Fibroids

Fibroids (uterine leiomyomas) are non-cancerous growths that grow in and around the uterus (womb). They are very common, developing in 1 in every 3 women. Most women have no symptoms, however, they can cause heavy periods (menorrhagia) and pelvic pain if they grow large enough.

Fibroids can be categorised by where, on the uterus, they grow:

  • Intramural fibroids – The most common type of fibroid, they develop within the muscle wall of the uterus.
  • Subserosal fibroids – Develop on the outside of the uterus, and grow into the pelvis. If they are connected to the uterus only by a narrow piece of tissue, they are then known as pedunculated subserosal fibroids.
  • Submucosal fibroids – Develop in the muscle layer beneath the inner lining of the uterus, and grow into the uterus. They can also be connected to the uterus only by a narrow piece of tissue, making them pedunculated submuscosal fibroids.

It is not known what causes fibroids to begin growing, however there are a number of factors which have been connected to women being at an increased risk. Including oestrogen levels, ethnicity and lifestyle.

Fibroids often result in difficulties conceiving, and carrying a baby to full term. Unfortunately, many of the treatments also carry a risk of permanent infertility. Therefore it is important to be aware of the early symptoms of fibroids, and seek diagnosis as soon as possible if you are experiencing them. Fibroids can be diagnosed through an ultrasound scan and, if large enough, may even be obvious during a routine pelvic examination such as a smear test.


What are the Symptoms of Fibroids?

Only 1 in 3 women suffering with fibroids will experience any noticeable symptoms. If fibroids become particularly large, they can however, cause a great deal of pelvic pain and may make conceiving and carrying a baby to full term, impossible.

Symptoms include:

  • very heavy periods (menorrhagia)
  • very painful periods (dysmenorrhea)
  • pressure or pain in the abdomen
  • lower back pain
  • pain and discomfort during sex
  • miscarriages, difficulty getting pregnant or even infertility
  • urinary incontinence
  • constipation

To read about how fibroids can result in incontinence, visit the Causes and Diagnosis of incontinence page. To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.


What Causes Fibroids?

It is not known why fibroids develop, however, there are a number of risk factors which studies suggest increase your likelihood of developing them:

  • Oestrogen levels - Studies suggest oestrogen promotes the growth of fibroids, as they usually develop during a women's reproductive years and shrink after menopause.
  • Stress - Stress can increase oestrogen levels.
  • Being overweight or obese - Being overweight means you have higher natural levels of oestrogen.
  • Ethnicity - Studies suggest women of African-Caribbean origin are 2-3 times more likely to suffer from fibroids than white females. Research suggests this is in part due to the prevalence in vitamin D deficiency in this group.
  • Pregnancy - Hormone changes can cause fibroids to grow larger during pregnancy, sometimes to the extent that they obstruct vaginal childbirth making a cesarean necessary.
  • Red meat - If eaten in substantial quantities, it is believed that red meat increases your risk of developing fibroids.
  • An inactive lifestyle - Studies suggest there is a 40% higher risk of developing fibroids if you rarely exercise.

To read about other causes of pelvic pain, visit the Causes and Diagnosis of Pelvic Pain page.


How to Treat Fibroids

Unless your fibroids are causing a problem, no treatment is usually necessary, and they will usually shrink or disappear after menopause. However, if fibroids are causing pain and discomfort, they may also be affecting your fertility. Your doctor can provide medication to reduce your heavy periods and shrink the fibroids, alongside painkillers to manage the pain.

There are surgical options available to treat fibroids, however these often make you infertile, and come with associated health risks. Undergoing pelvic surgery comes with a risk of suffering from pelvic floor disorders in the future. Therefore all treatment options should be considered before surgery is elected for.

Treatment options include:

  • Having children - It may seem odd, but studies suggest that with each child you have, your risk of developing fibroids decreases. The reasons for this are currently unknown, but it is believed to be related to hormone levels.
  • Review your diet - Studies suggest that a balanced diet rich in green vegetables, fruit (due to their antioxidant and pro-vitamin A properties) and dairy, may reduce fibroid size.
  • Review your lifestyle - Regularly exercising (at least 4 hours of vigorous exercise a week) and maintaining a low BMI can reduce the growth of fibroids.
  • Vitamin D supplements - Studies suggest vitamin D3 can reduce the size and spread of fibroids. It is for this reason that it is sometimes recommended as a preventative measure for cancer.
  • Medication - Medicines aim to thin the lining of the uterus, and reduce menstrual bleeding as a result.
    • Progestogen - Used to reduce heavy periods by slowing the growth of the womb lining. It can be taken orally or injected, and in some cases can be an effective contraception. Associated risks include acne and weight gain.
    • Anti-inflammatory medicines - This group of drugs includes ibuprofen, and can be taken 3 times a day during your period to reduce bleeding to a manageable level and relieve pain. Associated risks include indigestion and diarrhoea.
    • Levonorgestrel intrauterine system (LNG-IUS) - A small T-shaped plastic device that sits in the uterus and gradually releases progestogen. Can be used as a contraception.
    • Tranexamic acid - A tablet to be taken 3-4 times each day of your period (for up to 4 days). It stops the small blood vessels in the uterus from bleeding, reducing blood loss by 50%. Associated risks include indigestion and diarrhoea. If symptoms have not improved within 3 months, this treatment is discontinued due to its side-effects.
    • Gonadotropin releasing hormone analogues (GnRHas) - This group of hormones are injected. They influence the pituitary gland to stop your periods and the production of oestrogen, in order to shrink your fibroids. They are not a contraception, however, they can also help with urge incontinence and constipation. They are sometimes used before surgery to make the fibroids more manageable to remove. Associated risks include: sweating and hot flushes, stiff muscles, osteoporosis (thinning of the bones) and vaginal dryness.
  • Surgery - Fibroid surgery involves removing either just the fibroids themselves, or removing the whole uterus as part of a hysterectomy. Depending on the location and size of your fibroids, depends on the surgery that is available to you.
    • Hysteroscopic resection or morcellation - A hysteroscope (a light and camera on the end of a long, thin tube) is inserted into the vagina and into the uterus. Instruments are passed through the hysteroscope, which cut submuscosal fibroids into small pieces that can be removed through the tube.
    • Uterine artery embolisation (UAE) - Considered less invasive than other surgeries, this procedure blocks the fibroids blood supply, causing them to shrink. They will not go completely. Using live x-ray guidance, your surgeon will inject small particles into the uterine arteries to block them. You will be awake during this procedure, and will be given a local anaesthetic to reduce your pain. This procedure has an 83% success rate in improving symptoms, and can be completed on even large fibroids. However, the reduced blood supply often leads to difficulties conceiving (64% of women will suffer a miscarriage).
    • Laparoscopic laser myomectomy - Through a keyhole surgery in the abdomen (laparosocopy), a laser fibre is passed through the uterus wall to destroy the fibroids. This procedure is usually only recommended for women suffering from very small fibroids. The procedure is done whilst you are under general anaesthetic. Associated risks include damage to the bowel and urinary tract, and the risk of the scar opening during childbirth. This procedure is less often completed as an open abdominal surgery, called open myomectomy surgery.
    • Endometrial ablation - Considered a minor procedure as you can go home the same day, this 20 minute procedure removes the lining of the uterus. It can be done with laser energy, a heated wire loop, or hot fluid in a balloon. It can be used for small intramural fibroids, or heavy bleeding without fibroids. Associated risks: damage to the womb and associated organs, temporary vaginal bleeding, stomach cramps and bloody discharge. You will struggle to conceive following this surgery, and if you do so, the pregnancy will likely experience complications.
    • Hysterectomy - The entire uterus (womb) is removed. It is the most effective cure for fibroids and is used where there are very large fibroids which cause severe bleeding, and no more children are wanted. In the USA, fibroids are the leading cause of hysterectomy's.

To read about other treatments available for pelvic pain, visit our pelvic pain treatment page.


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