MyFibroid Plan is a patient-developed tool to help you explore your treatment options and prepare for your visit.
This patient decision aid was developed as part of a quality improvement initiative with patients who have faced similar decisions.
If you'd like, you can print a PDF version of this document to bring with you to your appointment, or you can review a copy available at the clinic.
Uterine fibroids are muscular tumors that develop in the wall of the uterus. These growths vary in size and can cause symptoms such as heavy menstrual bleeding, pelvic pressure, and pain.
Hormone imbalances, genetic factors and family history may all play a part. We do know that hormone levels of estrogen and progesterone can cause fibroids to grow bigger.
You can treat symptoms with medications that decrease bleeding or decrease the size of fibroids. If these medications don't work for you or you cannot take them, surgery may be an option.
Intramural fibroids: These are the most common type of fibroids. They develop in the uterine wall and may expand.
Pedunculated fibroids: These grow on stalks or stems. The stems are attached to the uterine wall and may grow either outside the uterus or inside the uterine cavity.
Subserosal fibroids: These develop in the outer portion of the uterus and may continue to grow outward.
Submucosal fibroids: These develop within the uterine cavity and may cause heavy and prolonged periods.
Depending on where your fibroids are located, certain surgical options may be more suitable.
1) Your age and future fertility plans
2) The location, number and size of your fibroids
Based on your future fertility plans, these are the surgical options to discuss with your doctor.
Hysteroscopic myomectomy — may be possible for submucosal fibroids within the uterine cavity.
Open myomectomy — for when there are many or very large fibroids.
Laparoscopic myomectomy (keyhole surgery) — if there are few or small fibroids.
Open hysterectomy — if the uterus is very large.
Laparoscopic hysterectomy (keyhole surgery) — when possible.
Hysteroscopic myomectomy may be considered in some patients who do not plan to have children. Discuss this with your doctor.
Blocks blood flow to shrink fibroids. Not recommended if you are planning a pregnancy.
Uses heat to shrink fibroids. Not recommended if you are planning a pregnancy.
Check what applies to you to discuss further with your doctor.
What are the benefits and risks of each option?
For each option, what matters to you most?
What else do you need before making a decision?
What are the next steps?
Tap an option to learn more information, then return here to explore others.
You don't need to have any treatment at all if you aren't bothered by symptoms. Many patients live with uterine fibroids and do not start treatment. Uterine fibroids are not cancerous, so you do not need to get any treatment for them.
You can try medications to treat heavy bleeding, bulk symptoms or both. Medications can be tried if you have not been on any treatment before, or are not interested in having surgery. Some medications contain hormones while others do not. Talk to your doctor about the best medication for you.
A hysterectomy removes your whole uterus, including fibroids.
It can be done as laparoscopic surgery (through key hole incisions) or open surgery. This depends on your uterus and other factors.
Minimally invasive. It involves removing the uterus and fibroids through a small cut at the top of the vagina. Recovery time: 2 to 4 weeks.
You would have an incision in your belly. Recovery time: 4 to 6 weeks. You should not place anything in the vagina, lift anything over 10 pounds, or submerge yourself in water for 6 weeks.
| Factors to consider | Benefits | Risks |
|---|---|---|
| How well it works | Removes the fibroids completely along with your uterus. You will no longer have periods. | This is a major surgery. There is a risk of complications such as infection, blood transfusion, blood clots, or injury to surrounding organs like the bowel or bladder. |
| Long-term outcomes | There is no risk of the fibroids returning. Resolves symptoms like heavy bleeding. | Pain and pressure symptoms may persist if these are not related to your fibroids. |
| Recovery | If done through laparoscopic surgery, you will have a shorter recovery time (2 to 4 weeks). | Recovery time can be up to 6 weeks. You should not place anything in the vagina, lift over 10 pounds, or submerge in water for 6 weeks. |
| Future reproductive outcomes | This is a permanent solution if you have no plans to carry a pregnancy in the future. | |
| Hormonal effects | The ovaries can be left inside which avoids early menopause. | If ovaries are removed, you will go through menopause and may have symptoms like hot flashes and mood swings. |
Myomectomy involves removing fibroids. The uterus is left in place and you will continue to have periods after surgery. Fibroids may remain and may grow back.
This option is often chosen by patients who want to get pregnant in the future or want to keep their uterus. In some cases, this surgery may improve chances of pregnancy.
There are 3 main ways to do this surgery. The approach that is chosen depends on the location, size, and number of fibroids.
Before having a myomectomy, your surgeon may ask you to take medications to shrink fibroids and the uterus and stop heavy bleeding. The most commonly used medication is called a GnRH agonist (brand name Lupron).
If you get pregnant after having a myomectomy, you will likely need to have your baby by a cesarean section rather than a vaginal delivery. Ask your doctor about this.
| Factors to consider | Benefits | Risks |
|---|---|---|
| How well it works | Can remove larger fibroids and relieve symptoms like heavy bleeding and pelvic pressure. | Sometimes, not all of the fibroids can be removed. Some patients will continue to have heavy bleeding and pelvic pressure symptoms. |
| Long-term outcomes | Keeps the uterus, which can be important if you want to get pregnant in the future or for emotional reasons. | Fibroids can return. 1 in 10 patients will need another surgery. Scar tissue often forms after a myomectomy, which may make future abdominal surgery more complicated. |
| Future reproductive outcomes | You can become pregnant after a myomectomy. In some cases, myomectomy may improve your chances of pregnancy. | If you have many or large fibroids, your doctor will likely recommend you deliver by cesarean section in the future (rather than a vaginal birth). |
| Hormonal effects | There is no impact on hormones or menopause. | Hormonal imbalance is not a concern unless the ovaries are damaged or removed during surgery. |
UAE treats fibroids by cutting off the blood supply, causing them to shrink. It is a minimally invasive procedure.
Preserves the uterus but is not recommended for those planning pregnancy.
Helps reduce heavy bleeding and fibroid-related pressure symptoms.
It is done by an interventional radiologist and involves:
| Factors to consider | Benefits | Risks |
|---|---|---|
| How well it works | Effective in shrinking fibroids. Relieves symptoms like heavy bleeding and pelvic pressure in about 3 in 4 women. | May not work for all fibroids, especially large or calcified ones. Not recommended for submucosal or pedunculated fibroids. |
| Long-term outcomes | Many women experience long-term symptom relief. | Fibroids can return. 1 in 5 women will need another surgery for their fibroids later in life. |
| Recovery | Shorter recovery time compared to other surgery (usually 1–2 weeks for most patients). | Pain is often significant. There is a rare risk of infection requiring emergency hysterectomy. |
| Future reproductive outcomes | Pregnancy is not recommended after this procedure. Pregnancy can come with increased risks including preterm labour, miscarriage, or problems with the placenta. | |
| Hormonal effects | No direct impact on hormone production. | Some women may experience early menopause symptoms, if the ovaries are affected by the procedure. |
Minimally invasive procedure using small incisions in the belly. The surgeon uses ultrasound to target fibroids with heat, shrinking them to reduce symptoms. The uterus remains intact, but pregnancy is not recommended after this procedure.
Symptom improvement peaks at 3 months and can continue for up to a year. Your body mass index must be less than 40 to have this procedure.
| Factors to consider | Benefits | Risks |
|---|---|---|
| How well it works | Effective in reducing symptoms like heavy bleeding and pelvic pressure by shrinking fibroid size. | May not be as effective for very large fibroids or if fibroids are in certain locations. Some fibroids may not shrink enough to fully relieve symptoms. |
| Long-term outcomes | Many women experience long-term symptom relief. Can reduce the need for further surgery, especially in patients with smaller fibroids. | Fibroids can grow in the future. About 11% of patients will need another surgery. This is about 1 in 10 patients. |
| Recovery | Shorter recovery time compared to hysterectomy and myomectomy (usually 1–2 weeks). Most patients can go home the same day of surgery. | Some discomfort after the procedure, including cramping and bloating. This may last for a few days to a week. |
| Future reproductive outcomes | Keeps the uterus. However currently, pregnancy is not recommended after this procedure. Pregnancy may come with increased risks including miscarriage or problems with the placenta. | |
| Hormonal effects | No direct impact on hormone production. | In rare cases, there may be unintended effects on the ovaries and hormone production. |
Tap any topic to learn more. These are optional — come back whenever you're ready.
Most fibroids do not affect your chances of getting pregnant or having a miscarriage. However, this depends on where your fibroids are:
Surgery for fibroids may affect fertility if there is scarring. It may also affect how you deliver your baby. If you have an abdominal myomectomy, you will probably need to have a cesarean section for future pregnancies.
Women's fertility normally declines after age 30 with a more significant decrease at age 35.
Fertility treatments are more successful in younger women under age 35. After age 40, success rates decline and risks increase.
If a woman's own eggs are no longer viable, or you are age 41 or older, egg donation is an option. In this process, donated eggs are fertilized with your partner's sperm and implanted into your uterus.
For women who are unable to carry a pregnancy due to age or other health reasons, surrogacy may be an option. This involves another woman carrying the pregnancy using either the couple's own or donor eggs and sperm.
Fertility treatments can be expensive. Ask your doctor if you are interested in seeing a fertility specialist.
Most fibroids stay the same size during pregnancy. However about 1 in 3 may get larger during pregnancy due to hormone changes. After the pregnancy, they tend to shrink in size.
Many people with fibroids have healthy pregnancies. However, the size, number and location of fibroids can affect the risk of complications.
The most common complication is pain from fibroid degeneration. This is when a fibroid grows bigger than its blood supply. It causes sharp pain in a small area, usually in the first half of pregnancy.
Most patients with fibroids can have a vaginal delivery; however, a cesarean section may be recommended in the cases above.
Uterine fibroids are almost never cancerous and do not increase the risk of uterine cancer.
In 1 in 1,000 cases, a mass looking like a fibroid may in fact be a leiomyosarcoma, a rare cancer. That risk increases with a woman's age.
Your doctor will assess your history and pelvic imaging for any risk factors.
Patients with fibroids and heavy periods may need an endometrial biopsy to check for precancerous or cancerous cells before surgery.
Morcellation is a process where fibroids or the uterus itself are cut into smaller pieces so they can be removed through smaller incisions. Smaller incisions lead to quicker recovery times, less pain, and smaller scars.
Morcellation is generally safe. In the very small chance that a fibroid contains cancer, morcellation could spread the cancerous cells within the abdomen, leading to worse outcomes.
Before morcellation, patients must have a biopsy of the lining of the uterus (endometrial biopsy) to check that there is no pre-cancer or cancer. This does not guarantee that you don't have cancer but is a good screening test.
If there is any concern that a fibroid could have cancer, morcellation will not be done.
The alternative to morcellation is to have a larger incision so that the fibroid or uterus can be removed as one piece.
Research suggests that Vitamin D may help slow the growth of fibroids and even reduce their size in some cases. Vitamin D is a safe and low-risk option that may help with fibroid management, especially for smaller fibroids. It's not a cure, but maintaining healthy Vitamin D levels benefits overall health.
More research is needed to confirm its effectiveness. Doses used in research studies are higher than what is currently available. Talk to your doctor about checking your Vitamin D levels and finding the right dosage for you.
Click to explore community supports suggested by gynecologists at Unity Health Toronto:
The Fibroid Foundation Care About Fibroids The White Dress ProjectRate how important each reason is to you on a scale from 0 to 5. 0 = not important · 5 = very important
| Hysterectomy | Myomectomy | Lap RFA | Don't Know | |
|---|---|---|---|---|
| Which option has the highest chance of improving my heavy bleeding and/or bulk symptoms? | ||||
| Which option has the lowest chance of surgical complications? | ||||
| Which option has the lowest risk of blood transfusion? | ||||
| Which option has the highest chance of serious harm? |
If you answered 'No' to any of those, discuss with your health care provider.
Thank you for completing this decision aid. Your responses will be reviewed during your upcoming appointment with your gynecologist, where you can discuss your options further.
If you'd like, you can print a PDF version of this document to bring with you to your appointment, or you can review a copy available at the clinic. Either way, we'll make sure you have all the support and information you need to make the best decision for your care.
This information is not intended to replace the advice of a healthcare provider.
Format based on the Ottawa Personal Decision Guide © 2000, A O'Connor, D Stacey, University of Ottawa, Canada.
