A fibroid is a benign (non-cancerous) growth of the womb (uterus). They are very common and usually cause no symptoms. However, they can cause heavy periods, anaemia, back pain, pelvic pain, abdominal swelling, infertility and urinary problems. Their size can vary from very small to very large; some can be as big as a melon. Fibroids can grow, shrink or even disappear with time. They can be single or multiple and can occur anywhere within the muscle of the womb and are described according to where they grow:
Intramural fibroids grow within the muscle tissue of the womb. This is the most common place for fibroids to form.
Subserous fibroids grow next to the outside wall of the womb.
Submucous fibroids grow next to the inner cavity of the womb.
Pedunculated fibroids grow from the outside wall of the womb and are attached to it by a narrow stalk.
What are the treatment options for fibroids?
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. You can change your mind and consider treatment if symptoms get worse. Your doctor may advise you to have a repeat scan to assess the growth and size of your fibroids.
2. Medication to lessen bleeding and pain
The following medicines are used to treat heavy periods whatever the cause, including heavy periods that are caused by fibroids. These medicines may not work so well if your fibroids are large. However, one or more of the following may be worth a try if your periods are heavy and the fibroids are small:
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. They are taken for a few days at the time of your period. They work by reducing the high level of a chemical (prostaglandin) in the lining of the womb. Prostaglandin seems to contribute to heavy and painful periods.
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. However it can sometimes be difficult to insert into the womb in women with fibroids.
3. 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. Fibroids shrink if the level of oestrogen falls. This can ease heavy periods and pressure symptoms due to fibroids. However, a low oestrogen level can cause symptoms similar to going through the menopause (hot flushes, etc). It may also increase the risk of osteoporosis. Therefore this treatment is given for a maximum of six months.
GnRH analogues are often prescribed for three to four months before having an operation, which will make it easier to remove fibroids. Sometimes a low dose of HRT is also given to reduce the incidence of menopausal side-effects.
4. Surgery and other operative treatments
There are several different operations available to remove and treat fibroids.
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. A hysterectomy may be a good option for women who have completed their family.
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). The type of operation depends on the size, number and position of the fibroids. Recurrence of the fibroid is fairly common after a myomectomy. There is a risk of very heavy bleeding with this operation and a hysterectomy may be needed if that situation arose.
5. Uterine artery embolisation
This “pin-hole” surgical procedure is carried out under Xray guidance by an Interventional Radiologist (Doctor specialising in Image-guided surgery) who works closely with your Gynaecologist. The procedure involves an overnight stay in hospital. Under sedation, it involves passing an arterial catheter (a thin flexible tube) from the femoral artery in the groin guided, by the Xray camera, to the uterine arteries that supply blood to the fibroids. Once in place, a substance that blocks the artery is injected through the catheter cutting off the blood supply to the fibroids. The fibroid tissue then dies and the fibroids begin to shrink. The complete process of fibroid shrinkage takes about 6-9 months but most women notice a marked improvement in their symptoms within three months. There is a good chance of success (approx 90%) with this procedure but in some cases it may require a repeat procedure.
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