Fibroids

A fibroid is a benign (non-cancerous) tumour in the uterus. They are also called uterine myomas, fibromyomas or leiomyomas. Their size can vary, they can be as small as a pea or as big as a melon and you may have more than one. They are common and may be found on an ultrasound scan done for another reason, or may be giving you heavy periods.
 
Types of Fibroids

Fibroids are also more common in women who weigh over 70 kg (11 stones). Oestrogen levels are higher in women who are obese or overweight and oestrogen can stimulate fibroids to grow.
Fibroids can increase in size, decrease in size or even go away with time.

Symptoms

Most women with fibroids don’t know they have them because they often don’t cause symptoms. Symptoms may include:

  • Heavy or more painful periods - Fibroids increase the amount of tissue in the uterus available to bleed. This can lead to low iron levels and to anaemia which will be diagnosed by a blood test. This is easily treated with iron tablets.
  • Pain during sex - Fibroids near to the vagina or cervix can cause pain during sex.
  • Bloating or swelling – Large fibroids can cause pressure in the pelvis or lower back.
  • Bladder or bowel symptoms – A fibroid pressing on the bladder may make you feel you need to pass urine more often. Pressure on the bowel may cause constipation.
  • Miscarriage or infertility - If the fibroids grow into the uterus they can sometimes block the fallopian tubes or interfere with implantation. This is rare but can cause problems becoming pregnant. Very rarely, fibroids can be a cause of miscarriages.
  • Problems during pregnancy – Most women don’t have any problems when they are pregnant. Occasionally, you may have pain or discomfort. This may be caused by the fibroid growing too large for its blood supply or twisting. Fibroids are associated with an increased risk of having a caesarean section, the baby lying breech and early labour. Your doctor will advise you further if you are pregnant and have fibroids.

What are the causes of Fibroids?

A fibroid is a collection of smooth muscle cells, and other cells from the uterine lining. It is not clear why fibroids develop. Fibroids are sensitive to oestrogen and progesterone, hormones that are made in the ovary. They swell when levels of female hormones are high - for example, during pregnancy and shrink when levels are low - after the menopause. This shrinkage of the fibroids after the menopause may be delayed if you take HRT.

How are Fibroids diagnosed?

Usually an ultrasound scan is done to confirm the diagnosis and to rule out other causes of any symptoms.

What treatments options are there for Fibroids?

Do nothing - If your fibroids are not causing any symptoms then treatment is not usually needed. After the menopause, fibroids often shrink and symptoms tend to go or ease. You can change your mind if you develop symptoms. Your doctor may advise you to have a repeat scan to assess the growth and size of your fibroids.

Symptom management – medications can be used to reduce the flow of your period if it is too heavy

  • Tranexamic acid is taken 3-4 times a day, for the first 3-4 days of your period. It works by reducing the breakdown of blood clots in the uterus.
  • Anti-inflammatory medicines such as ibuprofen and mefenamic acid. These also help to ease period pain. They are taken for a few days at the time of your period.
  • Contraception options such as the combined pill (COC) or IUS device or progestogen-only contraceptive pill (POP) may help.

Medication to shrink the fibroids - Some women are given medications to reduce their oestrogen and induce a chemical menopause. Fibroids shrink if the level of oestrogen falls. This can ease heavy periods and pressure symptoms due to fibroids. However, a low oestrogen level also causes symptoms similar to going through the menopause (hot flushes, etc). It may also increase the risk of 'thinning' of the bones (osteoporosis). Therefore, this treatment is given for a maximum of six months.

Surgery and other operative treatments

There are a number of operations potentially available to remove and treat fibroids.

Hysterectomy: this is the traditional and most common treatment for fibroids which cause symptoms. Hysterectomy is the removal of the uterus. This can be done in a number of ways. A hysterectomy may be a good option for women who have completed their family.

Myomectomy: this is a possible alternative, especially in women who may wish to have children in the future. In this operation, the fibroids are removed and the womb is left. This procedure is not always possible.

Uterine artery embolisation: this procedure is done by a specially trained radiologist rather than a surgeon. It reduces the blood supply to the fibroid, causing it to shrink. The complete process of fibroid shrinkage takes about 6-9 months but usually you will notice improvement in the first 3 months. There is a good chance of success with this procedure but nearly one in three women will need further treatment.

Myolysis: this means shrinking the fibroids in some way surgically. There are a number of ways of achieving this, including the following:

  • Endometrial ablation: the uterine lining is removed. There are various methods used, depending on your surgeon - for example, using laser energy, a heated wire loop or by microwave heating. This method is only suitable for certain fibroids. Treatment is either through the vagina or guided through the skin by MRI scan.
  • MRI-guided focused ultrasound: this treatment sends pulses of high-power ultrasound through the skin of the pelvis and targets the fibroid. It is effective but there is no research yet on the long-term outcome for women trying to conceive.
  • Ultrasound-guided high-intensity focused ultrasound: this treatment is guided by ultrasound.


Integriti GP's can help diagnose and help you facilitate your treatment pathway.


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