Excessive bleeding or pain
* Drugs or devices: birth-control pills; drugs that reduce female hormones; a blood-clotting agent called tranexamic acid; an intrauterine device – all have potentially serious side-effects
* Transcervical resection of the endometrium (TCRE), where only the lining is removed, works less than half the time (Br J Obstet Gynaecol, 1997; 104: 601-7)
* Endometrial ablation, where the womb lining is removed by laser, also has only a 50 per cent success rate (Br J Obstet Gynaecol, 1997; 104: 601-7), and can cause perforation of the uterus, ovarian and fallopian abscesses, and swelling of the lungs and brain (Br J Obstet Gynaecol, 1994; 101: 470-3).
* Keyhole surgery or hormonal drug therapy: symptoms often return (Lancet, 1992; 31 October), and can lead to artificial menopause, plus irreversible masculinisation (such as increased body hair and a deeper voice).
* Keyhole surgery is complicated and fails in 20 per cent of cases
* Bilateral uterine arterial embolisation, which involves cutting off the blood supply to the fibroid under local anaesthesia.
* A ring-shaped pessary is inserted into the vagina to support the womb.