What Are Ways to Manage Heavy Bleeding from Fibroids?

The women in my family have a history of fibroids and heavy bleeding that leads to iron deficiency. The procedure and outcomes I’ve heard for ablation are scary. Wondering what the evidence is, downsides, or how one would decide on a hysterectomy instead.

—Marjorie

Managing heavy bleeding from fibroids can have a significant impact on your quality of life. Heavy bleeding itself can interfere with your daily activities. It can also cause iron deficiency and anemia, which can make some women feel extra tired and run-down.

There are a few options for managing heavy bleeding from fibroids. You can think of them as falling into three groups: medical therapy, minor interventions, and surgery. In most cases, if you want to be able to become pregnant in the future, medical interventions — progestin-eluting IUDs and birth control pills — and resecting particular types of fibroids are the only options for managing heavy uterine bleeding.

If you don’t plan to have children or your family is complete, your options widen. Two types of interventions can be helpful to reduce heavy bleeding from fibroids: uterine artery embolization and endometrial ablation. Surgery such as hysterectomy is also an option. Let’s take a quick look at each option.

Uterine artery embolization is a procedure in which the doctor inserts a catheter through an artery in the groin, threads it up to the arteries that supply the uterus with blood, and inserts small particles that block the arteries, thus blocking blood flow to the uterus. A Cochrane review of uterine artery embolization reports that compared with surgical procedures like hysterectomy, patients are equally satisfied two years post-procedure. The authors found no increase in the rate of major complications. Uterine artery embolization is associated with more minor complications, though. Additionally, upward of 30% of women may require further surgery to treat symptoms after uterine artery embolization, compared with only about 7% after hysterectomy.

Endometrial ablation is a procedure that destroys the lining of the uterus. As a result, it greatly reduces bleeding or stops it altogether. But the guidelines regarding the management of fibroids don’t recommend endometrial ablation in most cases. In fact, there is no data to support using ablation in treating heavy bleeding due to fibroids except in women with bleeding disorders.

Hysterectomy used to be used to treat heavy bleeding from all types of causes much more frequently than it is now. This is likely because the advent of medical options such as progestin-eluting IUDs offer a much less invasive and less permanent option. There is also some data that hysterectomy is associated with menopause at an earlier age. This can put women at increased risk for osteoporosis and heart disease. However, the data correlating hysterectomy with earlier menopause may be skewed because of the many reasons why women have hysterectomies in the first place that may predispose them to earlier menopause. It’s not clear that the hysterectomy causes earlier menopause. In the Cochrane review linked above, women were equally happy with hysterectomy as a treatment for their fibroids compared with uterine artery embolization, and they were much less likely to need additional intervention.

The upshot: Conservative measures like progestin-eluting IUDs, minimally invasive procedures like uterine artery embolization, and hysterectomy can all be effective at treating heavy bleeding from fibroids.