Fibroids

Fibroids are non-cancerous (benign) growths made of womb muscle, that grow in or around the womb and about three in ten women have them. Fibroids can exist as a single lump, or there may be many of them. They vary in size from a few millimeters to many centimeters, and tend to grow slowly over time. The exact cause is unknown but their growth is linked to female hormones and they do run in families. They grow during a woman’s fertile period and reduce in size after the menopause. Women who have had children have a lower chance of having a fibroid. A woman will often not know she has fibroids until she is trying to get pregnant or during a routine gynaecology test or ultrasound scan. Some fibroids can be very large and can be easily felt with a pelvic examination and can even bulge out of the lower abdomen.

Symptoms

• Feeling off fullness in the tummy
• Enlargement of the tummy
• Heavy periods
• Abdominal pain
• Lower back pain
• Frequently needing to pass urine
• Constipation
• Discomfort during intercourse
• Difficulty becoming pregnant
• Problems during pregnancy, including increased risk of going into labour early, the baby being in an awkward position and growth problems

Treatment

Treatment depends on whether you have symptoms, where the fibroids are within the womb, whether you are trying to get pregnant, and how big the fibroids are.

If you have no symptoms, you do not need treatment or any further scans.

The contraceptive pill or Mirena (hormone) coil may be enough to help treat heavy periods.

If your periods are heavy, you may be offered a procedure called a hysteroscopy (camera test to check the womb lining). If a small fibroid is poking out into the womb cavity, this can be carefully shaved off and removed. Usually, this procedure requires a general anaesthetic. At the same time, a Mirena (hormone) coil can be inserted to help reduce your periods further. This procedure may also be offered if you are trying to become pregnant, although it may not help your chances of conceiving.

If you have pressure symptoms from fibroids, or your fibroids are very large and causing heavy periods, it is possible to remove them through either keyhole surgery (laparoscopic myomectomy) or through a larger cut in your tummy (open myomectomy). This operation involves making a cut in the womb wall, and shelling out the fibroids. It carries a significant risk of heavy bleeding requiring blood transfusion, and about one in ten women end up needing a hysterectomy (removal of the womb) in order to gain control of the heavy bleeding.

Before having a procedure to treat fibroids, your doctor may advise you to take a medication to block female hormones, preventing further fibroid growth or shrinking the fibroids to make removal easier. Both tablets and injections Esmya, goserelin) are available for this, but side effects are similar to the menopause and you may need to take hormone replacement therapy while you are taking these drugs.

If you have completed your family and have symptoms from your fibroids, other treatment options include uterine artery embolization and hysterectomy. Uterine artery embolization involves having a detailed scan (MRI) of your fibroids, and a small tube inserted into the top of your leg, in order that a fine catheter can be passed into the blood vessels supplying the womb to block the supply to the fibroids. This cuts off the blood supply and will shrink the fibroids over the coming weeks. It avoids having a major surgical procedure, but can cause pain and the dying fibroids can become infected. A hysterectomy involves removing the womb, either by keyhole (if the fibroids are small enough) or through the tummy. This is usually done using a general anaesthetic and involves staying in hospital for one or two nights.

Links

• http://www.nhs.uk/conditions/fibroids/Pages/Introduction.aspx
• http://www.webmd.com/women/uterine-fibroids/default.htm
• http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html?from=AtoZ
• http://www.britishfibroidtrust.org.uk