Fibroids are common, non-cancerous growths that develop in or around the womb (uterus). They are made from muscle and fibrous tissue and can vary considerably in size, number and location.
Some women have fibroids without experiencing any symptoms and may only discover them during a routine examination or scan. For others, fibroids can cause heavy or painful periods, pelvic pressure, abdominal discomfort, bladder or bowel symptoms and, in some circumstances, difficulties with fertility.
At Gynae Solution, we understand that symptoms such as heavy periods, pelvic pain or pressure can have a significant impact on your everyday life. Our aim is to establish whether fibroids are responsible for your symptoms, assess their size and location and discuss the treatment options most appropriate for you.
What Are Fibroids?
Fibroids, also known as uterine fibroids or leiomyomas, are benign growths that develop from the muscular wall of the womb.
They can develop in different areas of the womb and their location can have a significant effect on the symptoms they cause.
The main types include:
- Intramural fibroids, develop within the muscular wall of the womb.
- Submucosal fibroids, grow towards the inside of the womb and can affect the uterine cavity.
- Subserosal fibroids, develop on the outer surface of the womb and may grow towards the pelvis.
- Pedunculated fibroids, grow from the womb on a narrow stalk.
A woman may have a single fibroid or several fibroids, and they can range from very small growths to much larger fibroids that change the shape or size of the womb.
The location, number and size of your fibroids can all influence your symptoms and the treatment options available to you.
Fibroids are not cancer, and having fibroids does not mean that you have an increased risk of developing womb cancer.
Symptoms of Fibroids
Fibroids do not always cause symptoms. However, when they do, they can cause a range of problems depending on their size and position.
Common symptoms include:
- Heavy or prolonged periods
- Painful periods
- Pelvic or abdominal pain
- A feeling of pressure, heaviness or fullness in the lower abdomen
- Abdominal swelling or an enlarged-looking tummy
- Lower back pain
- Pain or discomfort during sexual intercourse
- Needing to urinate more frequently
- A sudden or urgent need to urinate
- Difficulty emptying the bladder
- Constipation or difficulty opening your bowels
- Bloating or abdominal discomfort
- Tiredness caused by anaemia from heavy menstrual bleeding
- Difficulty becoming pregnant in some circumstances
Fibroids can affect people very differently. A relatively small fibroid can cause significant symptoms if it is positioned within the uterine cavity, while a larger fibroid in another location may cause relatively few problems.
Heavy bleeding can also lead to iron-deficiency anaemia, which may cause tiredness, weakness and shortness of breath.
If your periods have become significantly heavier, more painful or longer than usual, or your symptoms are interfering with work, relationships or everyday activities, it is worth seeking medical advice.
Causes and Risk Factors
The exact reason why fibroids develop is not fully understood.
They are thought to be influenced by hormones, particularly oestrogen and progesterone, which help regulate the menstrual cycle and reproductive system.
Fibroids are most commonly diagnosed during the reproductive years and often become smaller after the menopause as hormone levels change.
Factors associated with an increased likelihood of developing fibroids include:
- Having a close family member with fibroids
- Increasing age during the reproductive years
- Being overweight or obese
- Having high blood pressure or diabetes
- Never having had a full-term pregnancy
- Certain ethnic backgrounds, with fibroids being more common among Black women
Having one or more risk factors does not mean that you will develop fibroids, and fibroids can occur in women without any obvious risk factors.
How Are Fibroids Diagnosed?
If you are experiencing symptoms that could be caused by fibroids, your GP or specialist will begin by discussing your symptoms and medical history.
You may be asked about:
- Your menstrual cycle
- How heavy or painful your periods are
- How long your periods last
- Any bleeding between periods
- Pelvic or abdominal pain
- Bladder or bowel symptoms
- Pain during sex
- Previous pregnancies
- Your fertility plans
- Any previous gynaecological conditions or surgery
- Any family history of fibroids
A physical examination may also be recommended.
Ultrasound Scan
An ultrasound scan is usually the main investigation used to diagnose fibroids.
An ultrasound can help identify:
- Whether fibroids are present
- How many fibroids you have
- Their size
- Their position
- Whether they are affecting the shape of the womb
A transvaginal ultrasound may be recommended because it can provide detailed images of the womb and surrounding pelvic organs. An abdominal ultrasound may also be used.
Ultrasound can also help identify other possible causes of your symptoms.
MRI Scan
An MRI scan may be recommended where more detailed information about the fibroids is required.
This can be particularly useful when there are multiple or larger fibroids, when the exact location of a fibroid needs to be established or when a procedure such as uterine artery embolisation or surgery is being considered.
NICE recommends ultrasound assessment before myomectomy or uterine artery embolisation, with MRI considered where additional information about the number, position, size or vascularity of the fibroids is needed.
Hysteroscopy
If a fibroid is suspected to be growing into the cavity of the womb, a hysteroscopy may be recommended.
This involves passing a small camera through the vagina and cervix so that the inside of the womb can be examined directly.
In some cases, treatment of a fibroid within the uterine cavity can be carried out during the same procedure.
Treatment Options for Fibroids
Not everyone with fibroids needs treatment.
If your fibroids are not causing symptoms, or your symptoms are mild, your specialist may recommend monitoring rather than immediate treatment.
If fibroids are causing significant symptoms, there are several treatment options available.
The most appropriate treatment will depend on:
- The size of your fibroids
- Their number
- Their location
- Your symptoms
- Your age
- Your general health
- Whether you want to become pregnant
- Whether you want to retain your womb
- Previous treatments you have tried
Treatment decisions should therefore be individualised rather than based on the size of the fibroid alone.
Medication
Medication may be recommended to manage symptoms, particularly heavy or painful periods.
Depending on your circumstances, treatment may include medicines such as:
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Tranexamic acid to reduce heavy menstrual bleeding
- Hormonal treatments
- Hormonal contraception
- Other specialist medication designed to alter hormone levels
Medication can help control symptoms but does not necessarily remove the fibroids themselves.
Uterine Artery Embolisation
Uterine artery embolisation (UAE) is a minimally invasive procedure that reduces the blood supply to the fibroids.
By reducing their blood supply, the fibroids can shrink and symptoms may improve.
UAE can be an alternative to surgery for some women and may be particularly attractive to those who want to avoid major surgery.
However, it is not suitable for everyone, particularly where future fertility is an important consideration. Your specialist will discuss whether it is appropriate for your circumstances.
Myomectomy
A myomectomy is an operation to remove fibroids while leaving the womb in place.
This may be an important option for women who wish to retain their uterus or who are considering future pregnancy.
The type of myomectomy performed depends largely on where the fibroid is located.
It may be possible to remove some fibroids through the vagina and cervix using hysteroscopic surgery, while other fibroids may require laparoscopic or open abdominal surgery.
The potential benefits and risks will depend on the number, size and location of the fibroids.
Hysterectomy
A hysterectomy involves removing the womb.
It is a permanent treatment for fibroids because the fibroids cannot return once the womb has been removed. However, it also means that you will no longer be able to become pregnant.
For this reason, hysterectomy is generally considered carefully and is not usually the first treatment offered simply for heavy menstrual bleeding. It may be considered when other treatment options have not worked, are unsuitable or have been declined, particularly when a woman does not wish to retain her fertility.
The decision to have a hysterectomy should involve a detailed discussion about the benefits, risks and alternatives.
Fibroids and Fertility
For many women, having fibroids does not affect their ability to become pregnant.
However, fibroids in certain locations can sometimes make conception more difficult or may be associated with pregnancy complications.
Fibroids that distort the cavity of the womb can be particularly relevant when considering fertility.
If you are trying to conceive, or are planning a future pregnancy, this should be discussed with your specialist before deciding on treatment.
Some procedures can affect fertility or prevent future pregnancy, while others are specifically designed to preserve the womb. Your treatment plan should therefore take your future fertility wishes into account.
Recovery and Aftercare
Your recovery will depend on the treatment you receive.
If you are being monitored without treatment, your specialist may recommend follow-up appointments or scans depending on your symptoms and circumstances.
Following a procedure or surgery, you will receive advice about managing discomfort, caring for any wounds and gradually returning to your usual activities.
Recovery following minimally invasive procedures is generally different from recovery following open surgery, and the length of recovery will depend on the extent of the procedure.
If you have experienced heavy menstrual bleeding, your doctor may also recommend monitoring or treating anaemia and iron deficiency.
It is important to contact your healthcare team if symptoms return, become worse or you develop new symptoms following treatment.
Risks and Benefits of Treatment
Every treatment for fibroids has potential benefits and risks.
The potential benefits may include:
- Reducing heavy menstrual bleeding
- Improving period pain
- Relieving pelvic pressure and discomfort
- Improving bladder or bowel symptoms
- Improving quality of life
- Treating fibroids that are affecting fertility in selected circumstances
- Reducing the size or number of fibroids
The risks depend on the treatment chosen.
Medication can cause side effects and may not be effective for larger or more symptomatic fibroids.
Uterine artery embolisation can cause pain and other complications and may have implications for future fertility.
Surgery carries risks such as bleeding, infection, blood clots and complications related to anaesthesia. Depending on the procedure, there may also be risks to surrounding organs.
A myomectomy can preserve the womb, but fibroids can develop again in the future.
A hysterectomy permanently removes the possibility of future pregnancy and, like any major operation, carries potential surgical risks. NICE recommends that women considering hysterectomy are fully informed about its implications, complications, fertility and alternative treatments.
Before recommending treatment, Mr Abu will discuss your individual circumstances, the potential benefits and risks and the alternatives available to you.
Living With Fibroids
Fibroids are common, but that does not mean you have to simply live with symptoms that are affecting your quality of life.
Heavy periods, persistent pelvic pain, pressure, tiredness and bladder or bowel problems can have a significant impact on everyday life. If your symptoms are interfering with work, relationships, exercise or normal activities, a specialist assessment can help establish whether fibroids are responsible and what can be done.
Specialist Fibroid Care
At Gynae Solution, we recognise that there is no single treatment that is right for every woman with fibroids.
Mr Jafaru Abu will take the time to understand your symptoms, review any previous investigations and assess the size, number and location of your fibroids.
Where treatment is appropriate, he will explain your options clearly, including non-surgical and surgical approaches, and consider your individual priorities, including whether you wish to become pregnant or retain your womb.
If you are experiencing heavy or painful periods, pelvic pressure, abdominal discomfort or other symptoms that may be caused by fibroids, contact Gynae Solution to arrange a consultation with Mr Jafaru Abu.
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