Fibroids are non-cancerous tumours which grow in or around the womb and can make periods heavy and painful. They are fairly common with around 40% of women developing them at some stage in their life. However, most women have no symptoms and so they will go undetected.
The exact cause of fibroids is unknown, however they are linked to oestrogen the reproductive hormone produced by the ovaries. They usually occur in women between the ages of 30 & 50 years old and tend to increase in size when oestrogen levels are at their highest, such as during pregnancy, and are also known to shrink after the menopause when oestrogen levels are low.
Depending on the size of the fibroid(s) and where they are within the womb the following symptoms may be experienced:-
- Heavy periods which can cause anaemia
- Pain in the abdomen
- Swelling in the pelvic area
- A need to empty the bladder more often than normal, or feel an urgent need to pass urine if a fibroid is pressing on the bladder
- Constipation if a fibroid is pressing on the bowel
A pelvic examination & an ultrasound scan will usually be performed if fibroids are suspected. If the periods are heavy a blood test to check for anaemia may also be part of the initial investigations.
A hysteroscopy may be recommended to examine the inside of the womb. This is a relatively quick procedure which can be carried out under local or gerneral anaesthetic and involves inserting a small telescope (hysteroscope) into the vagina. In some cases a small tissue sample called a biopsy may be removed during a hysteroscopy which will then be sent for analysis.
Whilst there isn’t a medication that can cure fibroids, there are treatments which can help reduce symptoms.
- Tranexamic acid helps by reducing the heavy bleeding that fibroids can cause
- A Mirena device works by thinning the lining of the womb and can therefore be very effective in treating heavy periods.
- Treatment with medicines called gonadotrophin-releasing hormone analogues (GnRH analogues) can lower oestrogen levels, which usually shrinks fibroids.
Surgery may be considered if the fibroid symptoms are particularly severe and medication has been ineffective. Treatment with GnRH analogues can be used to shrink the fibroids prior to surgery.
There are several different procedures used to treat fibroids. The most frequently performed procedures are:-
Hysterectomy is a surgical procedure to remove the womb. It is the most effective way of preventing fibroids from coming back & may be recommended if you have large fibroids or heavy bleeding and you do not wish to have any more children.
There are a number of different ways a hysterectomy can be carried out, including through the abdomen, vagina or through a number of small incisions in your abdomen (laparoscopic).
A myomectomy is a surgical procedure to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy, particularly for women who still wish to have children.
However, a myomectomy is not suitable for every type of fibroid & suitability for this procedure will be assessed by taking into account the size, number and position of the fibroids.
Depending on the size and position of the fibroids, a myomectomy may involve making either a number of small cuts in the tummy (keyhole surgery), or a single larger incision (open surgery). The surgery will be carried out under general anaesthetic and usually involves a stay in hospital for a few days after the procedure.
It s generally an effective treatment however there is a possibility that fibroids will grow back and further surgery will be needed.