Fibroids

Although fibroids are a common problem, the way the fibroids and its treatment impacts you physically and emotionally is unique to you. Take time to gather all the information, talk to your doctors, assess all the options and make sure that you get the treatment that is right for you. This webpage should help answer some of your queries. You can arrange an appointment to see Dr Nimit Goyal if you wish to proceed with uterine artery embolisation or have further questions.

What are fibroids?

Fibroids are non cancerous swellings (benign tumours) of the womb (uterus). They are not cancerous and so are very unlikely to be a threat to life. Fibroids are however very common affecting about half of all women at some stage in their lives. Though most women with fibroids have no symptoms and may not even know they have them, a minority suffer very distressing symptoms.

Fibroids are made up of muscle and fibrous tissue and tend to have a large supply of blood to them. What causes fibroids is not well understood but they are certainly influenced by your body’s hormones and most likely to grow faster when oestrogen is highest in a woman’s middle life. Because of this reason, they are rare in teenagers, most common in 30-50 year olds and shrink naturally after the menopause.

Fibroids are much more common in black women than white women. Your chance of developing them is also increased if you are heavy, if other members of your family have been diagnosed with them, or if you have no children. Fibroids vary considerably in size and number; some may be the size of a marble others are like a large pumpkin.

What are the symptoms caused by fibroids?

Many women don’t get symptoms due to fibroids but in some women fibroids can have a profound effect on their lives. Fibroids may cause following symptoms in upto a third of patients:

heavy or painful periods (menorrhagia)
tummy (abdominal) pain
lower back pain
a frequent need to urinate
constipation
pain or discomfort during sex
In rare cases, further complications caused by fibroids can affect pregnancy or cause infertility

Infertility and Problems with Pregnancy

Most fibroids do not affect your ability to become pregnant or the pregnancy itself. However, some may make pregnancy more uncomfortable than normal.

In some women, the fibroids can make conception difficult and can cause miscarriage. This may happen due to pressure effect of the fibroid by blocking the fallopian tube and thereby preventing the egg travelling from the ovary to the uterus. A fibroid within the lining of the womb may also interfere with the growing embryo.

During childbirth, large fibroids can pose problems by obstructing the passage of the baby. This may require a caesarian section to safely deliver the baby.

How are Fibroids diagnosed?

Your symptoms and clinical examination will make your GP or gynaecologist suspect a diagnosis or fibroids. A scan will help to confirm this suspicion.

Ultrasound

Ultrasound of the Uterus showing a large Fibroid

An ultrasound scan used sound waves to produce images of your internal organs. It will be able to give a very accurate idea of whether or not you have fibroids. An ultrasound scan is sometimes performed internally (through the vagina) which may add further valuable information to the scan.

Magnetic resonance Imaging (MRI)

MRI Scan of the Uterus showing a large Fibroid

Magnetic resonance scans give great details of the anatomy of your pelvic area including the uterus. They can show exactly how many fibroids you have, what is their size, how much blood supply they have, where are they located within the uterus (sub-mucous, sub-serosal, intra-mural), whether they are pedunculated (attached to uterus with a stalk) and if there is any suggestion of a different disease which may be relevant to the management of your problems. Magnetic Resonance is much more accurate than ultrasound and can often help in diagnosing which treatment option is right for you.

Hysteroscopy

Hysterscopy is having a look directly at the lining of the womb. This is done by inserting a small camera into the womb through the cervix. This can usually be done without need for general anaesthesia. It can be useful for diagnosing sub-mucosal fibroids. A biopsy of the lining of the womb can be taken at the time of the hysteroscopy.

Your gynaecologist may recommend a hysteroscopy particularly if your main problem is heavy periods.

How are fibroids treated?

Fibroids don’t need to be treated if they aren’t causing symptoms. However, if you have symptoms caused by the fibroids, there are several treatment options. Your GP or Gynaecologist will be able to discuss these options with you.

Medication: Medicines are available that can be used to reduce heavy periods, but they are generally less effective the larger your fibroids are. If medications prove ineffective, surgery or other, less invasive procedures may be recommended.
Uterine Artery Embolisation: This is a non-surgical procedure performed by an Interventional Radiologist which is NICE approved and has further advantage of keeping fertility options open.
Surgical options: Surgery to remove your fibroids may be considered if your symptoms are particularly severe and medication has been ineffective. Some of the surgical options include:
- Hysterectomy
- Myomectomy

The surgical procedures generally tend to have longer recovery times although your gynaecologist will be able to provide you with more details about these procedures.

NICE guidance on heavy menstrual bleeding and Fibroids

NICE recommends a referral for consideration for Uterine artery embolisation or surgery (myomectomy or hysterectomy). All these techniques should be discussed with the patient. Women should be informed that UAE or myomectomy may potentially allow them to retain their fertility. Myomectomy is recommended for women with heavy menstrual bleeding associated with fibroids who want to retain their uterus. UAE is recommended for women with heavy menstrual bleeding associated with fibroids and who want to retain their uterus and/or avoid uterus. Hysterectomy should be considered only when:

Other treatment options have failed, are contra-indicated or declined
The patient expresses a wish for amenorrhoea (no periods)
The woman specifically requests it
The woman no longer wishes to retain her uterus and fertility