From the Guidelines
The next steps after an MRI suggests aggressive degenerating fibroids should include prompt consultation with a gynecologist to discuss treatment options based on your symptoms, fibroid characteristics, and reproductive goals. Treatment may include medications such as GnRH agonists (leuprolide acetate 3.75 mg monthly injections) or tranexamic acid (1300 mg three times daily during menstruation) to manage symptoms temporarily, as suggested by recent guidelines 1. For definitive treatment, procedural options include:
- Myomectomy (surgical removal of fibroids while preserving the uterus)
- Hysterectomy (complete uterus removal), which is usually appropriate as a next step for a postmenopausal patient with uterine fibroids, symptomatic with heavy uterine bleeding or bulk symptoms 1
- Uterine artery embolization (blocking blood flow to fibroids)
- Focused ultrasound therapy Pain management during degeneration typically involves NSAIDs like ibuprofen (600-800 mg every 6-8 hours) or naproxen (500 mg twice daily). Degenerating fibroids occur when fibroids outgrow their blood supply, causing tissue death and inflammation that can produce severe pain, fever, and elevated white blood cell counts. While most fibroids are benign, your doctor should also discuss the small possibility of leiomyosarcoma (a rare cancer) and may recommend additional testing if there are concerning features on imaging, as highlighted in recent studies 1. The use of MRI in evaluating fibroids is well-established, with the modality exceling at identifying and mapping fibroids, and the use of a gadolinium-based IV contrast agent is preferred for identification of fibroid vascularity and other characteristics 1.
From the Research
Next Steps for Aggressive Degenerating Fibroids
If an MRI pelvis suggests aggressive degenerating fibroids, the following steps can be considered:
- Consult a healthcare provider to discuss the diagnosis and potential treatment options 2, 3
- Evaluate the size and location of the fibroids, as well as any symptoms being experienced, to determine the best course of treatment 2, 3
- Consider medical treatment options, such as medication to shrink the fibroids or improve symptoms 2, 3
- Discuss surgical options, including myomectomy or hysterectomy, with a healthcare provider 2, 3
- Explore minimally invasive treatment options, such as uterine artery embolization (UAE) or magnetic resonance-guided focused ultrasound surgery (MRgFUS) 4, 5, 6
Treatment Options
Treatment options for aggressive degenerating fibroids may include:
- Uterine artery embolization (UAE) to reduce blood flow to the fibroids and alleviate symptoms 4, 5
- Magnetic resonance-guided focused ultrasound surgery (MRgFUS) to ablate the fibroids and reduce symptoms 6
- Myomectomy to remove the fibroids while preserving the uterus 2, 3
- Hysterectomy to remove the uterus and fibroids 2, 3
Importance of Patient Selection
Patient selection is critical when considering treatment options for aggressive degenerating fibroids 6
- Factors such as fibroid type and location, position relative to adjacent anatomical structures, and the presence of co-existent pelvic disease should be considered when selecting patients for treatment 6
- Successful outcomes with MRgFUS have been correlated with the volume of fibroids ablated during the procedure, highlighting the importance of patient selection 6