids are harmless, cause no 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. What treatment you choose may depend on how bad your symptoms are and whether you want to preserve your fertility.

For mild symptoms or when nearing menopause

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

If you are nearing menopause, watchful waiting may be an option for you. It depends on how tolerable your symptoms are. After menopause, your estrogen and progesterone levels will drop. This 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. The following medicines are used to relieve heavy menstrual bleeding, anemia, or painful periods, but they don't shrink fibroids:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). They improve menstrual cramping and reduce bleeding for many women.
• Birth control hormones (pill, patch, or ring). They lighten menstrual bleeding and pain while preventing pregnancy.
• An intrauterine device (IUD) that releases small amounts of the hormone progesterone into the uterus. It may reduce heavy menstrual bleeding.
• A progestin shot (Depo-Provera) every 3 months. It may lighten your bleeding. It also prevents pregnancy. Based on different studies, progestin may shrink fibroids or may make them grow. This might be different for each woman.
• Iron supplements, available without a prescription. They are an important part of correcting anemia caused by fibroid blood loss.

For infertility and pregnancy problems

If you have fibroids, there's no way to know for sure if they are affecting your fertility. Fibroids are the cause of infertility in only a small number of women. Most 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's transferred to the uterus.

Surgery to remove the fibroid, called myomectomy, may improve your chances of having a baby. Because fibroids can grow again, it's best to try to become pregnant as soon as you can after a myomectomy.

For severe fibroid symptoms

If you have fibroid-related pain, heavy bleeding, or a large fibroid that is pressing on other organs, you can think about shrinking the fibroid, removing the fibroid (myomectomy), or removing the entire uterus (hysterectomy). After all treatments except hysterectomy, fibroids may grow back. Myomectomy or treatment with medicine is recommended for women who have childbearing plans.

You can try:

Shrinking a fibroid for a short time.

Hormone therapy with a gonadotropin-releasing hormone analogue (GnRH-a) puts the body in a state like menopause. This shrinks both the uterus and the fibroids. Fibroids grow back after GnRH-a therapy has ended. This therapy can help to:

• Shrink a fibroid before it is removed with surgery. This lowers your risk of heavy blood loss and scar tissue from the surgery.
• Provide short-term relief as a "bridge therapy" if you are nearing menopause. (Fibroids naturally shrink after menopause.)

GnRH-a therapy is used for only a few months, because it can weaken the bones. It also may cause unpleasant menopausal symptoms.

Shrinking or destroying fibroids without surgery.

Uterine fibroid embolization (UFE) (also called uterine artery embolization) stops the blood supply to the fibroid. The fibroid then shrinks and may break down. UFE preserves the uterus, but pregnancy isn't common after treatment. UFE isn't usually recommended for women who plan to become pregnant.

MRI-guided focused ultrasound uses high-intensity ultrasound waves to break down the fibroids. Studies show that this treatment is safe and works well at relieving symptoms. But more studies are needed to find out if it works over time. This treatment may not be available everywhere.

Endometrial ablation is a treatment that destroys the lining of the uterus. It may use a laser beam, heat, electricity, freezing, or microwaves. As the lining of the uterus heals, it will scar. This scarring reduces or prevents bleeding.

Surgery to remove fibroids.

Myomectomy can often be done through one or more small incisions using laparoscopy or through the vagina (hysteroscopy). Some surgeries can be done using robotic tools. Sometimes a larger incision in the belly is needed. It depends on where the fibroid is located in the uterus. Myomectomy preserves the uterus, and it makes pregnancy possible for some women.

Surgery to remove the entire uterus.

Hysterectomy is available to women with long-lasting or severe symptoms who have no future pregnancy plans. Hysterectomy has both positive and negative long-term effects.

Heavy, prolonged, and painful periods caused by uterine fibroids will stop on their own after you reach menopause. If you are nearing menopause and can tolerate your symptoms, you can try to control your symptoms with home treatment and medicine until menopause.