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What are fibroids?
Fibroids affect approximately two in three individuals aged 30 to 50. It is quite common for women over the age of 30 to have at least one fibroid. Symptoms can vary, and some individuals may not experience symptoms at all. Fibroids can impact daily life, causing difficulties in day-to-day activities. Therefore, it is essential to be aware of the symptoms, so you know when to reach out to your doctor.
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Definition of fibroids
Fibroids are non-cancerous growths that develop in or around the uterus. They are composed of muscle and fibrous tissue and can vary in size, ranging from as small as a pea to as large as a melon. There are different types of fibroids depending on their location.
Intramural fibroids – These grow inside the wall of the uterus and are the most common type. They can distort the shape of the uterine cavity.
Subserous fibroids – These fibroids grow from the outer wall of the uterus into the space of the pelvis.
Submucous fibroids – These grow from the inner wall into the space of the uterus.
Causes of fibroids
The exact cause of fibroids is still unclear, but it is believed that hormones, particularly oestrogen and progesterone, may stimulate their growth.
Certain factors increase the risk of developing fibroids, including age, being overweight or obese, and being of African-Caribbean descent. Interestingly, individuals who have had children tend to have a lower risk of developing fibroids.
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Symptoms of fibroids
Many people with fibroids may be unaware that they have them, as fibroids can sometimes be asymptomatic. However, some individuals may experience symptoms, especially around the time of their period. These symptoms can include:
· Heavy or painful menstrual periods
· Irregular menstrual cycles
· Abdominal swelling
· Abdominal pain
· Bloating or constipation
· A frequent need to urinate
In rare cases, fibroids can lead to complications that may impact fertility. If you experience any of these symptoms, it is important to consult your doctor so that a treatment plan can be put in place.
How are fibroids diagnosed?
Fibroids can be diagnosed using several methods. In some cases, they are only discovered during routine gynaecological examinations or tests for other conditions, as they often do not present any symptoms.
Ultrasound scan – There are two types of ultrasound scans used to identify fibroids: abdominal and transvaginal. An abdominal scan involves placing an ultrasound probe on the outside of the stomach, while a transvaginal scan is performed using a small ultrasound probe inserted into the vagina. Both methods enable doctors to diagnose the presence of fibroids.
Hysteroscopy – This procedure involves inserting a flexible telescope into the uterus to examine the inside of the uterus. In some cases, a small tissue sample may be obtained during a hysteroscopy for further investigation. While there may be some discomfort during the procedure, taking paracetamol or ibuprofen an hour beforehand can help alleviate pain.
Laparoscopy – This is a minimally invasive procedure that allows doctors to inspect the pelvic organs through a small incision in the stomach while the patient is under general anaesthetic. If any abnormal tissue is detected, a biopsy may be taken to confirm a diagnosis, such as endometriosis.
How are fibroids treated?
Treatment for fibroids depends on symptoms and location. If symptoms are mild or absent, treatment may not be necessary, as fibroids can shrink after menopause.
Pain management – Anti-inflammatory medications such as ibuprofen can help manage pain and reduce heavy periods.
Medication for heavy bleeding - Doctors may prescribe tranexamic acid, the contraceptive pill or progesterone. The levonorgestrel-releasing intrauterine system, which is a small, T-shaped plastic device placed in the uterus, is also used to decrease bleeding.
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Medication to shrink fibroids - Options include gonadotropin-releasing hormone analogues (GnRHas) to lower oestrogen levels and ulipristal acetate for moderate to severe symptoms, though the latter carries risks of liver damage.
Surgery – If medication is ineffective, surgical options include:
Hysterectomy: Removal of the uterus, recommended for large fibroids or severe bleeding, which eliminates the possibility of pregnancy.
Myomectomy: Removal of fibroids, preserving the uterus for those who wish to conceive.
Transcervical Resection: Removal of fibroids via hysteroscope, a narrow telescope with a light and a camera.
Endometrial Ablation: Removal of the uterine lining to reduce heavy bleeding, suitable for those not wishing to conceive.
Uterine artery embolisation (UAE): Blocks the blood supply to fibroids to induce shrinkage via an injection.
MRI-guided ultrasound surgery: Uses ultrasound waves to remove fibroids.
Some procedures may affect fertility; however, your doctor will provide guidance on the best treatment options for you.
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