What are fibroids?

Fibroids are benign, or non-cancerous, growths that develop in or around the wall of the womb (uterus). They are made of muscle and fibrous tissue, they vary greatly in size, and a woman may have just one or several. Fibroids are very common, and many women never know they have them. In this post I explain the symptoms, the different types of fibroids, and how they are diagnosed and treated.

What are the symptoms of fibroids?

Some women with fibroids have no symptoms at all. However, if you have any of the following, it is important to see your GP or a gynaecologist, because fibroids can grow over time and lead to complications:

• heavy or painful periods
• anaemia from heavy bleeding, which can cause tiredness, dizziness, weakness and headaches
• bleeding between periods or after sex
• pain or discomfort during sex
• a swollen tummy that can make you look pregnant
• tummy pain or lower back pain
• needing to pass urine often, constipation or bloating
• low mood
• difficulty getting pregnant, or an increased risk of miscarriage

Heavy periods should never simply be put up with. NICE explains how heavy menstrual bleeding should be assessed and treated, and our menstrual disorders page covers other causes of heavy periods.

Types of fibroids

Fibroids are named after where they grow, and it is possible to have more than one type at the same time:

• Intramural fibroids grow within the muscle wall of the womb. They are the most common type and can change the shape of the womb.
• Submucosal fibroids grow under the lining of the womb and bulge into its cavity. They are most likely to cause heavy bleeding.
• Subserosal fibroids grow on the outer wall of the womb. They often cause no symptoms, but large ones can press on the bladder or bowel.
• Pedunculated fibroids grow on a stalk, either inside the womb or on its outer surface.

How are fibroids diagnosed?

To diagnose fibroids, you may need one or more tests, such as an ultrasound scan (see gynaecological ultrasounds), an MRI scan or a hysteroscopy, in which a small camera is used to look inside the womb. These tests confirm the diagnosis and show the size, number and position of the fibroids. They also help to rule out other, more serious causes of bleeding.

How are fibroids treated?

Treatment depends on how much your symptoms affect you, the size and position of your fibroids, and whether you would like to have children in the future.

Medicines can help to control symptoms. Options include anti-inflammatory painkillers, tranexamic acid to reduce bleeding, and hormonal treatments such as the contraceptive pill, a hormonal coil or progesterone tablets to regulate periods. Medicines called GnRH analogues can shrink fibroids, and are sometimes given for a few months before surgery to make the operation easier.

Surgery may be considered for large fibroids or severe symptoms. The options include:

• a myomectomy, to remove the fibroids and keep the womb, often by keyhole surgery
• a transcervical resection, which removes submucosal fibroids through the cervix
• a hysterectomy, to remove the womb, for women who have completed their family (see total laparoscopic hysterectomy)

There is also uterine artery embolisation (UAE), a non-surgical procedure that blocks the blood vessels feeding the fibroids, so that they shrink.

Choosing the right treatment

There is no single right answer for everyone with fibroids. At your consultation, Mr Jaf Abu will discuss the risks and benefits of each option with you, so that you can decide what suits you best. The Royal College of Obstetricians and Gynaecologists has helpful patient information on gynaecological treatments, and our fibroids page has more detail. To arrange an appointment, please get in touch.