Fibroids
A Fibroid is an abnormal growth of muscular tissue within the uterus. It is not a cancer and usually does not require treatment. In some women, due to the fibroid’s size or location, it may cause problems requiring treatment.
Fibroids can be found in up to 40% of women. Most of these women will not experience any symptoms
Fibroids grow at a very slow rate and will often have been present for many years before they are diagnosed. They will continue to grow slowly until the menopause after which they usually shrink in size.
Fibroids are categorized by their location, which includes:
- Intramural – growing in the uterine wall. Intramural fibroids are the most common variety
- Submucosal – growing in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain
- Subserosal – growing on the exterior wall of the uterus. They sometimes appear like balloon on a stick
Diagnosis
When a clinical history or examination suggests fibroids, an ultrasound will be organised to confirm the diagnosis.
Other investigations, such as hysteroscopy (video imagining of the uterine cavity which is done in hospital), CT scan or MRI (performed at radiology departments) may be required.
Symptoms
Some symptoms women with fibroids may experience include:
Heavy or painful periods
Lengthy periods
Recurrent miscarriage
Infertility
Bladder, bowel or pressure symptoms
Pelvic pain
General information
Hormone therapy is safe and will not usually increase the size of fibroids. However fibroids have been reported to grow in women using hormone patches, so these should be avoided.
The role of fibroids in causing infertility is controversial. There is some evidence to suggest that large fibroids may impair fertility and increase the risk of miscarriage, preterm labour and the need for a caesarean delivery. Removal of large fibroids may therefore be considered prior to pregnancy and in the management of some cases of infertility. The benefits will always need to be weighed up against the risks of surgery and you should discuss all options with your doctor.
Very occasionally cancer can occur in a fibroid (sarcoma). Although rare it should be suspected in women who are postmenopausal, who are bleeding and have a rapidly growing uterus.
Treatment of Fibroids
- Treatment of fibroids depends on the age of the patient and the symptoms they experience.
- Most women will require no treatment at all.
- If the presenting problem is menstrual irregularities then it is usual to investigate for other causes of heavy periods. When these have been ruled out, a trial of medication may be used as first line management.
- Women who have a very large fibroid or multiple fibroids that are causing symptoms, and who have completed their family, will usually be offered a hysterectomy.
- Women with large fibroids who are symptomatic and who still want children may be offered a myomectomy.
