Uterine Fibroids



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What are they?

Uterine fibroids are benign (non-cancer) growths of the womb. They are very common in women and we believe they affect more than 50% of all women at one stage or the other.

What causes fibroids?

We do not know what causes fibroids. They are more common in older women and in women who have never had children. Fibroids are also more common in certain ethnic groups (Africans). They tend to be more common in some families suggesting a genetic influence.

What problems can fibroids lead to?

Fibroids can give rise to a variety of problems including:
Heavy menstrual periods: fibroids are one of the commonest causes of heavy menstrual periods that might be severe enough to cause flooding and passage of large clots. Pelvic pain: fibroids typically cause painful menstrual periods but can also cause non-cyclical pelvic pain as well as pain during sex.

Abdominal swelling: fibroids can grow to enormous sizes and lead to swelling of the abdomen. They have been confused for pregnancy in the past.

Infertility: because fibroids are more common in women who have not had children and in those with difficulty conceiving, we think they might interfere with the process of conception. It is not clear how they do this but we think some fibroids might cause a blockage of the fallopian tubes or a distortion of the lining of the womb that interferes with implantation.

Pressure on other organs: large fibroids can cause pressure symptoms on some of the other pelvic organs. In the bladder this could cause frequent passing of urine, urinary leakage and rarely retention of urine. In the ureters this could cause obstruction to the flow of urine and lead to urinary infection and pain. Pressure on the rectum could cause constipation and rarely intestinal obstruction.

Cancer (rare): very rarely fibroids can undergo malignant change and become cancers. The scenarios that favour this occurrence are fibroids found in older women (around the time of the menopause), the presence of non-cyclical pain and rapid growth of the fibroid over a short space of time.

How are fibroids investigated?

A detailed history and both abdominal and pelvic examinations are the first steps in the investigation of fibroids. The main way of diagnosing fibroids is by ultrasound scanning and this can reveal the number, size and locations of the fibroids. It might occasionally be necessary to perform an MRI scan to obtain this information in situations where the ultrasound scan is not very informative. Rarely, other investigations might be warranted (such as investigations of the urinary and intestinal) tracts to rule out other conditions.

How are fibroids treated?

There are several options for treating fibroids and the appropriate option will be dependent on the woman’s age, symptoms, reproductive expectations and state of health as well as on the number, size and locations of the fibroids.

Medical measures: the pain associated with fibroids can be reduced with painkillers (usually the anti-inflammatory drugs) and the heavy menstrual bleeding can be reduced with drugs like tranexamic acid, mefenamic acid and progesterones. The size of fibroids (and so symptoms arising from them) can be reduced by drugs that suppress ovarian action. All these measures can provide temporary relief before a more permanent solution is provided and they all have the disadvantage of interfering with fertility.

Myomectomy: this is the most common way of treating fibroids. It is an operation that removes the fibroids without removing the womb and so it serves to retain fertility. There are three ways of achieving myomectomy; hysteroscopic, laparoscopic and by laparotomy. Hysteroscopic myomectomy is the simplest way of undertaken this procedure and is normally performed as a day-case. It is only suitable for fibroids that grow into the cavity of the womb (submucosal) and that are less than 5cm in size. Laparoscopic myomectomy achieves removal of fibroids through keyhole surgery and is suitable when there are no more than five fibroids and where the womb is not bigger than 16 weeks size. It entails overnight stay in hospital and a three-week recovery period. Myomectomy through laparotomy is the traditional way of doing this operation and entails a five-day hospital stay and six-week recovery period. Every myomectomy operation carries a small risk of hysterectomy.

Hysterectomy: this is suitable for older women who have completed their families and/or have no further need to retain their uterus. It is normally undertaken through a laparotomy and so entails a five-day hospital stay and six-week recovery period.

Uterine artery embolisation (UAE): this is a procedure whereby the arteries that supply the fibroids are blocked off leading to shrinkage of the fibroids. This is successful in reducing symptoms in many women and can reduce the size of the womb by about half. The currently available evidence would suggest that it is not suitable for women contemplating pregnancies in future.

Complimentary therapies

There is no evidence that complimentary therapies are effective in treating fibroids but they may be useful for controlling some of its symptoms (such as painful periods).

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