How to shrink fibroids: claims against the evidence

Some medicines can reduce fibroid size while treatment continues. Uterine artery embolization is a procedure used most often for fibroid-related vaginal bleeding [5]. The Office on Women’s Health reports that fibroids either stop growing or get smaller after menopause [2]. No available treatment permanently stops fibroid growth, and fibroid symptoms return after effective therapy stops [4]. Supplements, teas, cleansing regimens and diets do not appear in the fibroid treatment lists published by Cleveland Clinic or the Office on Women’s Health [1][2].

What does “shrink fibroids” mean?

Cleveland Clinic describes a uterine fibroid, also called a leiomyoma, as muscle and tissue that grows in the uterine wall or on the outside of the uterus [1]. Fibroids can be intramural, submucosal, subserosal or pedunculated, depending on where they develop [1]. The tests Cleveland Clinic lists for finding or assessing fibroids include ultrasonography, magnetic resonance imaging, computed tomography, hysteroscopy, hysterosalpingography, sonohysterography and laparoscopy [1].

“Shrink” can refer to a change in fibroid size. Cleveland Clinic lists excessive or painful menstrual bleeding, bleeding between periods, lower-abdominal fullness or bloating, frequent urination, pain during sex, low back pain, constipation or rectal pressure, chronic vaginal discharge, incomplete bladder emptying and increased abdominal distention among fibroid symptoms [1].

Tranexamic acid reduced fibroid-associated heavy menstrual bleeding in the reviewed evidence, but it does not treat the fibroid directly [4]. The review reports decreased menstrual bleeding, pelvic pain and leiomyoma size in several studies of elagolix or relugolix [4].

Which medicines can reduce fibroid size?

The published review reports that several studies found lower menstrual bleeding, less pelvic pain and smaller leiomyoma size among women treated with elagolix or relugolix [4]. Cleveland Clinic lists GnRH agonists as medicines that shrink fibroids temporarily and lists elagolix as an oral therapy for fibroids [1].

The review states that no available treatment permanently ceases fibroid tumor growth [4]. It also states that fibroid symptoms return after effective therapies stop [4]. This is the documented boundary for medication: some drug treatments can reduce size while treatment continues, but medical treatment does not remove fibroids [1][4].

The review says that direct evidence for contraceptive hormones in fibroid-associated heavy menstrual bleeding is limited, and that a review of progestogen treatment found a lack of evidence in that setting [4].

Ask which result is being measured. Ask whether the medicine is intended to reduce bleeding, reduce pain, change fibroid size or address more than one of these outcomes. Ask how long the treatment is expected to continue and what happens after it stops.

Can menopause shrink fibroids?

The Office on Women’s Health reports that fibroids either stop growing or get smaller after menopause [2]. Cleveland Clinic reports that fibroid frequency rises through the 30s and 40s up to menopause [1]. Cleveland Clinic also reports that approximately 40% to 80% of people with a uterus have fibroids, most often between ages 30 and 50 [1].

Perimenopause can include heavier or lighter periods and menstrual cycles that become longer or shorter than usual [3].

Heavy menstrual bleeding includes periods lasting longer than seven days, bleeding through a pad or tampon every hour for several hours, needing more than one pad at a time, changing pads during the night, and passing clots the size of a quarter or larger several times a day [3]. Cleveland Clinic says that bleeding through at least two pads or tampons each hour and continuing at that level for two to three consecutive hours calls for prompt professional evaluation [3].

Fibroids are one possible cause of heavy menstrual bleeding. Cleveland Clinic also lists hormone imbalance, polyps, adenomyosis, infections, pregnancy complications, bleeding disorders such as von Willebrand disease, liver or kidney disease, cancers and some medicines, including blood thinners [3].

What does uterine artery embolization change?

Cleveland Clinic describes uterine artery embolization as a minimally invasive treatment used most often for vaginal bleeding related to fibroids [5]. The procedure uses a tiny puncture and is less invasive than myomectomy or hysterectomy [5].

Cleveland Clinic reports that as many as 90% of patients are back to normal activities within 10 days, with most people resuming activity during the first one to two weeks [5]. The source reports that 32% of people had fibroid symptoms five years after uterine artery embolization [5]. It also reports that menstrual cycles shut down permanently in about 1% to 5% of people after the procedure [5].

Cleveland Clinic says uterine artery embolization should not be performed in someone with a pelvic infection or an allergic reaction to contrast dyes [5]. Ask which result will be measured after the procedure, including bleeding, pain, pressure or fibroid size.

What can myomectomy and hysterectomy change?

A myomectomy removes uterine fibroids while preserving uterine tissue, so pregnancy remains possible [6]. Cleveland Clinic lists hysteroscopic, laparoscopic or robotic, and open abdominal approaches [6]. Recovery varies by approach, from a matter of days after a hysteroscopic myomectomy to up to six weeks at home after an open myomectomy [6].

Fibroids can appear again after a myomectomy [6]. Cleveland Clinic reports that the risk of developing more fibroids later is higher for patients below age 40 who already have several [6]. Risks listed by the source include bleeding, infection, blood clots, damage to nearby organs, reaction to anesthesia and an increased chance of needing a cesarean delivery [6].

A hysterectomy removes the uterus and most likely the cervix [1]. After a hysterectomy, a person cannot become pregnant and will not have menstrual periods [1]. Ovaries are not always removed, and whether they are removed depends on the type of surgery and the reason for it [1].

Cleveland Clinic reports that hysterectomy recovery generally takes four to six weeks, with vaginal and laparoscopic routes tending to heal faster than an abdominal operation [1]. Radiofrequency ablation and endometrial ablation also appear in Cleveland Clinic’s published treatment lists for fibroids and heavy bleeding [1].

What do supplements, teas and diets do to fibroid size?

No supplement, herbal product, tea, cleansing regimen or diet appears in Cleveland Clinic’s published fibroid treatment options [1]. None appears in the Office on Women’s Health treatment information for fibroids [2]. The published sources do not document these approaches reducing fibroid size.

Write down the exact name of any product you use. Bring that information to an appointment and ask whether the product has documented evidence for changing fibroid size.

Can bleeding treatment shrink a fibroid?

Tranexamic acid significantly reduced fibroid-associated heavy menstrual bleeding in the reviewed evidence, but it did not treat the fibroid directly [4]. Cleveland Clinic lists tranexamic acid among treatments for heavy menstrual bleeding [3].

The reviewed evidence does not provide long-term treatment data for tranexamic acid [4]. The review also reports limited direct data for contraceptive hormone use in fibroid-associated heavy menstrual bleeding and a lack of evidence for progestogens in that setting [4].

Ask which outcome the evidence supports for the medicine being offered.

Claim against evidence

How does this apply to Black women?

The published sources report that fibroids develop at earlier ages in Black women, are more likely to be symptomatic, and have greater size and growth rates in Black women [1]. In an ultrasound-screened cohort, estimated cumulative incidence by age 50 was over 80% for Black women and nearly 70% for white women [2].

The same cohort found that the difference between the age-specific cumulative incidence curves was highly significant, with an odds ratio of 2.9 and a 95% confidence interval of 2.5 to 3.4 [2]. These figures do not identify which treatment will change a particular fibroid.

Ask what problem is being treated, what result will be measured and what happens after treatment stops.

What to do next

1. Write down whether your goal is less bleeding, less pain, less pressure, a smaller fibroid on imaging, pregnancy preservation or more than one of these outcomes.
2. Record the exact name of every supplement, tea, product or medicine you use.
3. Ask, “Is this treatment meant to change fibroid size, reduce symptoms, or both?”
4. Ask whether you need imaging to find or assess fibroids, including ultrasonography, MRI, CT, hysteroscopy, hysterosalpingography, sonohysterography or laparoscopy [1].
5. If medication is offered, ask how long any size reduction is expected to last and what the plan is after treatment stops [4].
6. If bleeding soaks at least two pads or tampons each hour for two to three consecutive hours, seek prompt professional evaluation [3].
7. Ask which result will be measured after a procedure, such as bleeding, pain, pressure or fibroid size.
8. If myomectomy is discussed, ask about the approach, recovery and the possibility that fibroids can appear again [6].

Related on Ruby: fibroid medications and fibroid treatment without surgery.

Sources

1. Cleveland Clinic, Uterine fibroids. https://my.clevelandclinic.org/health/diseases/9130-uterine-fibroids
2. Office on Women’s Health, Uterine fibroids. https://womenshealth.gov/a-z-topics/uterine-fibroids
3. Cleveland Clinic, Menorrhagia. https://my.clevelandclinic.org/health/diseases/17734-menorrhagia-heavy-menstrual-bleeding
4. Barseghyan 2023, The efficacy of medical management of leiomyoma-associated heavy menstrual bleeding, PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC10958631/
5. Cleveland Clinic, Uterine artery embolization. https://my.clevelandclinic.org/health/treatments/17954-uterine-artery-embolization
6. Cleveland Clinic, Myomectomy. https://my.clevelandclinic.org/health/treatments/15448-myomectomy