What are Fibroids?

Overview  |  Symptoms  |  Complications  |  Causes  |  Diagnosis  |  Treatment

Fibroids sometimes referred to as myomas, leiomyomas, or fibromyomas, are benign growths that develop in or around your womb (uterus). The growths – made up of fibrous tissue and muscle – vary in size with some growing as large as a football.  It is extremely rare for fibroids to spread to other parts of your body, although they can grow or shrink in size and sometimes disappear with time.

There are different types of fibroids. They have been named according to where they grow in and around the womb.

  • Intramural fibroids: These are the most common type of fibroids. They develop within the muscular tissue wall of the womb.
  • Submucosal fibroids: These develop in the inner wall of the womb and  grow into the middle. 
  • Subserosal fibroids: These fibroids tend to be larger than others and they grow outside the womb and into the pelvic area. 
  • Pedunculated fibroids: These fibroids grow from the wall outside of the womb and are only attached by a narrow stalk. 

Symptoms of Fibroids

The majority of women do not actually suffer from any symptoms associated with fibroids and, in a lot of cases, are completely unaware that they have them. Symptoms include:

heavy or painful periods: Bleeding tends to be heavier than normal which could result in anaemia (low levels of iron). Some women also find that their periods are painful.

abdominal discomfort: If your fibroids are particularly large, there may be some swelling or discomfort in your abdominal (tummy) area. Pain may also be experienced in the lower back and legs.

pain during sex: When fibroids grow near the cervix (neck of the womb) or vagina, sexual intercourse can sometimes cause pain or discomfort. Medically referred to as dyspareunia.

bladder and bowel problems: Sometimes, a fibroid can press on the bladder and if that occurs can lead to an increased need to pass urine. When a fibroid is pressed on the bowels, which is quite rare, it can result in constipation.

Complications

Although fibroids tend not to cause any problems, there are some known complications associated with them, especially in relation to pregnancy and infertility.

Pregnancy: For most women, fibroids do not cause any problems during pregnancy and they have a normal pregnancy and delivery, although in some cases there are complications including the risk of premature birth, breech birth, need for caesarean section due to a blocked vagina and rarely, miscarriage.

Infertility: This is quite rare but, if fibroids are particularity large, there is a chance that they might cause a blockage in the fallopian tube.

Causes of Fibroids

While fibroids are common – 1 in 4 women will develop fibroids at some point in their life – it is not known what causes them. However, they are sensitive to estrogen (oestrogen) and typically grow when high levels are present and shrink when levels are low. You are more likely to develop fibroids if you:

  • have not had children
  • are between the ages of 30 – 50
  • are overweight
  • are of African-Caribbean descent – three times more likely than Caucasian women

How are fibroids diagnosed?

Most cases of fibroids go undiagnosed due to absent symptoms. If you think you have fibroids your doctor will do a pelvic examination. It is likely that your doctor will refer you to a specialist who will carry out the following tests.

Ultrasound scan: This is one of the main tests that doctors use to diagnose fibroids. It is a painless procedure and is carried out by using a scan to produce an image which will show whether you have fibroids or not.  There are two types of ultrasound scans – a transvaginal and an abdominal. During a transvaginal ultrasound, the probe is inserted into the vagina and with the abdominal scan, it is moved over the stomach.

Laparoscopy: During a laparoscopic operation, a small tube with a camera is passed into your abdomen via a small incision. The camera is used to examine and look for fibroids, also how they have affected their surroundings.

Hysteroscopy: This procedure, carried out under local or general anaesthetic, consists of a small camera inserted into the vagina. The camera is used to examine the inside of the womb for fibroids.

Biopsy: In a small number of cases, a biopsy may be carried out. This occurs during a laparoscopy or hysteroscopy and involves a small sample of tissue being removed for further testing.

Treating Fibroids

If you have been diagnosed with fibroids but do not suffer from any symptoms, then it is likely your doctor will take an observational approach. If your symptoms get worse and interfere with your life then your doctor can find you a solution. There are various treatments available and these include:

Medication for Symptoms

Non-steroidal anti-inflammatory medication (NSAIDs)

NSAIDs, like ibuprofen and mefenamic acid, are used to ease symptoms of fibroids including heavy periods.  Doctors recommend that you take NSAIDs a few days before your period begins and until bleeding stops, or is heavily reduced. This treatment works by reducing levels of prostaglandin, a hormone produced in the body associated with heavy periods.  The NSAIDS will also reduce any pain during menstruation.

Contraceptive pill

The pill prevents pregnancy by stopping the egg from being released. Doctors suggest the contraceptive pill as some help reduce pain during periods.

Levonorgestrel-releasing intrauterine system (IUS)

The IUS is a form of contraception that is inserted into your womb. It releases levonorgestrel, a progestogen hormone, which slows down the growth of womb lining and makes it thinner, leading to a reduction in bleeding.

Tranexamic acid

Tranexamic acid is offered if the IUS is unsuitable. These tablets are taken 3-4 times daily during menstruation.

Medication to Shrink Fibroids

Some women are offered medication to shrink their fibroids if the treatment outlined above is ineffective. Gonadotrophin-releasing hormones (GnRH) are administered by injection and result in low levels of estrogen in the body, which cause fibroids to decrease in size. This medication can also reduce heavy bleeding. Due to the side effects of GnRH – menopausal symptoms and risk of osteoporosis –  it can only be used for a maximum of six months.

Operative Treatments

Surgery is offered to patients when other methods of treatment have proved ineffective.

Hysterectomy

A Hysterectomy, a surgery to remove the womb, is the main way to treat fibroids that do not respond to other, less invasive methods.  It is recommended if symptoms are particularly bad and if you have finished having children.

Myomectomy

This is an alternative method to a hysterectomy as it does not interfere with fertility. It is a procedure that is used to remove fibroids that grow from the wall of the womb.