If abnormal bleeding is your primary concern, you may undergo a procedure called a dilation and curettage (D&C). The cervix is dilated wide enough to introduce a curved blade that scrapes out the lining of the uterus.

The two main reasons for this procedure are:

• To obtain a sample of endometrial tissue for examination to rule out endometrial cancer
• To reduce the thickness of the endometrium, which may cure the excessive bleeding

Uterine fibroid embolization is designed to cut off the blood flow to fibroids and essentially "kill" them off by cutting their lifeline.

During this procedure, the radiologist will thread a catheter into an artery in your groin and guide it into the uterus. The catheter will be threaded with the aide of dye and x-rays. The radiologist will then inject small particles to block the blood supply feeding the fibroids.

Myolysis is a procedure that shrinks the fibroids, using a directed heat source. Several devices can be used that employ high frequency electrical current or lasers to cauterize (burn) the blood supply to the fibroids. The devices are usually inserted through very small incisions and guided by a laparoscope. As an alternative, cryohemolysis utilizes liquid nitrogen to freeze the fibroids.

The fibroids remain in place and are not surgically removed. Without a blood supply, the fibroids shrink. Myolysis and cryohemolysis are done on fibroids of certain sizes near the surface of the uterus.

In this procedure, you will be inside an MRI machine, which will allow your doctor to view your uterus and the rest of the abdominal area. Focused sound waves will be used to destroy the fibroids, while leaving your uterus completely intact.

Myomectomy is the surgical removal of fibroids without removing the uterus. Unlike a hysterectomy, a myomectomy can preserve fertility. There are a variety of ways a myomectomy can be performed depending on where the fibroids are located and how large they are. Examples are:

• Laparotomy (abdominal myomectomy)—This technique uses a surgical entry into the abdomen. The doctor can remove fibroids on the surface and in the body of the uterus.
• Laparoscopic myomectomy—Some fibroids are small and accessible enough to be removed through small incisions near the navel using a laparoscope (a thin telescope with a light).
• Laparoscopic myomectomy with mini-laparotomy—Larger fibroids on the surface of the uterus may be removed through a slightly larger incision using a combination of standard surgical techniques and a laparoscope.
• Laparoscopic-assisted vaginal myomectomy (LAVM)—Some fibroids can be reached through the vagina, using a similar combination of standard surgery and a laparoscope.
• Hysteroscopic myomectomy—Fibroids located on the inside of the uterus may be reached using a different but similar instrument, a hysteroscope, which is inserted through the vagina and cervix.
• Endometrial ablation —This procedure applies heat to the uterine lining, thus destroying it and preventing further abnormal bleeding. It is only effective against fibroids that are within the uterine lining.

The oldest approach to the problem of fibroids is to remove the uterus. This is a hysterectomy. There are different types of this procedure, such as:

A supracervical hysterectomy is surgery to remove the uterus only. This is not done as often because the cervix can still cause problems. However, a woman may choose this option if she wants to keep her cervix or if the removal of the cervix may make the surgery more difficult.

A total hysterectomy is done either through the abdomen or, if the uterus is small enough, through the vagina. A vaginal approach may be combined with a repair of weakened and stretched tissues in the vaginal walls.

Pregnancy is impossible after a hysterectomy.