Fibroids

Fibroids are abnormal growths in the uterus that consist of muscular and fibrous tissue. Fibroids are found in up to 1 in 3 women of childbearing age in the UK and are more common black women. Fibroids occur singly or in groups and may be as small as a pea or as big as a grapefruit. Small fibroids may not cause problems, but larger ones may affect menstruation or fertility.


What are the causes?

The cause of fibroids is unknown, but they are thought to be related to an abnormal response by the uterus to the female sex hormone oestrogen. Fibroids do not occur before puberty, when the ovaries begin to increase oestrogen production, and they usually stop growing after the menopause. They also increase in size at times when there are increased levels of oestrogen in the body, such as during pregnancy and when taking the combined contraceptive pill or hormone replacement therapy.

What are the symptoms?

Most small fibroids do not cause symptoms, but the common symptoms of larger fibroids include:

- Prolonged menstrual bleeding.
- Abdominal pain during periods.
- Heavy bleeding during periods.

Heavy blood loss may lead to anaemia, cause pale skin and tiredness. Large fibroids may distort the uterus, which can often result in infertility or in recurrent miscarriages. During pregnancy, a large fibroid may cause the fetus to lie in an abnormal position. Fibroids may also press on the bladder, causing a need to pass urine often, or on the rectum, causing back pain. Rarely, a fibroid may become twisted, resulting in sudden pain in the lower abdomen.

How are they diagnosed?

The doctor will perform a pelvic examination. You may also have ultrasound scanning of the uterus or a hysteroscopy, in which a viewing instrument is inserted into the uterus through the cervix. A sample of the fibroid will be removed during the hysteroscopy to check that the growth is not cancerous. Sometimes, fibroids show up on X-rays that are taken for other reasons.

What is the treatment?

Small fibroids often do not need treatment but should be checked regularly by your doctor to make sure that they have not grown. If treatment is necessary, fibroids may be removed during a hysteroscopy if they are on an inner wall. Rarely, fibroids are treated using an in injection of a substance that blocks the blood vessels supplying them, causing the fibroids to shrink.

Large fibroids can be removed via an incision in the abdomen. Before having the surgery, you may be prescribed hormones that suppress the production of oestrogen so that the fibroids shrink. If you have persistent, large fibroids and do not want children, you may consider having a hysterectomy. Removal of fibroids usually results in regained fertility, but in about 1 in 10 women fibroids recur. Fibroids usually start to shrink after the menopause, when oestrogen levels in the body fall.

HYSTEROSCOPY

A hysteroscope is an instrument used to see inside the uterus and fallopian tubes. Hysteroscopy is used to diagnose disorders such as uterine polyps and can be performed under general or local anaesthesia in an outpatient clinic. Minor surgery, such as the removal fibroids, may also be carried out through the hysteroscope. The procedure usually lasts 15 minutes or less.