One of the most important things to understand about fibroid treatment is that there is no single correct answer that applies to every patient. The right approach depends on a combination of factors that are specific to you — the size, number, and location of your fibroids, the severity of your symptoms, your reproductive goals, how close you are to menopause, and your own preferences about the level of intervention you are willing to consider.
What that means in practice is that two women with fibroids can receive entirely different treatment recommendations from the same provider — and both can be exactly right. A 42-year-old with a single submucosal fibroid causing heavy bleeding and no desire for future pregnancy has a very different set of optimal options than a 34-year-old with multiple intramural fibroids, moderate symptoms, and plans to conceive. Neither situation requires the same approach.
This page presents the complete range of fibroid treatment options available at Lapeer Women’s Health — from watchful observation through advanced robotic-assisted surgery — with an explanation of how each approach works, who it is most appropriate for, and what the limitations are. The goal is to give you enough information to have a meaningful conversation with Dr. Andrei about what makes sense for your situation specifically.
Before any treatment recommendation is made, Dr. Andrei conducts a thorough evaluation designed to answer several specific questions about your situation. These answers are what make a treatment plan individualized rather than generic.
Fibroid Location, Size, and Number
A pelvic ultrasound — typically including a transvaginal view for better resolution — is the most important diagnostic step in fibroid evaluation. It identifies where each fibroid sits within or around the uterus, how large each one is, and how many are present. This information directly determines which treatment approaches are anatomically feasible, which are most likely to be effective, and which can be avoided.
Symptom Severity and Quality of Life Impact
Treatment intensity should be proportional to symptom burden. A woman with small, incidentally discovered fibroids and no meaningful symptoms is not a surgical candidate. A woman whose heavy bleeding has produced significant anemia, whose daily activities are regularly disrupted, and who has not found relief with medical management is a very different situation. Accurately characterizing the impact of symptoms on daily function is an essential part of calibrating the right treatment level.
Reproductive Goals
Whether a patient wishes to preserve fertility or the option of future pregnancy is one of the most important variables in fibroid treatment planning. Uterus-preserving approaches — including myomectomy and most medical management options — are prioritized for women who want to maintain reproductive potential. For women who have completed childbearing, the full range of options including hysterectomy can be considered without that constraint.
Proximity to Menopause
Fibroids are estrogen-dependent and typically shrink after menopause as estrogen levels decline. For women who are within a few years of menopause and whose symptoms are manageable, watchful waiting or bridging medical management may be entirely appropriate — allowing natural hormonal changes to resolve the problem without surgical intervention. For women who are a decade or more from menopause with significant symptoms, waiting is not a neutral choice.
Prior Treatment History
What has been tried before — and how well it worked — shapes what comes next. A patient who has already had a hormonal IUD placed with inadequate symptom control has different needs than one who has not yet tried any medical management. A patient who has previously undergone myomectomy and has recurrent fibroids is in a different situation from a first-time surgical candidate. Prior treatment history is always part of the evaluation.
The following covers every category of fibroid treatment available at Lapeer Women’s Health, presented in order from least to most invasive. Not every option is appropriate for every patient — but every recommendation Dr. Andrei makes comes after considering the full range.
Watchful Observation
For women with small or asymptomatic fibroids, or those approaching menopause when natural regression is likely, periodic monitoring without active treatment is often the most appropriate initial approach. This is not a passive choice — it is a deliberate clinical decision that involves scheduled ultrasound monitoring to track fibroid behavior over time, baseline lab work to assess iron and blood count, and a clear plan for reassessment if symptoms change. Many fibroid patients are appropriately observed for months or years before any active intervention is warranted.
Tranexamic Acid (Lysteda)
Tranexamic acid is a non-hormonal medication taken during the heavy days of the menstrual cycle that works by stabilizing blood clotting at the level of the uterine lining. It does not affect fibroid size or growth, but it can meaningfully reduce bleeding volume during each cycle. It is a useful option for women who want to reduce the impact of heavy periods without hormonal therapy and who are not yet ready for a surgical approach. It has no contraceptive effect and does not interfere with fertility.
Hormonal IUD (Mirena / Liletta)
A hormonal IUD releases a small amount of progestin locally within the uterine cavity, thinning the endometrial lining and significantly reducing menstrual flow over time. It is highly effective for bleeding control in women whose fibroids do not significantly distort the uterine cavity. For women with submucosal or large intramural fibroids that alter the shape of the cavity, IUD placement may be technically difficult or less effective. Ultrasound evaluation of the uterine cavity is important before recommending this approach.
Combined Oral Contraceptives and Progestin Therapy
Hormonal contraceptives can reduce menstrual flow and improve cycle regularity in women with fibroids, though their effect on fibroid size is modest. They are often used as a first-line medical option for women with mild to moderate symptoms who also desire contraception, or as a bridge while awaiting a planned procedure. Progestin-only therapy has a similar role and may be preferred in women for whom estrogen is contraindicated.
GnRH Agonists (Lupron)
GnRH agonists work by temporarily suppressing estrogen production, creating a state of temporary menopause that causes fibroids to shrink and menstrual bleeding to stop. They are highly effective at reducing fibroid volume and improving anemia before surgery, making them a common preoperative tool. Because they induce menopausal symptoms and cause bone density loss over time, they are typically used for a defined period of three to six months rather than as a long-term solution. Fibroid regrowth typically occurs after the medication is stopped.
GnRH Antagonists (Oriahnn / Myfembree)
Newer GnRH antagonist medications represent an advance over traditional GnRH agonists in that they work more quickly, do not cause an initial flare in estrogen before suppressing it, and are formulated with low-dose hormonal add-back therapy to minimize menopausal side effects. They are FDA-approved for the management of heavy menstrual bleeding from fibroids and represent a meaningful option for women who are not surgical candidates, who are approaching menopause, or who need longer-term medical management than GnRH agonists can safely provide.
Endometrial Ablation
Endometrial ablation destroys the uterine lining to reduce or eliminate menstrual bleeding. It is a minimally invasive in-office or outpatient procedure with rapid recovery. However, it has important limitations in the context of fibroids: it is not appropriate for women who wish to preserve fertility, it is most effective when fibroids are small and do not significantly distort the uterine cavity, and it does not address fibroid-related pressure symptoms. For carefully selected patients — typically those with small fibroids and primarily bleeding symptoms who have completed childbearing — it can be an effective and efficient option.
Hysteroscopic Myomectomy
Hysteroscopic myomectomy removes submucosal fibroids that protrude into the uterine cavity using a thin instrument passed through the cervix without any external incisions. It is the most targeted and minimally invasive surgical option for submucosal fibroids specifically — the fibroid type most directly responsible for heavy menstrual bleeding. Recovery is typically rapid, fertility is preserved, and many women experience a dramatic improvement in bleeding immediately following the procedure. It is not appropriate for fibroids that are located primarily within the uterine wall or on the outer surface of the uterus.
Laparoscopic Myomectomy
Laparoscopic myomectomy removes intramural and subserosal fibroids through small abdominal incisions using a camera and specialized instruments. It preserves the uterus, allows for full fertility potential after recovery, and offers the advantages of minimally invasive surgery — including smaller incisions, less postoperative pain, and faster recovery — compared to traditional open myomectomy. It is appropriate for women with a moderate number of fibroids in accessible locations and is a well-established approach for women who wish to keep their uterus.
Robotic-Assisted Myomectomy
Robotic-assisted myomectomy uses the da Vinci surgical system to give the surgeon enhanced visualization, precision, and range of motion compared to standard laparoscopy. It is particularly well-suited for complex cases involving multiple fibroids, large fibroids, or fibroids in anatomically challenging locations that would be technically difficult to remove using standard laparoscopic instruments. Dr. Andrei is trained and credentialed in robotic-assisted gynecologic surgery and performs robotic myomectomy at her affiliated hospital facilities. Recovery is similar to laparoscopic myomectomy — typically faster than open surgery.
Laparoscopic and Robotic-Assisted Hysterectomy
Hysterectomy removes the uterus and is the only treatment that permanently eliminates both fibroids and the possibility of their recurrence. For women who have completed childbearing, who have a significant fibroid burden, or for whom other approaches have not provided adequate relief, it is often the most effective and durable solution. Dr. Andrei performs minimally invasive hysterectomy — both laparoscopic and robotic-assisted — with a strong emphasis on reducing recovery time, minimizing blood loss, and avoiding the longer recovery associated with open abdominal surgery. The decision to pursue hysterectomy is made collaboratively and never as a default.
The right treatment is the one that is matched to your specific anatomy, your symptoms, your goals, and your stage of life — presented clearly, without pressure, after a proper evaluation.
For patients whose fibroids require surgical intervention, Dr. Andrei’s training in minimally invasive and robotic-assisted techniques translates into a broader range of surgical options, shorter recovery times, and a surgeon with direct experience in the approaches most appropriate for fibroid disease.
Robotic & Laparoscopic Expertise
Dr. Andrei performs robotic-assisted and laparoscopic myomectomy and hysterectomy — including complex cases involving multiple or large fibroids. Minimally invasive approaches are prioritized whenever they are safe and technically feasible, with the goal of reducing recovery time and surgical impact for every patient.
Hospital Affiliations
Surgical procedures are performed at McLaren Lapeer Hospital, McLaren Flint Hospital, and Henry Ford Rochester Hospital — providing access to facilities equipped for the full range of minimally invasive gynecologic surgery for patients from both the Lapeer and Rochester Hills service areas.
No Referral Required
You do not need a referral from another provider to schedule a fibroid evaluation or surgical consultation with Dr. Andrei. Contact either our Lapeer or Rochester Hills office directly to schedule. If you have existing imaging or records, bringing them to your appointment will help — but they are not required to get started.
Many women arrive at Lapeer Women’s Health having been told that their only surgical option is hysterectomy — or that their fibroids are not yet large enough to treat — or that they should simply wait. Sometimes those recommendations are entirely appropriate. But sometimes they reflect a limited view of what is available.
The goal of a fibroid evaluation at Lapeer Women’s Health is not to recommend a particular treatment. It is to make sure you have a complete and accurate picture of every option that is appropriate for your situation — so that whatever decision you make, it is an informed one.
Dr. Ramona D. Andrei and the team at Lapeer Women’s Health are here to provide that evaluation — at both our Lapeer and Rochester Hills offices, without a referral, and without pressure toward any particular outcome.
Fibroid Treatment Options
A thorough evaluation is the starting point for every treatment decision. Our team at Lapeer Women’s Health will make sure you have the complete picture — at both our Lapeer and Rochester Hills offices, without a referral required.
Schedule a Gynecologic VisitThe information on this page is intended for educational purposes only and does not constitute medical advice. Individual symptoms, diagnoses, and treatment options vary significantly. Reading this content does not establish a physician-patient relationship with Dr. Ramona D. Andrei or Lapeer Women’s Health. If you are experiencing a medical emergency, call 911 or go to the nearest emergency room immediately. Please consult a qualified healthcare provider for advice specific to your situation. Content reviewed by Dr. Ramona D. Andrei, MD PhD FACOG.
Gynecologic care for women of every age
Lapeer Women’s Health — Rochester Hills
2710 S Rochester Rd, Suite 2
Rochester Hills, MI 48307
Serving patients in Lapeer, Rochester Hills, and surrounding communities throughout Southeast Michigan.