Uterine fibroids are common, non-cancerous muscular growths that develop within the wall of the uterus. While many women experience no symptoms, others suffer from heavy menstrual bleeding, pelvic pain, or pressure, necessitating treatment. Because these growths vary significantly in size, number, and location, the optimal treatment plan is highly individualized, depending on the patient’s symptoms and desire to preserve fertility. Effective management often requires a collaborative approach involving several distinct medical specialists.
Initial Assessment and Monitoring
The initial step in addressing uterine fibroids typically begins with a general Obstetrician-Gynecologist (OB-GYN). This specialist manages the overall reproductive health of the patient and is often the first to identify fibroids during a routine pelvic examination. The OB-GYN uses imaging tools, such as transvaginal or abdominal ultrasound, to confirm the diagnosis and map the size and location of the fibroids.
For patients with small, asymptomatic fibroids, the OB-GYN may recommend a strategy of watchful waiting, monitoring the growths over time. If symptoms are mild, they may initially prescribe medical treatments, such as hormonal birth control or nonsteroidal anti-inflammatory drugs (NSAIDs), to help manage pain and excessive bleeding. The general OB-GYN serves as the primary coordinator, determining when a patient’s condition warrants referral to a subspecialist for more advanced medical or procedural intervention.
Surgical and Medical Management Specialists
When conservative medical management fails to relieve symptoms, the general OB-GYN, or a gynecologic surgeon specializing in complex cases, will propose surgical options. These specialists are trained to perform procedures designed to address the physical presence of the fibroids within the uterus. They offer both uterine-sparing surgery and definitive removal of the uterus, depending on the patient’s future plans.
One primary surgical option is a myomectomy, which involves removing the fibroids while leaving the uterus intact, a procedure often preferred by patients who wish to retain their fertility. Myomectomies can be performed using various techniques, including hysteroscopic surgery for growths inside the uterine cavity, or laparoscopic and traditional open abdominal approaches for fibroids embedded in the uterine wall. The other major surgical solution is a hysterectomy, which is the complete removal of the uterus, providing a permanent cure for fibroid symptoms and eliminating recurrence.
In cases where fibroids are interfering with conception, a Reproductive Endocrinologist (REI) may be brought in to coordinate care. REIs specialize in hormonal and fertility issues, and they often work closely with the gynecologic surgeon to determine the optimal timing and technique for a myomectomy. Although fibroids are overwhelmingly benign, a Gynecologic Oncologist might be consulted in rare instances where imaging suggests a suspicion of a cancerous growth, known as a leiomyosarcoma.
Minimally Invasive Procedure Experts
A distinct group of specialists focuses on non-surgical and minimally invasive procedures. The Interventional Radiologist (IR) is a physician who uses advanced imaging guidance to perform procedures through tiny incisions. The IR’s primary treatment for fibroids is Uterine Fibroid Embolization (UFE), a non-surgical technique that shrinks the growths.
During UFE, the IR inserts a thin catheter into an artery and guides it to the uterine arteries that supply blood to the fibroids. They then inject microscopic particles, which effectively block the blood flow to the tumors. Deprived of oxygen and nutrients, the fibroids soften and shrink over several weeks and months, leading to significant symptom relief in most patients. UFE is an option for women who want to preserve their uterus but wish to avoid an operative procedure.
Other non-surgical techniques are also performed by specialists who work with imaging technology. For instance, procedures like Magnetic Resonance-guided Focused Ultrasound Surgery (MRgFUS) use high-intensity ultrasound waves to destroy fibroid tissue through the skin. This non-invasive approach is typically performed by a radiologist in collaboration with a gynecologist, highlighting the multi-specialty nature of modern fibroid care.
Coordinating Care and Selecting a Provider
The decision of which specialist to see is ultimately driven by the patient’s symptoms and reproductive goals. The initial OB-GYN acts as the central point of contact, facilitating the necessary consultations with other specialists once conservative treatment is deemed insufficient. A patient who desires a surgical cure and does not plan on future pregnancy will likely be referred to a gynecologic surgeon for a hysterectomy.
Patients who want to maintain their uterus must weigh the options of a myomectomy performed by a surgeon against the non-surgical UFE procedure performed by an IR. The size and location of the fibroids are physically limiting factors that influence this choice, as certain fibroid types are better suited for one procedure over another. It is the specialist team’s role to present all evidence-based options clearly so the patient can make an informed decision based on their individual circumstances.