Fibroids that do not cause symptoms, are small, or occur in a woman nearing menopause often do not require treatment. Certain signs and symptoms, though, may signal the need for treatment:

• Heavy or painful menstrual periods
• Bleeding between periods
• Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
• Rapid increase in growth of the fibroid
• Infertility
• Pelvic pain

If you have fibroids or have had them in the past, make sure to have regular checkups. If you have symptoms of fibroids, see your doctor right away. There is no need to limit your sexual activi-ty unless the fibroids cause pain during sex. Fibroids may be treated by removing them with surgery. Drugs, such as gonadotropin-releasing hormone (GnRH) agonists, may be used to shrink fibroids temporarily and to control bleeding to prepare for surgery. The fibroids may be removed with myomectomy or hysterectomy. The choice of treatment depends on factors such as your own wishes and medical advice about the size and location of the fibroids.

Myomectomy
Myomectomy is the surgical removal of fibroids, leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have chil-dren. If a woman does become pregnant after a myomectomy, she may need to have a cesarean delivery (the baby is born through a surgical cut made in the mother's abdomen and uterus). Some-times, though, a myomectomy causes internal scarring that can lead to infertility. Fibroids may develop again, even after the procedure. If they do, more surgery is needed in 20-40% of cases.

Myomectomy may be done in a number of ways:

• Laparotomy
• Laparoscopy
• Hysteroscopy

The method used depends on the location and size of the fibroids. For a laparotomy, an incision (cut) is made in the abdomen. The fibroids then are removed through the incision. Fibroids also can be removed through the laparoscope that is used to view the inside of the abdomen. Hysteroscopy can be used to remove fibroids that protrude into the cavity of the uterus. The fibroids may be removed with a resectoscope, a tiny wire ioop that uses electric power, or with a laser. Either of these instruments can be inserted through the hysteroscope. Although it cannot re-move fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. This type of treatment is often done with pain relief, but you may not need to stay in the hospital.

Hysterectomy
Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. It depends on other factors. Hysterectomy may be needed if:

• Pain or abnormal bleeding persists
• Fibroids are very large
• Other treatments are not possible
• A woman no longer wants children

If your doctor thinks you need a hysterectomy, he or she will first rule out other problems with the uterus, such as diseases of the endometrium (the lining of the uterus).