What is a fibroid?

Uterine fibroids are benign (non-cancerous) growths in the uterus (womb). They develop from the cells that make up the muscle of the uterus. They are also called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may appear inside the uterus, on its outer surface, within its wall, or attached to it by a stemlike structure. Fibroids can range in size from small, pea-sized growths to large, round ones that may be more than 10 cm. As they grow, they can distort the inside as well as the outside of the uterus. Sometimes fibroids grow large enough to completely fill the pelvis or abdomen. A woman may have only one fibroid or many of varying sizes. They may remain very small for a long time, suddenly expand, or grow slowly over a number of years.

How common are fibroids?

Fibroids are the most common type of growth found in a woman’s pelvis. They occur in about 25 to 50 per cent of all women. Fibroids are most common in women aged 30 to 40 years, but can occur at any age. Many women who have fibroids are not aware of them because the growths can remain small and not cause symptoms or problems. These often do not require treatment.

What are the symptoms?

Most fibroids, even large ones, produce no symptoms at all. When symptoms do occur, they can include:

changes in menstruation (more bleeding, longer or more frequent menstrual periods, period pain)
pain – heavy and aching in the abdomen/lower back and/or during sex.
Pressure – frequent or difficult urination; constipation or difficult bowel movements; abdominal cramps.
These symptoms are not unique to fibroids. Because fibroids are so common these symptoms may well be signs of other problems.

Can fibroids cause complications?

Fibroids that are attached to the uterus by a stem may twist. This can cause pain, nausea or fever. Fibroids may become infected. In most cases, this happens only when there is an infection already in the area. In very rare cases, rapid growth of the fibroid and other symptoms may signal cancer. Fibroids also may cause infertility. This is rare, and other factors should be explored before fibroids are considered the cause of a couple’s infertility.

How are fibroids diagnosed?

The first signs of fibroids may be detected during a routine pelvic exam. Ultrasound scan, hysteroscopy (telescope to look directly into the inside of the uterus), and laparsscopy (telescope to look directly into the abdomen) all have a role in providing more information about fibroids. Some of these tests may be helpful to check on the growth of the fibroid over time.

What are the treatment options?

Fibroids may be managed by:

Observation of the fibroids. Fibroids that do not cause symptoms, are small, or occur in a woman nearing menopause, often do not require treatment.

Medications. Some medications are helpful to deal with the symptoms produced by fibroids for example, the contraceptive pill, anti-inflammatory tablets, and Mirena intrauterine system. There are no medicines that effectively reduce the size of fibroids in the long-term.

Myomectomy. This is an operation that involves removing the fibroids from the uterus. Because a woman keeps her uterus, she may still be able to have children. If a woman does become pregnant after a myomectomy, she may need to have a caesarean birth. Sometimes a myomectomy causes internal scarring that can lead to infertility. Fibroids may develop again, even after the procedure. If they do, more surgery is needed in 20 to 40 per cent of cases. This operation can be done via hysteroscopy, laparoscopy or laparotomy depending on the size and the location of the fibroids

Uterine artery embolisation. This is a procedure that involves blocking the blood vessels to the uterus in order to halt the growth of the fibroids. It involves a small cut in the groin area. A small tube is then passed through each of the two arteries to the uterus through which tiny particles are injected to cut off the blood flow. Many women have cramping for a few hours after the procedure. Some women have nausea or fever. The effects of uterine artery embolisation on a woman’s fertility are not known. Women who may want to have children may want to consider other forms of treatment.

Hysterectomy, an operation to remove the uterus with the fibroids and usually the cervix as well.

How effective is treatment?

The effectiveness of the treatment depends on the size and location of the fibroid as well as your proximity to menopause. Your doctor will provide you with more specific advice.