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Fibroids

fibroids

A fibroid is a benign (non-cancerous) growth of the womb (uterus). They are also called uterine myomas, fibromyomas or leiomyomas. Their size can vary.

  • Intramural fibroids grow within the muscle tissue of the womb. This is the most common place for fibroids to form.
  • Subserous fibroids grow from the outside wall of the womb into the pelvis.
  • Submucous fibroids grow from the inner wall into the middle of the womb.
  • Pedunculated fibroids grow from the outside wall of the womb and are attached to it by a narrow stalk.

How common are fibroids?

They are common. At least 1 in 4 women develops one or more fibroids in her lifetime. They usually develop in women aged 30-50 and can sometimes run in families. Fibroids are also more common in women who weigh over 70 kg (11 stones). This is thought to be due to the higher levels of oestrogen hormone that occur in larger women.

What causes fibroids?

A fibroid is like an overgrowth of smooth muscle cells. It is not clear why they develop. Fibroids are sensitive to oestrogen, the hormone that is made in the ovary. Fibroids tend to swell when levels of oestrogen are high - for example, during pregnancy. They also shrink when oestrogen levels are low - after the menopause.

What symptoms and problems are caused by fibroids?

Many women who have fibroids are not aware that they have them. Sometimes one is found during a routine examination by a doctor or by chance during a scan which you may have for another reason. Symptoms may include:

Heavy or more painful periods

  • Bloating or swelling
  • Bladder or bowel symptoms
  • Occasionally a fibroid may press on the bladder which lies in front of the womb. You may then pass urine more often than usual. Rarely, pressure on the bowel (which lies behind the womb) may cause constipation.
  • Pain during sexual intercourse
  • Miscarriage or infertility
  • Problems during pregnancy

However, fibroids can be associated with an increased risk of having a Caesarean section, the baby lying breech (rather than head first) and early labor.

How are fibroids diagnosed?

Some fibroids can be felt during an internal (vaginal) examination by a doctor. Sometimes an ultrasound scan to confirm the diagnosis and to rule out other causes of any symptoms.

What are the treatment options for fibroids?

Observation

If your fibroids are not causing any symptoms then treatment is not usually needed. Many women choose not to have treatment if they have symptoms that are not too bad. After the menopause, fibroids often shrink and symptoms tend to go or ease.

Medication to improve symptoms

  • Tranexamic acid is taken 3-4 times a day, for the duration of each period. It works by reducing the breakdown of blood clots in the womb.
  • Anti-inflammatory medicines such as ibuprofen and mefenamic acid. These also help to ease period pain.
  • The contraceptive pill may help you to have lighter periods and can often help with period pain too.
  • Levonorgestrel intrauterine system (LNG-IUS) is similar to the coil that is used for contraception. It is inserted into the womb and slowly releases a regular small amount of progestogen hormone called levonorgestrel. It works by making the lining of the womb very thin, so bleeding is lighter.

Medication to shrink the fibroids

Some women are given a gonadotrophin-releasing hormone (GnRH) analogue. This is a hormone medicine that causes you to have a very low level of oestrogen in your body. GnRH analogues, such as goserelin or leuprorelin acetate , are often prescribed for three to four months before having an operation, which will make it easier to remove fibroids.

Surgery and other operative treatments

  • Hysterectomy This is the traditional and most common treatment for fibroids which cause symptoms. Hysterectomy is the removal of the womb. This can be done by making a bikini scar in the lower abdomen. Or, if the fibroids are small enough, the womb can be removed through the vagina so there are no scars.
  • Myomectomy This is a possible alternative, especially in women who may wish to have children in the future. In this operation, the fibroids are removed and the womb is left. This procedure is not always possible. This operation can be done through an incision (cut) in the abdomen, via keyhole surgery (laparoscopically) or through the vagina (hysteroscopically).
  • Endometrial ablation This procedure involves removing the lining of the womb. This can be done by different methods. For example, using laser energy, a heated wire loop or by microwave heating. This method is usually only recommended for fibroids close to the inner lining of the womb.
  • Uterine artery embolization. This procedure is done by a specially trained radiologist (X-ray doctor) rather than a surgeon. It involves putting a catheter (a thin flexible tube) into an artery (blood vessel) in the leg. It is guided, using X-ray pictures, to an artery in the womb that supplies the fibroid. Once there, a substance that blocks the artery is injected through the catheter. As the artery supplying the fibroid becomes blocked it means the fibroid loses its blood supply and so the fibroid shrinks.

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