Fibroids are a common gynaecological problem, usually presenting during your reproductive years. As the name suggests, fibroids are composed of firm rubbery fibrous tissue, and sometimes have muscle cells within them too. Fibroids usually grow in the uterus, but occasionally in the cervix or just outside the uterus in the inner wall of the pelvis. The medical term for a fibroid is a leiomyoma. 

What causes fibroids?

The honest answer is no-one really knows. They are more common in women with a family history of the condition. Certain ethnic backgrounds are more pre-disposed, in particular Japanese women, and women of African-American descent, though they are still common in Caucasian women too. An old saying in gynaecology was “50% of women will have a fibroid by the age of 50”, though this is possibly an underestimate! Sometimes a woman will have a solitary fibroid, however, just as often they are multiple: often between 2 and 20 fibroids might be found on Ultrasound or in surgery. In rare cases, more than 100 fibroids have been identified in a single patient’s uterus! 

How do I know if I have fibroids? 

You won’t know until you have presented to your GP or gynaecologist and he or she examines you. Symptoms typically can be heavier periods, prolonged periods, pelvic pressure (rather than pain), and sometimes bloating. As uterine fibroids grow, you may experience bladder frequency (needing to pee more often), constipation, and discomfort or pain with intercourse. Examination and a pelvic ultrasound will lead to a diagnosis. 

Can fibroids be a problem in pregnancy? 

It depends.  

Some fibroids protrude into the uterine cavity (submucosal) and can affect fertility and have been associated with miscarriage. Other fibroids grow on the outside of the uterus (subserosal) and don’t affect pregnancy to any great extent. Some fibroids are large, grow in the muscular wall (intramural) and will grow rapidly with the increased blood flow and oestrogen production in pregnancy. This may cause significant pain on occasion or lead to premature labour.  

Are fibroids ever cancerous?  

Fortunately, this is rare. Malignant change is estimated to only occur in 1 in 1000 cases. These cases are usually of a single rapidly enlarging and painful fibroid. 

What treatments are available?  

Firstly, many women have small fibroids and no clinical problem arising from this, so you may require no treatment at all. A simple follow up appointment with a scan in the rooms annually may be enough. If heavy bleeding is the problem, then medication may help. Surgery performed within the uterus using a special telescope (hysteroscope) may be indicated to shave back the fibroids that involve the cavity and interfere with the lining of the uterus. Sometimes, you may be required to have surgery to remove large fibroids from your uterus to relieve symptoms. This may be keyhole or open surgery.  

Sometimes, hysterectomy (removal of the uterus) may be the appropriate solution for very large fibroids in women who have completed their families.  

In recent years, developments in radiology have allowed a technique to block the blood supply to an individual fibroid causing it to die and shrink in size. Known as fibroid embolization, this technique is suitable in some but not all cases. 

Which treatment will be right for me? 

Basically, treatment options for uterine fibroids depend on age, childbearing status, symptoms and the number and position of the fibroids themselves. When I see patients with fibroids, careful consideration is given to all the above. An open discussion is had so that you can decide what is the best option for your personal requirements.  

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Author: Dr Peter England, Obstetrician and Gynaecologist.
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