Introduction

Uterine fibroids are non-cancerous growths that develop in or on the womb (uterus). They are made up of muscle and fibrous tissue and can vary in size. Many assigned female at birth (AFAB) tend to have fibroids without experiencing any symptoms, while others may experience heavy or painful period pain, menstrual bleeding or other symptoms.¹

Understanding the treatment options available for uterine fibroids is important for those experiencing symptoms, as it allows for informed decision-making and the treatment plans to be tailored based on their needs and goals. This understanding is vital because treatment choices vary significantly based on the size and number of the fibroids and where they are located, as well as the person’s desire to have children.²

AFAB can be educated on their health conditions, treatment options, and potential outcomes by actively engaging in discussions and sharing information. This empowerment can increase confidence in their ability to manage their health and make informed choices.

Understanding uterine fibroids

What are fibroids?

Fibroids are non-cancerous growths that develop in or around the womb. They are typically benign tumours made up of muscle and connective tissue. Most small fibroids do not cause any symptoms and do not require treatment other than regular observation by your healthcare provider.

Larger fibroids can cause you to experience a variety of symptoms, including:

• Menorrhagia: heavy or painful bleeding during your menstrual cycle
• Dyspareunia: pain during sex
• Constipation or feeling pressure in your rectum
• Increased abdominal distention (enlargement), causing the appearance of pregnancy
• Frequent urination
• Inability to pee or empty your bladder

How fibroids affect quality of life

Fibroids can significantly impact the quality of life due to physical discomfort, emotional and psychological distress, and potential fertility concerns. The physical symptoms, such as pelvic pain and heavy bleeding, can lead to reduced social and work participation, and chronic pain can negatively impact your overall well-being.

Emotional and psychological impacts include anxiety and depression. Furthermore, fibroids can affect fertility and the potential to have a baby.³ 

What is shared decision-making?

Definition and purpose

Shared decision-making involves healthcare professionals working together with you to decide on the appropriate care that is most suitable for you. It involves sharing information, discussing preferences, and reaching a mutually agreeable plan based on both evidence and your values. The purpose is to make sure you feel empowered and involved in decisions about your health.⁴

Why it matters in fibroid treatment

• Multiple treatment options: fibroids can be treated through various methods such as medical management (medications), non-surgical procedures and surgical interventions (myomectomy or hysterectomy)
• Individualised approach: each treatment option has different risks, benefits, and effects on fertility and lifestyle

Treatment options for fibroids

Watchful waiting

For fibroids that are not causing significant problems, particularly in AFAB nearing menopause, as fibroids tend to shrink after menopause, watchful waiting could be the best option.

Medication

• Hormonal therapies, such as gonadotropin-releasing hormone (GnRH) agonists, can shrink fibroids and reduce bleeding, but their effects are temporary, and fibroids may return once treatment stops
• Other medications like progesterone and oral contraceptives may help manage symptoms
• Non-hormonal options include pain management medications and tranexamic acid to help with bleeding. Tranexamic acid can only be taken on heavy bleeding days

Non-surgical procedures

• Uterine artery embolisation (UAE): blocks blood supply to the fibroids, causing them to shrink and die
• MRI-guided focused ultrasound: uses focused ultrasound energy, guided by MRI, to destroy fibroid tissue, preserving the uterus⁵
• Radiofrequency ablation: uses heat generated by radiofrequency energy to destroy fibroid tissue
• Endometrial ablation: destroys the lining of the uterus, which can reduce heavy bleeding caused by fibroids

Surgical options

• Abdominal myomectomy: surgical removal of fibroids, preserving the uterus
• Hysterectomy: removal of the uterus, a definitive treatment option if you wish not to conceive

Some non-surgical and surgical options may impact fertility, so it is important to discuss this with your doctor.

Empowering AFAB through education

Importance of accessible information

Empowering AFAB through education, particularly regarding healthcare, involves providing accessible, culturally sensitive information and encouraging a collaborative relationship between healthcare providers and patients. This includes giving clear explanations of risks, benefits, and alternatives, listening to concerns, and presenting unbiased options while respecting your values and goals.⁶

Challenges in shared decision-making

Shared decision-making in fibroid treatment, like in other areas of healthcare, faces several challenges.

Time constraints in consultations

Some healthcare providers believe that shared decision-making is too time-consuming during visits. The pressure of time can lead to the temptation to propose treatments rather than explore all possible options quickly. Nevertheless, research indicates that shared decision-making typically does not extend the length of appointments. 

Time constraints can also hinder professionals from participating in training to enhance their shared decision-making abilities. Patients often perceive that their doctors and nurses are "too busy," which can discourage them from asking questions or expressing their concerns during consultations.⁷

Health literacy gaps

Health literacy is the ability to understand and use health information to make informed decisions and follow instructions. Unfortunately, some AFAB may not fully understand medical terms used during fibroid treatment discussions, making shared decision-making difficult.⁸

• Limited access to information: not everyone has easy access to reliable health resources, which can widen knowledge gaps
• Some AFAB might feel unsure or intimidated when speaking with healthcare professionals, leading to missed opportunities to discuss treatment options
• Misinformation: online sources and social media can spread confusing or incorrect information, making it harder for AFAB to make well-informed choices

Cultural and social barriers

Cultural beliefs can significantly influence how comfortable someone feels about sharing decisions with their doctor. In some cultures, there is a strong expectation that the doctor makes all decisions, and questioning them may be seen as disrespectful. Language differences and limited health literacy can also make it harder for AFAB to understand their options and feel confident participating. Social factors, such as education level and access to healthcare, can affect a person’s ability to engage in shared decision-making.⁹

Improving the process

Use of decision aids

Decision aids are tools that can be pamphlets or online modules that help clarify the decisions that need to be made and give information about options and outcomes. These aids allow AFAB to review information at their own pace, helping them feel more prepared for discussions.¹⁰

Encouraging open communication

Creating a supportive and judgement-free environment encourages AFAB to share their thoughts and concerns. Healthcare providers can ask open-ended questions to invite more meaningful conversations.¹¹

Follow-up and ongoing support

• Revisiting decisions over time is important, especially if symptoms change or new treatments become available
• Regular check-ins help make sure that the chosen treatment plan still matches the AFAB needs and preferences

Summary

• Shared decision-making in fibroid treatments helps AFAB feel more informed, empowered, and involved in their care
• By understanding treatment options like watchful waiting, medication, and surgery procedures, AFAB can choose what best suits their needs and goals
• Accessible education, open communication, and support from healthcare providers improve confidence and decision-making
• Addressing challenges like time constraints, health literacy gaps, and cultural barriers can lead to better outcomes and greater satisfaction
• Shared decision-making ensures AFAB stay at the centre of their care, helping them feel respected and in control of their health journey