Often referred to as uterine myomas, fibromas or leiomyomas, fibroids are benign (non-cancerous) growths that develop in or around the womb.
They are firm, compact tumours that consist of muscle cells and fibrous connective tissue within the uterus and they can vary in diameter, from the size of a pea to the size of a small orange.
Fibroids are a very common issue. Some reports claim that 30% to 77% of women will develop fibroids during their reproductive years. However, many women are unaware that they have fibroids because they simply don’t experience any symptoms. Moreover, only 1 in 3 fibroids are large enough to be detected by a healthcare professional during an examination.
What causes Fibroids to grow in the Uterus?
There is inconclusive evidence to pinpoint why fibroids grow but it is widely believed that they develop from an abnormal muscle cell which rapidly multiples from high levels of oestrogen in the body. This is why women who are approaching the menopause are considered to be at the greatest risk of developing fibroids.
Women who are clinically obese or of black ethnicity are also thought to be at a higher risk of fibroids, although the reasons for this are not clear.
What are the symptoms of Fibroids?
While symptoms do not always present themselves, the magnitude to which a woman can exhibit the key symptoms can range from mild to severe and varies from person to person.
The most common symptoms include:
- Heavy, prolonged or painful periods
- Abnormal bleeding between mensuration
- Abdominal pain or discomfort
- Back pain
- Pelvic pain (caused by tumour pressing on the pelvic organs)
- Frequent urination or difficulty passing urine
- Pain during sex
- A firm mass, often located near the middle of the pelvis, which can be felt by a doctor
Types of Fibroids
- Intramural fibroids – They develop in the muscle of the womb.
If large enough, they can distort the shape of the uterus and cause heavy periods, pain and pressure.
- Subserosal fibroids – they originate in the muscle wall but protrude outside the womb into the pelvis.
- Submucosal fibroids – they grow into the inner cavity of the womb and are more likely to cause bleeding problems or difficulties when trying to conceive.
Pregnancy and Fibroids
There is also a complex relationship between infertility and fibroids. While fibromas don’t typically interfere with conception, they have been associated with recurrent miscarriages and/or subfertility. This could be because submucosal fibroids may prevent implantation and, thereby, affect the growth of a foetus. In such cases, we often recommend removing the fibroids before a woman tries to fall pregnant again.
In essence, it’s not yet known whether having children actually protects women from developing fibroids or whether fibroids are a factor in reduced fertility amongst women who have no children. Further research is being conducted to improve our knowledge of this.
Detection & Diagnosis
Fibroids are most often found during a physical examination of the pelvic and abdominal area. As previously indicated they will form an irregular yet firm pelvic mass. As well as a complete medical history the following diagnostic procedures may also be used:
- Transvaginal ultrasound: A small instrument called a transducer is carefully placed inside the vagina. It uses sound waves to assess the shape, size and consistency of the uterus. It can confirm the diagnosis and map the measurements of the fibroids.
- Magnetic resonance imaging (MRI): This is a non-invasive procedure that creates a 2D representation of the womb. It is used to evaluate the size and location of the fibroids in order to help determine the appropriate form of treatment.
- Hysterosonography: This test uses a saline solution to distend the uterine cavity and fallopian tubes. This helps to provide an ultrasound which accurately shows the presence of submucosal fibroids. It can also be used to rule out tubal obstruction.
- Hysteroscopy: A small telescope called a hysteroscope is inserted through the vagina. It provides a visual examination of the cervix canal and the uterus. It is the gold standard investigation for the diagnosis (and treatment) of submucosal fibroids. In the vast majority of cases, it can be performed with or without local anaesthetic.
- A blood test may also be carried out to check for iron-deficiency anaemia if heavy bleeding is caused by the uterine fibroids.
Treatment for Fibroids
From the outset, it’s important to note that not all fibroids require a course of treatment. Depending on the type and severity of the fibroids we will offer different treatments.
In almost all cases, the fibroids will shrink and may eventually disappear after menopause.