Uterine fibroids

Fibroids are common, with around one in three women developing them.

Fibroids are non-cancerous growths made up of muscle and fibrous tissue that develops within the myometrium and their growth is influenced by the hormones oestrogen and progesterone. Risk factors include: early menarche, nulliparity, obesity and are more common in women of afro Caribbean origin. 

Woman may have a single or multiple fibroids which are entirely within the wall of the uterus, distorting the lining of the womb or located under the outside layer of the uterus. The location and size of the fibroids influences the likelihood of symptoms and their severity.

Symptoms

Symptoms may include:

• heavy menstrual bleeding and therefore potentially anaemia
• painful periods
• abdominal or back pain
• distended abdomen
• pressure symptoms including increased need to pass urine and constipation
• possible subfertility. 

Uterine fibroid investigations

Investigations may include:

• vaginal examination
• ultrasound scan and or
• a hysteroscopy.

Treatment

Fibroids don't need to be treated if they aren't causing any symptoms.

Many women are unaware they have fibroids until they are informed after an incidental finding on ultrasound. Half of all women with fibroids will be asymptomatic and therefore Fibroids treatment is not necessary. Over time particularly after the menopause when the oestrogen levels drop, fibroids may shrink and even disappear without treatment.

Treatment will depend on a woman’s preference but also her age and whether she has completed her family, the severity of symptoms and the size and location of the fibroids.
If heavy menstrual bleeding is impacting a woman’s quality of life then hormonal treatments may be beneficial and include: the levonorgestrel-releasing intrauterine system, combined oral contraceptive pill, oral progesterone.

Non hormonal options are suitable for women who are trying to conceive and include Tranexamic acid or non-steroidal anti-inflammatory preparations. If medical treatments are ineffective then surgical options include myomectomy, endometrial ablation, uterine artery embolisation, MRI guided focused ultrasound interventions or hysterectomy.