Treatment	Description	Advantages	Disadvantages
GnRH therapy	Medical therapy to suppress estrogen production and shrink uterine fibroids	Shrinkage of uterine fibroids may allow removal with less blood loss, or removal by laparoscope or hysteroscope	Induces premature menopause-like symptoms; associated with premature bone mineral loss3; rapid regrowth of fibroids when therapy is discontinued
Abdominal myomectomy	Open abdominal surgery to resect symptomatic uterine fibroids	Allows uterine conservation, usually in women who desire fertility	Postoperative recovery period of six weeks; general anesthesia required; transfusion rate of 3 to 20 percent3,4; adhesions may cause problems5; recurrence rate of 10 to 27 percent5,6
Laparoscopic myomectomy	Laparoscopic removal of uterine fibroids	Much shorter recovery period than with abdominal myomectomy; best suited for pedunculated and subserosal fibroids or smaller intramural fibroids7,8	Large, multiple or deep uterine fibroids are problematic; procedure-related adhesion formation may be significant; general anesthesia required7,8
Laparoscopic myolysis	Laser probe used to heat coagulate uterine fibroids	Treated uterine fibroids may shrink up to 40 percent by 6-month follow-up7	“Dense and fibrous adhesions” noted at second-look laparoscopy7*
Hysteroscopic resection and/or endometrial ablation	Hysteroscope is inserted into endometrial cavity, guiding the resection of submucous fibroids; endometrium is scraped and burned to create amenorrhea	Outpatient procedure for bleeding patients; short recovery period	Mortality from fluid overload and infection reported but rare; a 32 percent failure rate reported at 2 years post-ablation9 with a high rate (52 percent) of adenomyosis, possibly caused by ablation10; destroys fertility potential; a 13 percent rate of synechiae formation following hysteroscopic resection without ablation10
Uterine fibroid embolization	An arteriographic catheter is passed through the femoral artery into the uterine arteries; tiny particles are injected that block blood flow inside the fibroids and cause infarct; other uterine structures are spared; uterine fibroids shrink, relieving symptoms	Abnormal bleeding and “bulk symptoms” improved in about 80 to 90 percent of patients11,12; surgical incision and general anesthesia not required; no blood loss; all fibroids treated at once13; no recurrences noted14 †; return to normal activities in 7 to 10 days	As expensive as hysterectomy; effect on fertility uncertain; delayed infection may occur in a small percentage of patients; availability to all patients may be limited‡; long-term follow-up data unavailable; some HMOs may not cover procedure cost