Fibroid Treatment in Pakistan: What Are Your Options?
Uterine fibroids are among the most common gynaecological conditions I see in women during their reproductive years. Many of my patients are diagnosed after an ultrasound and understandably feel anxious about what the diagnosis means and what they should do next.
The reassuring news is that fibroid treatment is not the same for every woman. Depending on the size, number, and location of the fibroids as well as the symptoms they are causing there is usually more than one treatment option to consider.
In this article, I will explain the most common treatments for uterine fibroids in simple language, including what each treatment involves, who it may be suitable for, and what you can generally expect.
If you have been diagnosed with fibroids and would like individual guidance, you can book a consultation with me at South East Hospital, PWD Islamabad. I also offer online consultations for patients living in other cities across Pakistan.
What Are Uterine Fibroids?
Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop within or around the uterus. They are made up of muscle and fibrous tissue and can vary considerably in size—from a very small growth to a mass large enough to enlarge the uterus.
Fibroids are commonly classified according to their location:
- Intramural fibroids develop within the muscular wall of the uterus and are the most common type.
- Submucosal fibroids develop just beneath the inner lining of the uterus and may project into the uterine cavity.
- Subserosal fibroids grow on the outer surface of the uterus.
Not every woman with fibroids experiences symptoms. Some women live with fibroids for many years without knowing they have them. Others may experience heavy or prolonged periods, pelvic pain or pressure, abdominal bloating, frequent urination, difficulty conceiving, or complications during pregnancy.
When I advise a patient about treatment, I consider not only the size of the fibroids but also how they are affecting her daily life, general health, fertility, and future family plans.
Does Every Fibroid Need Treatment?
No. Not every fibroid requires immediate treatment.
If your fibroids are small, stable, and not causing significant symptoms, I may recommend monitoring them through periodic check-ups and ultrasound scans. This approach is sometimes called watchful waiting.
Treatment is more likely to be recommended when fibroids are:
- Causing heavy or prolonged menstrual bleeding
- Leading to iron-deficiency anaemia
- Causing persistent pelvic pain or pressure
- Pressing on the bladder or bowel
- Affecting fertility
- Associated with recurrent pregnancy loss
- Increasing noticeably in size
- Interfering with everyday activities or quality of life
If you are experiencing any of these problems, it is important to discuss them with a qualified gynaecologist. The most appropriate treatment will depend on your symptoms, age, overall health, ultrasound findings, and whether you wish to have children in the future.
Most Common Fibroid Treatment Options
1. Hormonal and Medical Treatment
For many women, the first step is medical management. Medicines do not always remove fibroids, but they can help control symptoms such as heavy bleeding, painful periods, and anaemia.
The medicines I may consider include:
GnRH Agonists and Antagonists
These medicines reduce the activity of hormones that stimulate fibroid growth. They may temporarily shrink fibroids and reduce menstrual bleeding.
They are sometimes prescribed before surgery to make the procedure easier or to improve anaemia. Because prolonged use can cause side effects such as hot flushes and reduced bone density, they are generally used for a limited period under medical supervision.
Combined Oral Contraceptive Pills and Progestins
Hormonal contraceptive pills and progestin medicines may help regulate periods, reduce menstrual bleeding, and improve pain. However, they do not usually shrink the fibroids themselves.
Levonorgestrel Intrauterine System
The levonorgestrel intrauterine system, commonly called a hormonal coil, can be effective for controlling heavy menstrual bleeding.
However, it may not be suitable when a fibroid significantly changes the shape of the uterine cavity. I assess the location of the fibroids before recommending this option.
Tranexamic Acid
Tranexamic acid is a non-hormonal medicine taken during the menstrual period to reduce heavy bleeding. It can improve bleeding symptoms but does not shrink fibroids.
Iron Supplements
Women who lose a significant amount of blood during their periods may develop iron-deficiency anaemia. In these cases, I may prescribe oral or intravenous iron alongside treatment for the underlying bleeding.
Medical treatment is often suitable for short- to medium-term symptom control, for women who are approaching menopause, or as preparation before surgery. Fibroids often become smaller after menopause as hormone levels decline, although every patient’s situation is different.
2. Myomectomy — Surgical Removal of Fibroids
A myomectomy is an operation in which I remove the fibroids while preserving the uterus. It is commonly considered for women who wish to retain their fertility or who do not want their uterus removed.
The surgical approach depends on the size, number, and location of the fibroids.
Laparoscopic Myomectomy
Laparoscopic myomectomy is performed through small abdominal incisions using keyhole surgery. It may be suitable for women with a limited number of appropriately sized fibroids.
Compared with open surgery, it generally results in smaller scars and a shorter recovery period. However, not every fibroid can be safely removed laparoscopically.
Hysteroscopic Myomectomy
Hysteroscopic myomectomy is used for fibroids that are located within or project into the uterine cavity.
A thin surgical instrument is passed through the vagina and cervix, so no external abdominal incision is required. Recovery is usually faster than with abdominal surgery.
Open Myomectomy
Open myomectomy, also known as abdominal myomectomy or laparotomy, may be recommended when the fibroids are very large, numerous, deeply embedded, or technically difficult to remove through keyhole surgery.
It requires a larger abdominal incision and usually involves a longer recovery period.
Myomectomy can provide significant relief from bleeding, pain, and pressure symptoms. However, because the uterus remains in place, new fibroids may develop in the future. The possibility of recurrence is higher in women who are younger or who have multiple fibroids.
3. Hysterectomy — Removal of the Uterus
A hysterectomy is an operation to remove the uterus. It is the only treatment that completely prevents uterine fibroids from returning.
Because pregnancy is no longer possible after a hysterectomy, I generally consider this option for women who have completed their families or who have severe, recurrent symptoms that have not responded to other treatments.
A hysterectomy may be performed through:
- Open abdominal surgery
- Laparoscopic or keyhole surgery
- Vaginal surgery
The most appropriate approach depends on the size of the uterus, previous operations, the patient’s health, and other clinical factors.
Recovery may take approximately two to six weeks, depending on the type of surgery and the individual patient. Menstrual periods stop permanently after the uterus is removed.
Removing the uterus does not automatically mean that the ovaries must also be removed. When healthy ovaries are preserved, the patient does not usually enter immediate surgical menopause.
Hysterectomy is a major operation and carries the usual risks associated with anaesthesia and surgery. However, for carefully selected patients, it can provide permanent relief from severe fibroid-related symptoms.
4. Uterine Artery Embolisation (UAE)
Uterine artery embolisation, commonly known as UAE, is a minimally invasive procedure performed by an interventional radiologist.
During UAE, a thin tube is inserted through a small puncture, usually in the groin or wrist. Tiny particles are then injected into the arteries supplying the fibroids. By reducing their blood supply, the procedure causes the fibroids to shrink gradually over the following weeks and months.
UAE may be considered for:
- Women who want to avoid major surgery
- Women who wish to preserve their uterus
- Women who have multiple fibroids
- Women who may not be suitable candidates for conventional surgery
Recovery is generally shorter than recovery after open surgery. Pelvic pain, cramping, tiredness, nausea, or a mild fever may occur during the first few days and can usually be managed with appropriate medication.
UAE can be effective for controlling heavy bleeding and pressure symptoms. However, its effects on future fertility and pregnancy are less predictable than those of myomectomy. For this reason, I usually advise women who wish to become pregnant to discuss fertility-preserving surgical options carefully before choosing UAE.
5. Endometrial Ablation
Endometrial ablation is a procedure that destroys or removes the inner lining of the uterus to reduce heavy menstrual bleeding.
It does not remove fibroids and is generally only considered when heavy bleeding is the main problem and the fibroids are small and appropriately located.
Pregnancy after endometrial ablation can be dangerous and may not be possible. Therefore, this treatment is only suitable for women who do not wish to become pregnant in the future. Reliable contraception may still be required after the procedure.
6. Watchful Waiting
If your fibroids are small, slow-growing, and not causing significant symptoms, immediate treatment may not be necessary.
I may advise regular clinical reviews and ultrasound scans to monitor any change in their size or appearance. You should also report any new symptoms, such as heavier bleeding, persistent pain, increasing abdominal swelling, or bladder pressure.
Fibroids commonly become smaller after menopause as oestrogen levels fall. For women who are close to menopause and have manageable symptoms, monitoring may sometimes be more appropriate than surgery.
Which Fibroid Treatment Is Right for You?
There is no single fibroid treatment that is best for every patient.
When recommending treatment, I consider:
- The size, number, and location of the fibroids
- The severity of your symptoms
- Your age and general health
- Your haemoglobin and iron levels
- Whether you wish to become pregnant
- Your previous pregnancies or miscarriages
- Previous abdominal or uterine surgery
- Your preference for surgical or non-surgical treatment
I will review your ultrasound and any relevant blood tests, ask about your symptoms, and explain which options are medically appropriate for you.
Sometimes a combination of treatments provides the best outcome. For example, medication may first be used to control bleeding, treat anaemia, or reduce the size of a fibroid before surgery.
The goal is not simply to treat an ultrasound finding. My aim is to choose an approach that improves your symptoms while respecting your fertility goals, health, and personal preferences.
Fibroids and Fertility: What You Should Know
Fibroids do not cause infertility in every woman. Many women with fibroids become pregnant naturally and have healthy pregnancies.
However, certain fibroids—particularly submucosal fibroids that distort the uterine cavity—may interfere with implantation or increase the risk of miscarriage. Large intramural fibroids may also affect fertility in some circumstances.
If you are trying to conceive and have been diagnosed with fibroids, I recommend a proper fertility evaluation rather than assuming that the fibroids are necessarily the cause.
The decision to remove a fibroid before pregnancy depends on:
- Its size
- Its location
- Whether it changes the shape of the uterine cavity
- Your age
- Your fertility history
- Whether you have experienced recurrent miscarriage
- Whether other causes of infertility have been identified
In selected patients, myomectomy may improve the chances of conception or a successful pregnancy. However, surgery is not automatically required for every woman with fibroids.
When Should You See a Gynaecologist?
You should arrange a gynaecological assessment if you experience:
- Periods that soak through pads, tampons, or clothing
- Menstrual bleeding lasting longer than seven days
- Passing large blood clots
- Persistent pelvic pain or pressure
- Frequent urination
- Difficulty emptying your bladder
- Constipation or pressure on the bowel
- Abdominal swelling or a feeling of heaviness
- Pain during intercourse
- Difficulty conceiving
- Recurrent pregnancy loss
- Tiredness, dizziness, palpitations, or breathlessness that may be caused by anaemia
These symptoms are not always caused by fibroids. Heavy bleeding and pelvic pain may also be associated with adenomyosis, endometriosis, uterine polyps, hormonal problems, thyroid conditions, pregnancy-related complications, or other gynaecological disorders.
A proper clinical assessment and appropriate investigations are therefore important before deciding on treatment.
FAQs
Can fibroids go away on their own without treatment?
Small fibroids that are not causing symptoms may stay stable for years. After menopause, oestrogen levels fall and fibroids typically shrink on their own. However, fibroids that are symptomatic causing heavy bleeding, pain, or fertility problems usually need medical attention and do not resolve without treatment.
Do I only need to see a gynecologist if I am planning a family or active in a relationship?
Yes. Hormonal medicines, GnRH antagonists, and the hormonal coil can manage symptoms without surgery. UAE is also a non-surgical procedure that shrinks fibroids. However, the best approach depends on the size, location, and number of fibroids, as well as your symptoms. Your gynaecologist will advise whether non-surgical options are suitable for your case.
Which fibroid treatment is best if I want to have children?
Myomectomy the surgical removal of fibroids while keeping the uterus is generally the preferred option for women who wish to preserve fertility. The type of myomectomy (laparoscopic, hysteroscopic, or open) depends on the fibroid’s size and location. UAE is generally not recommended for women planning a future pregnancy. Always discuss fertility goals with your doctor before deciding on treatment.
Can fibroids come back after treatment?
Yes. Fibroids can return after myomectomy, especially if a woman is still in her reproductive years. The risk is higher if there were many fibroids or if some could not be removed. Hysterectomy is the only treatment that permanently eliminates fibroids, as the uterus is removed. UAE can cause fibroids to shrink significantly, but new fibroids may develop over time.
Consult a Fibroid Specialist in Islamabad
I am Prof. Dr Sajida Guftaar, an MBBS and FCPS-qualified gynaecologist and obstetrician with more than 20 years of clinical experience.
I regularly assess and treat women with uterine fibroids, heavy menstrual bleeding, pelvic pain, fertility concerns, and pregnancy-related complications. My approach is to provide clear and individualised guidance based on each patient’s symptoms, examination, reports, health, and future plans.
I am available for consultations at South East Hospital, PWD Islamabad.
I also offer online consultations for patients from other cities across Pakistan who would like me to review their ultrasound reports, discuss their symptoms, or provide a second opinion before they decide on treatment.