Most women with uterine fibroids have no symptoms or just mild symptoms and do not need treatment. In one study, almost 80% of women who chose “watchful waiting” for their fibroids had no major changes in their bleeding, pain, bothersome symptoms, mental health, general health or activity after one year. After menopause, bleeding stops, fibroids decrease in size and the rate of surgery for fibroids decreases dramatically. So, for some women with fibroids “watchful waiting” will allow treatment to be avoided, perhaps indefinitely.

Treatment will be necessary for women with heavy bleeding that causes severe anemia or, very rarely, for blockage of the ureters (tubes that pass urine from the kidneys to the bladder) by very large fibroids. Some women may also chose treatment for heavy bleeding, pelvic pain or pressure, urinary frequency or incontinence that interferes with their quality of life. But, this decision is for each woman to make based on her own sense of her quality of life. Of interest, one study found that women who chose to have a hysterectomy because of fibroid-related symptoms had worse scores on quality-of-life questionnaires than women diagnosed with high blood pressure, heart disease, emphysema or arthritis.

However, if women are offered a hysterectomy as a first and sometimes only treatment option, they may choose to adapt to their symptoms and stop seeking treatment. If this has happened to you, get a second opinion from a gynecologist who regularly takes care of women with fibroids. Otherwise your symptoms (such as bleeding or pain) may slowly get worse (“symptom creep”) and can lead to fatigue from anemia, increasing discomfort and mental fatigue from concern about your situation.

At present, medications, a progesterone-releasing IUD, endometrial ablation, hysteroscopic myomectomy, laparoscopic myomectomy, abdominal myomectomy, uterine artery embolization and focused ultrasound are all available in addition to hysterectomy for treatment.