What You Need to Know

Fibroids are non-cancerous growths that develop in or around the womb (uterus). These growths, made up of muscle and fibrous tissue, can vary in size and are sometimes called uterine myomas or leiomyomas. Many women are unaware they have fibroids, but those with symptoms may experience heavy periods, abdominal pain, and other discomforts. This blog post will explore the causes, symptoms, types, diagnosis, treatment options, and the impact of fibroids on fertility.

Fibroids, also known as uterine myomas or leiomyomas, are non-cancerous growths that develop in or around the uterus. They consist of muscle and fibrous tissue and can range in size from a pea to a melon. Although common, affecting around 2 in 3 women at some point in their lives according to the NHS, many women are unaware they have fibroids due to the absence of symptoms. However, for those who do experience symptoms, fibroids can significantly impact their quality of life.

Symptoms of Fibroids

While many women with fibroids remain asymptomatic, approximately one-third may experience symptoms such as:

• Heavy or painful periods: Menstrual bleeding that is unusually heavy or lasts longer than normal.
• Abdominal pain: Persistent pain or discomfort in the lower abdomen.
• Lower back pain: A frequent and often severe backache.
• Frequent urination: A constant need to urinate due to pressure on the bladder.
• Constipation: Difficulty in bowel movements.
• Pain during sex: Discomfort or pain experienced during intercourse.

In rare cases, fibroids can lead to complications affecting pregnancy or causing infertility.

Diagnosis of Fibroids

Diagnosing fibroids often begins with a routine gynaecological examination where a doctor might feel irregularities in the shape of the uterus. If fibroids are suspected, several diagnostic tests can confirm their presence and determine their size and location:

1. Ultrasound Scan: The most common imaging test, an ultrasound uses sound waves to create a picture of the uterus. It can be done transabdominally (over the abdomen) or transvaginally (inside the vagina) for more detailed images. You can read what to expect during an ultrasound scan here.

2. Magnetic Resonance Imaging (MRI): An MRI provides detailed images of the uterus and helps in mapping the size and location of fibroids, especially useful for larger fibroids or when multiple fibroids are present.

3. Hysteroscopy: In this procedure, a small telescope (hysteroscope) is inserted through the cervix into the uterus. It allows the doctor to view the inside of the uterus and identify submucosal fibroids.

4. Blood Tests: Although not directly diagnostic for fibroids, blood tests can help rule out other conditions and check for anaemia caused by heavy menstrual bleeding.

Causes And Risk Factors

The exact cause of fibroids is unknown, but they are linked to the hormone oestrogen. Oestrogen, produced by the ovaries, stimulates the growth of fibroids. These growths typically develop during a woman’s reproductive years (16-50 years) when oestrogen levels are highest and tend to shrink after menopause due to the drop in hormone levels.

Certain factors increase the risk of developing fibroids:

• Age: Most common in women aged 30 to 50.
• Ethnicity: More frequent in women of African-Caribbean origin.
• Obesity: Overweight women have higher oestrogen levels, increasing the risk.
• Childbearing: Women who have had children are at a lower risk.
• Fibroids Turning Malignant: This is very rare, occurring in about 1 in 1000 cases. If fibroids grow at a very rapid rate, an MRI scan may be needed to obtain more information.

Types of Fibroids

Fibroids can grow in different parts of the uterus and vary in size. The main types include:

• Intramural fibroids: The most common type, growing in the muscle wall of the uterus.
• Subserosal fibroids: These grow outside the uterine wall into the pelvic cavity and can become very large.
• Submucosal fibroids: Develop in the muscle layer beneath the uterine lining and grow into the cavity of the uterus.
• Pedunculated fibroids: Subserosal or submucosal fibroids attached to the uterus by a narrow stalk of tissue.

Fibroids Treatment Options

Treatment for fibroids depends on the severity of symptoms and the size and location of the fibroids. Asymptomatic fibroids often require no treatment and may shrink after menopause. For symptomatic fibroids, treatment options include:

1. Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce menstrual bleeding. Hormonal treatments, like gonadotropin-releasing hormone (GnRH) agonists, can shrink fibroids temporarily by reducing oestrogen levels.

2. Hormone Therapy: Hormonal contraceptives can help control heavy menstrual bleeding but do not shrink fibroids. Progestin-releasing intrauterine devices (IUDs) can also reduce bleeding.

3. Minimally Invasive Procedures:

   • Uterine Artery Embolisation (UAE): This procedure cuts off the blood supply to fibroids, causing them to shrink.
   • Myomectomy: Surgical removal of fibroids while preserving the uterus, suitable for women who wish to maintain fertility.
   • Endometrial Ablation: Destroys the lining of the uterus to reduce menstrual bleeding.

4. Surgical Options:

   • Hysterectomy: Complete removal of the uterus, considered a definitive solution for fibroids, but it ends a woman’s ability to conceive.

Fibroids and Infertility

Fibroids can impact fertility, depending on their size and location. Submucosal fibroids, which distort the uterine cavity, are most likely to cause infertility and pregnancy complications, including recurrent miscarriage. Intramural fibroids that affect the uterine wall can also reduce fertility, though their impact is less clear. Conversely, subserosal fibroids, located outside the uterus, typically do not affect fertility.

For women with fibroids who experience infertility, treatment options like myomectomy can improve chances of conception. Surgical removal of submucosal fibroids has been shown to enhance pregnancy rates significantly.

Fibroids and Pregnancy

Fibroids are extremely common, with approximately 50% of women having fibroids in their lifetime. Most fibroids are small and asymptomatic, but some women worry about their impact on pregnancy. Here are some common concerns:

• Can fibroids affect the chances of getting pregnant? Generally, fibroids don’t interfere with conception unless they are submucosal or very large. They can sometimes block fallopian tubes or distort the uterine cavity, affecting implantation and causing sub-fertility or early pregnancy loss.
• Can fibroids interfere with pregnancy? While fibroids usually cause no problems, they can increase the risk of early pregnancy loss and preterm birth. They may also grow during pregnancy, causing discomfort and sometimes leading to complications like ‘red degeneration,’ where the fibroid’s tissue dies due to insufficient blood supply, causing pain.
• Can fibroids interfere with childbirth? Fibroids in the lower uterus can lead to fetal malposition, necessitating a Caesarean section. They can also cause post-partum haemorrhage due to interference with uterine contractions.
• What Can Be Done to Optimise Pregnancy Outcome? A consultation with a gynaecologist and an ultrasound scan is often required to assess fibroids. If they are large or within the uterine cavity, further intervention may be necessary. Correcting iron levels if fibroids cause anaemia is also important. Surgical removal of submucosal fibroids can improve pregnancy outcomes, though some procedures might require an elective C-section.
• How Long Should You Wait After Surgery to Try for a Baby? Consult with your surgeon about when it’s safe to start trying for a baby post-surgery. Generally, it’s recommended to wait a year after a myomectomy and three months after a hysteroscopic procedure.

How Can We Help:

At London Pregnancy Clinic, we provide comprehensive care for women with fibroids, including:

• Fibroids Testing and Monitoring Package: Available for self-pay patients, this package includes detailed diagnostics and ongoing monitoring to manage your condition effectively.
• Consultation and Ultrasound Services: Expert consultations and state-of-the-art ultrasound services to assess the size, location, and impact of fibroids.
• Surgical Options: Minimally invasive procedures and surgeries like myomectomy and UAE to treat fibroids and enhance fertility. We may refer you to a trusted specialist.
• Pregnancy Care: Specialised care to manage fibroids during pregnancy, ensuring the best possible outcomes for mother and baby.

For support, visit the British Fibroid Trust, a UK-based voluntary not-for-profit patient support group providing balanced information to help people make informed choices on treatment.

Final Thoughts

Fibroids are a common but manageable condition. Women experiencing symptoms should consult their GP for a diagnosis and discuss the best treatment options. Early intervention can alleviate symptoms and improve quality of life. For more information on fibroids and treatment options, visit the NHS website or contact London Pregnancy Clinic.