What are fibroids?
Fibroids affect up to 40% of women over the age of 35. They are non-cancerous tumours that grow in the womb and can vary in size from the size of a pea to the size of a grapefruit or even larger. The most common fibroids grow in the muscle wall of the womb, others grow in the outer layer of the womb or in the inner layer known as the endometrium.
Symptoms of fibroids
Some fibroids cause no symptoms. Others can cause one or more of the following;
- Heavy periods, sometimes with blood clots
- Pressure on the bladder, which can cause the need to urinate frequently and urgently
- Pressure on the bowel, resulting in constipation
- A pelvic mass
- Pelvic pressure or the sensation of feeling full in the lower tummy
- Lower tummy pain
- Increase in size around the waist
- Fertility issues
Why do they happen?
The exact cause is unknown but their growth is thought to be stimulated by the female hormone oestrogen. Fibroids shrink after the menopause. Women from an African and Afro-Caribbean background are found to be more likely to have fibroids.
How are they treated?
Before treatment is decided on, a number of diagnostic tests may be arranged. These may include an internal ultrasound, MRI scan or hysteroscopy (a camera test to look inside the womb) are performed, which can help to identify the size, number and position of the fibroids. Very small fibroids measuring less than 3cm may not need treatment.
Daily Ulipristil tablets or monthly injections of Gonadotrophin Releasing Hormone (GnRH) may be given for up to 6 months to treat symptoms ahead of surgery. These injections help to shrink the fibroids. When given in a continuous dose, they prevent the ovary from producing oestrogens and induce a state similar to menopause. Side effects for GnRH include night sweats, mood swings and hot flushes.
Myomectomy is the surgical removal of fibroids. This can be done by key hole surgery, or through a hysteroscopy, depending on the location of the fibroid. It can also be done as an open procedure, which involves an incision in the tummy. This procedure is usually carried out on women who wish to keep their womb and preserve their fertility. Whether this approach is possible depends on the size and location of the fibroids.
Hysterectomy: For some women a hysterectomy is necessary. This is the removal of the womb and the fibroids. The way the surgery is carried out (key hole or cutting open the tummy) will depend on the size of the fibroids.
Uterine Artery Embolisation
This involves blocking the blood supply to the fibroid. This procedure is carried out by inserting a small catheter into the artery of the leg or arm. Using a special x-ray video to trace the blood supply to the womb, the blood supply is then blocked using tiny plastic or gelatin sponge particles. This gradually shrinks the fibroid. This method is a good option for women who do not want surgery or may not be able to have surgery. It is not recommended for women who wish to conceive naturally or using fertility treatments.