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However, in rare cases the presence of fibroids may cause the IUD to be expelled from the uterus. Gonadotropin-releasing hormone (GnRH) agonists include the implant goserelin (Zoladex), a monthly injection of leuprolide (Lupron Depot, generic), and the nasal spray nafarelin (Synarel).

GnRH agonists block the release of the reproductive hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone). As a result, the ovaries stop ovulating and producing estrogen. Basically, GnRH agonists induce a temporary menopause. GnRH agonists may be used as drug treatment to shrink fibroids in women who are approaching the age of menopause. They may also be used as a preoperative treatment 3 to 4 months before fibroid surgery to reduce fibroid size so that a more minimally invasive surgical procedure can be performed.

Commonly reported side effects, which can be severe in some women, include menopausal-like symptoms. These symptoms include:The side effects vary in intensity, but typically resolve within 1 month after stopping the medication.

The most important concern is possible osteoporosis from estrogen loss. Women should not take these drugs for more than 6 months. It may be possible to extend treatment with GnRH agonists if low dose treatment with estrogen and progesterone is administered (add-back therapy).

Talk to your provider about this possibility. GnRH treatments used alone do not prevent pregnancy. Furthermore, if a woman becomes pregnant during their use, there is some risk for birth defects.

MyomectomyA myomectomy surgically removes only the fibroids and leaves the uterus intact, which helps preserve fertility. Myomectomy may also help regulate abnormal uterine bleeding caused by fibroids.

Not all women are candidates for myomectomy. If the fibroids are numerous or large, myomectomy can become complicated, resulting in increased blood loss. If cancer is found, conversion to a full hysterectomy may be necessary. To perform a myomectomy, the surgeon may use a standard "open" surgical approach (laparotomy) or less invasive ones (hysteroscopy or laparoscopy).

The risks for myomectomy are generally the same as those for other surgical procedures, including bleeding, infection, or injury to other areas. Laparoscopic power morcellation is a procedure that uses a tool to cut up uterine fibroids into tiny pieces to be removed through a small incision in the abdomen.

There is evidence that power morcellation may spread cancerous tissue in women with fibroids undergoing this procedure who have undetected uterine cancer. The FDA and other expert groups advise against the use of laparoscopic power morcellators for myomectomy or hysterectomy procedures. Myomectomy is not necessarily a permanent solution for fibroids. They can recur after these procedures.

Hence in general, myomectomy is used if fertility preservation is required, and hysterectomy is used if child bearing is complete to avoid the possibility of having to do a second procedure if fibroids grow back. Uterine artery embolization (UAE), also called uterine fibroid embolization (UFE), is a relatively new way of treating fibroids. UAE deprives fibroids of their blood supply, causing them to shrink. UAE is a minimally invasive radiology treatment and is technically a nonsurgical therapy.

It is less invasive than hysterectomy and myomectomy, and involves a shorter recovery time than the other procedures. The patient remains conscious, although sedated, during the procedure, which takes around 60 to 90 minutes. In general, UAE is considered an option for only those who have completed childbearing. The American College of Obstetricians and Gynecologists advises women who wish to have children that it is not yet known how this procedure affects their potential for becoming pregnant.

Compared to other procedures, women who have UAE miss fewer days of work. Serious complications occur in less than 0. In addition to potential impact on fertility, other postoperative effects may include.

Uterine artery embolization is very effective and most women are very satisfied with the results. However, some women may have fibroid recurrence and may need future procedures (repeat embolization or hysterectomy). Some studies suggest that women with larger single fibroids or larger uteruses are not good candidates for UAE. Pedunculated fibroids are usually not treated with UAE due to the risk of severe pain in this setting following the procedure.

Uterine artery embolization does not remove fibroid tissue. In the rare cases of sarcoma (cancer cells in the muscles of the uterus), this procedure may delay diagnosis and therefore worsen prognosis. Endometrial ablation destroys the lining of the uterus (the endometrium) and is usually performed to stop heavy menstrual bleeding. It may also be used to treat women with small fibroids. It is not helpful for large fibroids or for fibroids that have grown outside of the interior uterine lining.

For most women, this procedure stops the monthly menstrual flow. In some women, menstrual flow is not stopped but is significantly reduced. Most endometrial ablation procedures use some form of heat (radiofrequency, heated fluid, microwaves) to destroy the uterine lining.

The procedure is typically done on an outpatient basis and can take as few as 10 minutes to perform. Recovery generally takes a few days, although watery or bloody discharge can last for several weeks.

Endometrial ablation significantly decreases the likelihood a woman will become pregnant. However, pregnancy can still occur and this procedure increases the risks of complications, including miscarriage and ectopic (tubal) pregnancies.

Women who have this procedure must be committed to not becoming pregnant and to using birth control. A main concern of endometrial ablation is that it may delay or make it more difficult to diagnose uterine cancer in the future. MRgFUS is a non-invasive procedure that uses high-intensity ultrasound waves to heat and destroy (ablate) uterine fibroids. This "thermal ablation" procedure is performed with a device, the ExAblate, which combines magnetic resonance imaging (MRI) with ultrasound.

During the 3-hour procedure, the patient lies inside an MRI machine.