Fibroids

Fibroids are noncancerous growths or lumps of muscle tissue that form in the walls of the uterus. They can be as small as a pea, or as large as a rockmelon, or larger.

What causes fibroids?

We’re not sure why they occur, but we do know that the female hormones oestrogen and progesterone play a big role in their growth stimulation.

Fibroids can occur in women of reproductive age, growing until the onset of menopause. After menopause they tend to decrease in size and may slowly disappear altogether.
Somethings do increase your risk of getting fibroids, while others increase your risk.

Higher risk Lower risk
  • Early onset of periods
  • Obesity
  • A family history of fibroids
  • Never having given birth
  • Being of Afro-Caribbean descent
  • Age (risk increases in your late reproductive years)
  • Having polycystic ovary syndrome (PCOS)
  • High blood pressure (hypertension)
  • Smoking
  • Having more than 2 children
  • Having had a multiple birth
  • Use of Depo-Provera (a contraceptive)
  • Use of the oral contraceptive pill

 

What are the symptoms of fibroids?

Fibroids occur in up to 70% of women by the time they are 50. Many won’t even know they have fibroids because the majority don’t get symptoms at all. Symptoms depend on the size, location and number of fibroids. Symptoms can include

  • Heavy or prolonged periods
  • Iron deficiency (and anaemia)
  • Frequent urination
  • A pressure sensation on the bladder, bowel or back
  • Low back pain
  • A lump or swelling in the abdomen
  • Period pain
  • Painful sex

In very rare circumstances a fibroid may become cancerous and is then called a sarcoma.

How are fibroids diagnosed?

Fibroids are usually found during a gynaecological examination, pelvic ultrasound or during surgery for other conditions.

Fibroids may be found during a hysteroscopy which is an internal examination, usually under general anaesthesia, performed using a hysteroscope (a thin telescope). This is inserted along the vagina into a woman’s uterus to examine the inside cavity.

Fibroids can also be found during a laparoscopy (keyhole surgery). This is an examination, using a thin telescope performed under general anaesthesia, through a small cut in the navel (umbilicus) to look at or operate on the pelvic organs, such as the uterus, ovaries and uterine (fallopian) tubes.

Impact on fertility

Infertility is not a common problem for women with fibroids, less than three per cent of women may have fertility problems as a result of fibroids.

Fibroids & pregnancy

Sometimes fibroids cause problems in pregnancy or they interfere with labour and delivery. The number and position of the fibroids will determine if there is a problem. Fibroids can increase the risk of:

  • miscarriage
  • premature labour and delivery
  • the baby not being positioned with its head down and the crown presenting (malpresentation)
  • caesarean section because the fibroid obstructs the baby moving down into the birth canal
  • reduced placental flow because the fibroids put pressure on the placenta
  • severe bleeding after childbirth

A pregnancy following surgery to remove fibroids may increase the risk of the scar in the uterus rupturing during the pregnancy.

Management & treatment of fibroids

Most fibroids will not require treatment unless they are causing problems such as:

  • impairing fertility
  • period pain
  • heavy bleeding
  • pressure symptoms

Treatment will depend on:

  • the symptoms caused by the fibroid/s
  • whether the symptoms interfere with daily living
  • the position of the fibroid/s
  • the size of the fibroid/s

Treatments may include:

TREATMENT HOW IT WORKS
GnRH agonist (an artificial hormone used to prevent natural ovulation) It causes a temporary chemical menopause which shrinks the fibroids.
Intrauterine device (IUD) such as Mirena Placed in the uterus, it can reduce heavy periods.
Uterine artery embolisation
  • A fine substance or coil is injected into the uterine artery to reduce the blood supply to the fibroid causing the fibroid to shrink by 30-50%
  • The procedure is performed:
  • by a specialist radiologist using X-ray control
  • under sedation or anaesthesia
Endometrial resection A hysteroscope is used under general anaesthesia to cut out a fibroid that is partially or completely inside the cavity of the uterus, and partially in the wall of the uterus.  These are called ‘sub mucosal’ fibroids and they usually cause heavy periods.
Myomectomy Complete removal of a fibroid using:

  • laparoscopy (keyhole surgery)
  • laparotomy (an incision through the lower abdomen)
MRI–directed ultrasound technique Guided by an MRI, high intensity focused ultrasound waves cause a localised increase in temperature to destroy the fibroid.
Hysterectomy
  • Removal of some or all of the uterus particularly for multiple fibroids causing major symptoms
  • A hysterectomy is the only procedure that will permanently prevent fibroids from growing or recurring

A woman should make the decision to have a hysterectomy only after a discussion with her doctor about the reasons for the treatment, how it will be performed and the possible consequences. It is a treatment for women who no longer want to have children.

If you are experiencing any of the symptoms of fibroids, see your doctor at GS Health.

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