What are fibroids?
Fibroids (leiomyomas) are benign growths of smooth muscle, most commonly occuring in the uterus. The smooth muscle of the uterus essentially curls up into ball like growths which may be large, small, single or multiple and can grow in different parts of the uterus. All these factors go to determining what symptoms and effects they might have.
What symptoms do they cause?
Many women have fibroids and are unaware of them, as they cause no symptoms. There are, however, a number of ways in which they can effect a woman’s health and wellbeing.
- Heavy and painful periods. Depending on the number, size and location of the fibroids, they may cause the menstrual period to be heavy and painful. Prolonged heavy bleeding can lead to anaemia and have a significant effect on social and work areas of life also.
- Infertility and miscarriage. Some types of fibroid that distort the cavity of the womb may be associated with difficulties falling pregnant or maintaining a pregnancy in the early stages.
- Other pregnancy problems. Fibroids may be associated with abnormal attachment of the placenta, leading to bleeding during pregnancy and after delivery. If they are large and located in the lower part of the uterus, they may get in the way and lead to the need for a caesarean delivery. Rarely, a fibroid can cause pain in pregancy as it enlarges or undergoes “degeneration”.
- Other effects. If a uterus is significantly enlarged, it may cause abdominal bloating and pressure symptoms. Fibroids can also put pressure on the bowel or bladder causing symptoms with these organs as well
What causes Fibroids?
We don’t really know, but they are more common in some races and in families.
How are fibroids treated?
There are many different factors that need to be taken into account when determining what is the best treatment, and it will vary significantly from woman to woman. These factors include
- The primary symptoms (pain, bleeding, pressure etc.)
- The woman’s age and reproductive priorities and wishes
- The size and location of the fibroids
Medical Treatment – if the main symptoms are heavy bleeding and painful periods, then medical therapy (non-hormonal and hormonal) may be sufficient.
- Iron replacement if the heavy bleeding has lead to anaemia
- NSAID and antifibrinolytic medication to help with both the pain and amount of bleeding
- Hormonal contraception can be used to regulate and reduce the amount of bleeding with each period. This can be in the form of the combined oral contraceptive pill or long acting progestin only contraceptives (injectable, implant or intrauterine device).
- GnRH analogues – these medications suppress the ovaries and the hormones they produce, leading to a reduction in the size of fibroids in a significant number of women. However, as they induce a menopausal state, they are only used for the short term or in preparation for surgery.
- Radiographic embolisation of the uterine arteries. This procedure involves placing a catheter into the arteries that supply the fibroid (under X-ray guidance) and injecting particles to block off the blood supply. This avoids more invasive surgery, but is not recommended if future pregnancy is planned.
- Myomectomy. This refers to the surgical removal of the fibroid, with the preservation of the remaining uterus. It can be performed by either an abdominal (traditional open), laparoscopic (keyhole), or hysteroscopic (via the cervix) approach depending on the site and size of the fibroids. This procedure can have implications for future pregnancies, especially in terms of how babies are delivered with caesarean section being advised if the fibroid involves a significant thickness of the wall of the womb.
- Hysterectomy. The removal of the uterus may be appropriate if other options have failed or are not appropriate, and there is no desire for future childbearing.
The above information doesn’t take the place of a medical consultation so please seek further advice if your symptoms continue to concern you.