What are fibroids?
Fibroids (sometimes referred to a uterine myomas or leiomyomas) are benign growths of different sizes, which form in or around the womb. These non-cancerous growths are made up of muscle and tissue.
Most women with fibroids are unaware of it, as only around 1 in 3 will experience symptoms. In many cases, fibroids are discovered by chance when carrying out a routine gynaecological examination or a scan.
Fibroid symptoms include heavy or painful periods, abdominal pain, lower back pain, frequent urination, constipation and pain during sex.
Do I need treatment for fibroids?
Treatment is necessary if your fibroids are causing noticeable symptoms or discomfort on a daily basis or affect fertility. For most people, fibroids (and the associated symptoms) are mild and will shrink on their own without treatment once you have gone through the menopause. This is because fibroids begin to shrink once the body’s oestrogen levels decrease.
Each type of fibroid should be treated differently, and the choice of treatment depends on the severity of your symptoms, the size and location of the fibroids, your preferences, and other factors, such as your age and whether you want to have children. Your GP or consultant will talk to you and recommend the most suitable treatment path for you.
What medications are used to treat fibroids?
There are several different types of medication that can be used to help with fibroids. Medications will not eliminate fibroids, but they might shrink them or slow down their growth velocity. They work by affecting the hormones that regulate the menstrual cycle. However, medication can be less effective for larger fibroids.
Levonorgestrel intrauterine system (LNG-IUS)
This is a small plastic T-shaped device that is carefully placed inside the womb. It slowly releases the progestogen hormone, levonorgestrel, to stop the uterus lining from growing too quickly. It helps by making the lining thinner and bleeding becomes noticeably lighter.
Gonadotropin-releasing hormone (Gn-RH) agonists
These block the production of oestrogen and progesterone to create an artificial and temporary menopausal state. This effectively stops periods so fibroids can shrink. Sometimes, we may prescribe a Gn-RH agonist to reduce the size of a woman’s fibroids before elective surgery. It is only prescribed on a short-term basis.
There are a range of side effects to bear in mind with this category of treatment. You may experience menopausal symptoms, such as:
- Hot flushes
- Increased sweating
- Muscle stiffness
- Vaginal dryness
To mitigate against these side effects, gynaecologists may prescribe a combination of GnRH as and a low dose of hormone replacement therapy (HRT). Fibroids start growing again and the symptoms gradually return after the medication is stopped.
The contraceptive pill is a popular option for helping with fibroid symptoms. As well as making bleeding lighter, they can also reduce menstrual pain.
Similarly, the intra-uterine system (Mirena coil) can be implanted inside the womb. This progesterone-releasing coil can reduce heavy bleeding caused by fibroids. Whilst it can improve the symptoms, it will not reduce the size of the fibroids.
What are the surgical treatment options for fibroids?
This procedure involves removal of the fibroids while leaving the uterus in place. Through three or four very small incisions, the instruments are inserted into the abdomen and then the fibroids are removed from the uterus. The surgeon is able to view the abdominal area on a monitor through a small camera attached to one of the instruments.
It is the preferred treatment for intramural (fibroids growing inside the uterine muscle) and subserosal (fibroids protruding outside the uterine surface) fibroids, as it allows quick recovery, a shorter hospital stay, less pain after the operation and a quick return to regular daily activities.
This is a procedure where hysteroscope (a thin telescope) and small surgical instruments are used to remove submucosal fibroids from inside the womb. No incisions are needed because the hysteroscope is inserted through the vagina and into the womb. The procedure is often carried out under general anaesthetic and patients can usually go home on the same day.
After the procedure, patients often report having stomach cramps, but they do not last for long – normally only a couple of hours. There may also be a small amount of vaginal bleeding, but this usually stops after a couple of weeks.
Our experienced gynaecologists can also remove fibroids by carefully placing a hysteroscope inside the womb and using a morcellator to cut away and remove the fibroid tissue. The procedure can be carried out under general or local anaesthetic.
Patients can also go home the same day.
Minimally invasive surgery to remove Fibroids
Whilst we can offer surgical procedures, minimally invasive procedures are preferable. These methods include:
Uterine artery embolization (fibroid embolization)
Small particles are directed into the arteries which supply the uterus with blood and will cut off the blood supply to the fibroids. As a result, the fibroids shrink and die. It is a very effective technique but requires an MRI beforehand in order to decide whether the fibroids are suitable for embolisation.
It is performed under local anaesthetic by an interventional radiologist and is a day case procedure. The whole procedure should take around 45 minutes. No stitches are required, but a catheter will be inserted into the skin of the groin area, so there may be some bruising in this region afterwards. Patients can expert pain for the first 12-18 hours after the procedure and will be given strong painkillers. Lower abdominal pain is common for 7-10 days, as well as vaginal discharge.
The result of the procedure is that fibroids shrink, but do not disappear. Around 85-90% of patients who undergo this treatment see a relief in symptoms and require no further treatment.
Can fibroids come back after treatment?
Although the treatment options manage to successfully address the issue and provide relief of fibroid symptoms, many do not cause fibroids to disappear but rather to shrink. In some cases, fibroids may grow again and result in symptoms that require additional care.
The only treatment option in which there is no risk of fibroids returning is a hysterectomy, where the entire uterus is removed. However, this is a last resort treatment and is not suitable for the majority of fibroid patients.