A fibroid is a benign growth made of fibrous tissue and muscle that develops in and around a woman’s womb. Fibroids can vary greatly in number, size and the symptoms that they cause.
A high proportion of women will have fibroids but only a proportion (around one in three) will suffer from symptoms that impact their daily lives.
The cause of fibroids is unknown but is thought to be linked to the hormone oestrogen, produced primarily by the ovaries.
Fibroids tend to develop and grow during a woman’s reproductive years. After the menopause, fibroids often shrink, and symptoms will usually ease or disappear completely.
What are the symptoms of fibroids?
Fibroids are categorised based on their location within the womb.
A woman may have more than one type of fibroid at the same time. The symptoms and treatment depend on where the fibroids appear and grow.
There are three main categories of fibroids:
- Intramural fibroids – this is the most common form of fibroid. They develop within the wall of the womb and can cause the womb to change shape.
- Submucosal fibroids – these fibroids occur under the inner lining of the womb.
- Subserosal fibroids – these fibroids develop on the outer wall of the womb.
Symptoms of fibroids can include:
- Heavy periods (menorrhagia)
- Blood clots in your period
- Painful periods (dysmenorrhea)
- Abdominal pain
- Abdominal bloating and fullness
- Lower back pain
- Pelvic pain
- Longer menstruation
- Pain during sexual intercourse (dyspareunia)
- Inter-menstrual bleeding
- Increased frequency of urinating
- Depression or low mood
As most fibroids do not cause symptoms, they may be discovered by chance.
What treatments are available?
Many women will not need or seek treatment for fibroids if they are not causing any issues.
For women who do seek treatment, the severity of symptoms, personal preference and recommendations of health professionals will impact the management and treatment combination.
If fibroids are confirmed by ultrasound scan, you may be prescribed medications to alleviate symptoms.
These can include:
- Hormones that aid the regulation of periods. Normally, the hormonal treatments used include the contraceptive pill and the hormonal coil.
- Non-Steroidal anti-inflammatory medications may be prescribed to decrease inflammation, bleeding and act as pain killers.
- Tranexamic acid may be prescribed to decrease the volume of bleeding.
Depending on the severity of symptoms and response to initial treatment a referral to a gynaecologist can be made.
Seeing a specialist…
A gynaecologist is a specialist doctor who will further investigate symptoms experienced and can advise specialist treatment going forwards.
Firstly, your gynaecologist will discuss the symptoms and treatment you have received so far. Your doctor may wish to investigate further by conducting imaging tests to visualise the fibroids. Imagining is likely to start with an ultrasound scan, they may suggest further imaging possibly including an MRI scan.
Medications that can be prescribed by a gynaecologist include drugs that aim to shrink fibroids. A type medication that can be used are ‘gonadotrophin releasing hormone analogues’. This medication acts to reduce the production of oestrogen and in turn reduce the size of fibroids. These tend to be used on a short term basis. There are many side effects associated with these medications such as menopause like symptoms; hot flushes, increased sweating and vaginal dryness. The appropriateness, benefits and side effects of medications will be fully discussed before commencement with your specialist.
To aid diagnosis your gynaecologist may suggest performing a hysteroscopy. A hysteroscopy allows examination of the inside of the womb using a hysteroscope. A hysteroscope is a thin narrow tube with a camera and light at the end. The hysteroscope sends digital images back to a screen that is assessed by your doctor. Usually, the procedure is carried out as a day-case, meaning that you will only remain in hospital for the day but most likely will not be able to drive after the procedure. Most women have local anaesthetic for the procedure, however, if preferred a request for a general anaesthetic can be made. For the procedure the hysteroscope is passed through your vagina and cervix into the womb. The procedure itself can last between five to thirty minutes depending on findings.
There are many surgical options for the treatment of fibroids.
Surgery may be considered if your symptoms are severe and have a large impact on quality of life and where medication has been ineffective.
Each procedure will be discussed at length, with recommendation made by your surgeon as to which procedure to choose. Your wishes, the recommendation, risks and benefits will be outlined before a decision is made.
Some of the surgical options include:
Myomectomy – Myomectomy is a surgical procedure to remove the fibroids from the wall of your womb. Depending on the size and location of your fibroid a myomectomy may not be possible.
Hysteroscopic treatments – Using a hysteroscope, as discussed above, with added surgical instruments under general anaesthetic a hysteroscope can be used to remove fibroids without making an incision.
Hysterectomy – A hysterectomy is large a surgical procedure that removes the womb. It may be recommended if your symptoms are severe and you do not wish to have any more children. The full procedure, risks, benefits and side effects will be discussed with your surgeon before making a decision.
Uterine Artery Embolisation (UAE) – UAE involves visualising and blocking the blood vessels that supply fibroids. A radiologist (specialist doctor who interprets scans) will carry out the procedure. The procedure is usually performed under local anaesthetic, it involves injecting a radio-opaque solution through a small tube into the blood vessel in the leg
Endometrial Ablation – This procedure involves removing the lining of the womb to try to treat small fibroids in the lining of the womb. This procedure can also be used to reduce heavy bleeding in women without fibroids.
This article was produced by Wellbeing of Women Contributor Dr Alice Bolton