Understanding fibroids

What are fibroids?

Fibroids are benign (non-cancerous) tumours of the uterus (womb). They are also known as myomas. They are growths of smooth muscle and fibrous tissue.

The size of fibroids can vary from as small as a pea to that of a melon. At least one in five women develops a fibroid at some stage of their life, usually between the ages of 30-50 years.

What are the types of fibroids?

Fibroids are named according to where they are found in the uterus. There are four types :-

Intramural fibroids are found in the wall of the uterus and are the most common type of fibroids found in women.

Subserosal fibroids are found growing outside the wall of the uterus and can become very large. They can also grow on stalks (called pedunculated fibroids).

Submucosal fibroids are found in the muscle beneath the inner lining of the wall of the uterus.

Cervical fibroids are found in the wall of the cervix (neck of the uterus).

What are the symptoms of fibroids?

Many women with fibroids show no symptoms and are unaware that they have fibroids. However, if symptoms develop, you may experience one or more of the following:

· Heavy or painful periods in some cases this can lead to anaemia (low blood haemoglobin levels)

· Discomfort, or swelling, in your lower abdomen, particularly if your fibroids are large,

· Backache, or pains in your legs,

· Urinating frequently, usually if your fibroids are pressing on your bladder,

· Constipation which can be caused by the fibroids pressing on your rectum and

· Pain or discomfort during sex this is usually if your fibroids are growing near your vagina (or lower part of your cervix).

· Infertility

In some cases, you may have repeated miscarriages or infertility problems. Very rarely, fibroids can cause problems during pregnancy and labour.

How are fibroids diagnosed?

As fibroids rarely have symptoms, they are often found during a routine gynaecological (vaginal) examination.

If fibroids are suspected, an ultrasound scan can be used to confirm a diagnosis. Less commonly, a MRI Scan may be used if there are multiple fibroids, the uterus is very large or some other problem is being suspected.

What causes fibroids?

Fibroids are smooth muscle growths that occur between the ages of 16 and 50. During this time, the levels of female hormones (estrogen and progesterone) are at their highest. Fibroids tend to swell when estrogen levels are particularly high, for example, during pregnancy. They are also known to shrink when oestrogen levels are particularly low, such as after a woman has experienced the menopause. However, the exact cause of fibroids is still unknown.

How can fibroids affect infertility?

Infertility is more common in women with large fibroids as they can interfere with the fertilised egg attaching to the lining of your womb. If you have a submucosal type of fibroid (growing outside the wall of your womb), this could also affect the shape of your womb, making it harder for you to conceive (get pregnant).

How are fibroids treated?

If you do not have any symptoms from your fibroids, treatment may not be necessary and a regular follow up is advised. After the menopause, fibroids often shrink, and your symptoms will either disappear or ease slightly.

Treatment with medications

Most medicines do make the fibroids disappear, but can sometimes reduce the size and help with relieving certain symptoms. You doctor might give you medications which reduce the amount of bleeding and pain you have during your periods. If your haemoglobin levels are low, iron tablets would be prescribed.

Injections which contain a hormone medicine called gonadotropin releasing hormone agonist (GnRHa) may be given to reduce the size of the fibroid. Unfortunately, its effect is temporary and you cannot use it for a long duration.

Contraceptive pills and the Mirena coil can be used to reduce symptoms related to the fibroids, but cannot be used if you are trying for a pregnancy.

Surgical procedures

Surgical procedures for treating fibroids are usually considered if medications are ineffective. There are a number of different surgical procedures that can be carried out to treat fibroids. Common surgical procedures that are used to treat fibroids include:

Hysterectomy involves surgery to remove the uterus.

Myomectomy involves surgery to remove the fibroids from the uterus. A myomectomy is an alternative to having a hysterectomy, particularly for women still wishing to have children.

Both hysterectomy and myomectomy are performed using laparoscopic surgery at this centre.

Are there any long term risks?

Very rarely, in around one in 1,000 cases, a cancer called leiomyosarcoma may begin to develop in the fibroids.