Tranexamic acid reduces heavy periods by enhancing the body’s clotting ability. Rare but serious side effects such as deep venous thrombosis (DVT) and pulmonary embolism (clots in the lung) may occur. Therefore, it is not recommended for women with an increased risk of arterial or venous thrombosis.

NSAIDs are mainly used for period pain, but are not as effective as tranexamic acid for heavy periods.

Combined birth control pills are commonly prescribed for heavy menstrual periods. As fibroid growth is dependent on oestrogen, fibroid growth showed be monitored. A progestogen-only pill can also be used to control heavy periods.

Gonadotropin-releasing hormone (GnRH) agonists can be used to induce temporary menopause, so as to reduce blood supply and shrink fibroids. They are usually used for 3 – 6 months prior to fibroid surgery. Common side effects include hot flashes, mood changes and osteoporosis. Use is generally limited to six months and fibroids usually regrow after GnRH agonists are stopped.

Ryeqo is a hormone based oral medication with 3 ingredients. The first ingredient is the GnRHa relugolix, which inhibits the release of pituitary stimulating hormones, thus reduces oestrogen and progesterone production from the ovaries. The second ingredient is an oestrogen to alleviate menopause-like symptoms and prevent osteoporosis. The third ingredient is a progestogen to protect the endometrium.

Ryeqo can be used to alleviate fibroid related heavy menstrual bleeding. However, trial studies showed an insignificant fibroid volume loss of only 12% at 6 months. The drug is far less effective in shrinking fibroids comparing with UFE (uterine fibroid embolisation), which on average will shrink fibroid volume by 60% at 6 months.https://sydneyfibroidclinic.com.au/fibroids/case-studies/

In summary, Ryeqo is a combination hormone based oral treatment that can alleviate heavy menstrual bleeding but is not very effective in shrinking fibroids.

Ryeqo for fibroids, what is it and how effective is it?

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Mirena is an intrauterine device (IUD). It is a T-shaped plastic device that slowly releases the sex hormone progesterone over five years. It is used as contraceptive device that is effective for five years.

Though helpful for relieving heavy periods, Mirena does not reduce the size of fibroids, nor does it stop fibroid growth. If uterine fibroids are large and distort the cavity, Mirena may also be difficult to insert or remove and the device may not stay in place.

Please note: in some women, heavy bleeding is converted to prolonged spotting, which can be annoying for patients. Well-known side effects of Mirena are prolonged light bleeding (25%) and irregular bleeding (14%), with less common side effects of weight gain, ovarian cysts, lower abdominal pain and acne.

Mirena can be inserted in the rooms of your GP or gynaecologist. In some cases, it may need to be inserted in an operating room under sedation or a light general anaesthetic, depending on the perceived difficulty.

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Ablation uses heat energy to surgically destroy the inner lining of the uterus. It is performed under general anaesthetic in an operating theatre. If successful, menstrual flow will be diminished,  but ablation does not shrink fibroids and will not relieve symptoms related to the bulk of uterine fibroids.

If the uterine cavity is distorted by fibroids, ablation may not work – due to a lack of effective contact between the heating device and the lining of the uterus.

If adenomyosis is also present, sealing off the glands within the uterine muscle wall can lead to severe period pain.

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UFE is a safe, effective and minimally invasive, non-surgical alternative to a hysterectomy. Shrinking fibroids, reducing heavy periods and relieving pain, UFE has been shown to be as effective as a hysterectomy in improving women’s quality of life.

The procedure and its benefits can be summarised as follows:

• Local anaesthetic procedure
• Proven safety and effectiveness
• Over 90% patient satisfaction rate
• No surgical cuts, no general anaesthesia
• 1 – 2 nights hospital stay
• 1-week recovery
• Multiple fibroids treated in one go
• Keep your uterus and pelvic floor intact

Uterine fibroid embolisation (UFE) is performed by an interventional radiologist. During the procedure, tiny particles are injected inside the uterine arteries to block the blood flow, thereby starving the fibroids, causing shrinkage and alleviating symptoms. Only a tiny nick on the skin is needed to allow insertion of a small, 1 – 2mm diameter catheter into the femoral artery in the groin. This catheter is advanced into the arteries of the uterus under X-ray guidance.

The procedure is suitable for women who wish to avoid a hysterectomy, keep their uterus and recover quickly. Condoleezza Rice, the 66^th US Secretary of State, successfully underwent uterine fibroid embolisation for her fibroids in 2004. She chose UFE over hysterectomy.

For more information on UFE as a uterine fibroid treatment,  click the link to UFE FAQs

Learn More About UFE

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Hysteroscopic resection is a general anaesthetic procedure performed in an operating theatre. First the cervix is dilated. Then the hysteroscope (a mini telescope or endoscope) is inserted into the uterine cavity. A ‘shaving’ device is then used to remove the part of the fibroid protruding into the cavity.

Only small fibroids – less than 4 cm, protruding more than 50% into the cavity – are suitable for hysteroscopic resection. When there are other fibroids and/or adenomyosis present, hysteroscopic resection alone may not be sufficient to successfully control symptoms.

If a woman wishes to avoid a hysterectomy, hysteroscopic resection can be combined with UFE to achieve the goal of keeping her uterus, using two minor procedures to avoid a major operation like hysterectomy and its associated long-term side effects.

After UFE, fibroids adjacent to the uterine cavity might slough off as vaginal discharge and passage of fibroid tissue. Hysterescopic resection ( a curette procedure)  might be needed to “clean out ” the dead fibroids attached to the cavity.

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A myomectomy is possible for fibroids with suitable size and in suitable locations. Compared to a hysterectomy, a myomectomy is technically more demanding on the surgeon, takes longer to perform, and is more likely to require a blood transfusion. There is the risk that a myomectomy is sometimes converted to a hysterectomy if the surgeon is unable to control the bleeding or reconstruct the uterus.

Development of adhesion (internal scarring of the abdomen) is a potential complication that can affect future fertility and pregnancy. Fibroids left behind may grow and cause symptom recurrence in 40 – 50% of women after a myomectomy.

A myomectomy can be performed through open incision, or via keyhole (laparoscopic or robotic). Though recovery is quicker with laparoscopic/robotic myomectomy, major surgical risks may not be lower. Laparoscopic/robotic surgery is technically more demanding, with a steeper learning curve for surgeons, due to limited access and visualisation. The major surgery risks still exist, in terms of injuries to blood vessels, the bowel, the bladder and the ureter. An open myomectomy takes longer to recover, due to the larger surgical incision. The access and visualisation of adjacent structures are better and uterine reconstruction can be easier.

Whether an open or laparoscopic/robotic myomectomy is the right choice for you depends on the reason for your myomectomy, your desire for a quick recovery, and the skill and the experience of your surgeon.

At Sydney Fibroid Clinic, a myomectomy is discussed as a preferred option for women who still desire future pregnancy. To enable us to provide you with more definitive opinion, we would require you to have an MRI of your uterus, performed by one of our preferred MRI service providers.

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Traditionally when conservative treatments fail or are deemed unsuitable, a hysterectomy is offered. However, a hysterectomy is a major surgery that requires 3 – 5 days stay in hospital and 5 – 6 weeks of recovery, carries the risks of a major surgery and is associated with long-term adverse side effects.

A hysterectomy is a major surgery. The risk of severe complications from hysterectomy remains significant, at 3.5% to 11% to date in 2019. In addition to the immediate surgical risks, hysterectomy patients may experience long-term side effects like pelvic prolapse, urinary incontinence, early onset of menopause, increased cardiovascular risk, sexual dysfunction and constipation.

Since there are now many less invasive means to treat fibroid-related symptoms, hysterectomies should be considered as the last resort, when all other less invasive methods have failed. Depending on your specific situation, uterine fibroid embolisation, endometrial ablation, hysteroscopic resection, Mirena IUD or MRgFUS treatment may be your less invasive choice.

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MRgFUS treatment needs to be planned very carefully to avoid skin burns, bone or nerve damage, or thermal injury to bowels. Fibroids too close to the skin, spine or bowels are not suitable. Multiple fibroids and large fibroids are usually not suitable due to long procedure time.

The procedure can take 3-4 hours depending on the size(s), with patient lying face down inside the MRI machine. It is NOT currently funded by Medicare or health fund. Sydney Fibroid Clinic does NOT provide this treatment. The treatment is available in Melbourne.

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