| Infertility - Female Infertility Articles |
A fibroid is a benign (non-cancerous) growth of the uterus. They are also called myomas.
They can vary from pea-sized to the size of a melon. They can occur anywhere in the uterus and are named differently depending upon where they grow:
Intramural fibroids grow within the muscle tissue of the uterus. These are the most common place for fibroids to form.
Subserous fibroids grow from the outside wall of the uterus into the pelvis.
Submucous fibroids grow from the inner wall into the middle of the uterus.
Pedunculated fibroids grow from the outside wall of the uterus and are attached to the uterus by a narrow stalk.
How common are fibroids?
Fibroids are very common. At least 1 in 4 women develops one or more fibroids in their lifetime. They usually develop in women aged 30-50 years and can sometimes run in families. It is common to have several fibroids of various sizes, although some women just have one fibroid. Fibroids are more common in women from Afro-Caribbean origin.
What causes fibroids?
It is not clear why they develop. Like the uterus, fibroids are sensitive to oestrogen, the hormone that is made in the ovary. Fibroids tend to swell when levels of oestrogen are high, for example, during pregnancy. They also shrink when oestrogen levels are low, for example, after the menopause.
Symptoms only occur in about one in three women with fibroids. Many women who have fibroids are not aware that they have them. Sometimes one is found during a routine examination by a doctor or by chance during a scan which you may have for another reason.
Symptoms may include:
Heavy or more painful periods
Fibroids do not disturb the menstrual cycle but bleeding is often heavier than usual, sometimes with more pain. This can lead to low iron levels and anaemia which will be diagnosed by a blood test. This is easily treated with iron tablets.
Bloating or swelling
If a fibroid is large you may have discomfort or swelling in the lower abdomen. Some women experience lower back pain due to their fibroids.
Bladder or bowel symptoms
Occasionally, a fibroid may press on the bladder, which lies in front of the uterus. You may then pass urine more often than usual. Rarely, pressure on the rectum (which lies behind the uterus) may cause constipation.
Pain during sexual intercourse
If the fibroids grow near to the vagina or cervix (neck of the womb) then this can cause pain or discomfort during sexual intercourse (dyspareunia).
Miscarriage or infertility
If the fibroids grow into the cavity of the uterus they can sometimes block the fallopian tubes leading to problems with infertility. This is not common though. Very rarely, fibroids can be a cause of repeated miscarriages.
Problems during pregnancy
Many pregnant women have one or more fibroids which do not interfere with their pregnancy in any way. However, fibroids can be associated with an increased risk of having a Caesarean section, the baby lying breech (rather than head first) and early labour. Your doctor will advise you further if you are pregnant and have fibroids.
How are fibroids diagnosed?
An ultrasound scan or other tests are done to confirm the diagnosis and to rule out other causes of any symptoms.
What is the treatment for fibroids?
Observation
If fibroids are not causing any symptoms then treatment is not usually needed. Many women choose not to have treatment if they have symptoms that are not too bad. After the menopause, fibroids often shrink and symptoms tend to go or ease. You can change you mind and consider treatment if symptoms get worse. Your doctor may advise you to have a repeat scan to assess the growth and size of your fibroids.
Medication to shrink the fibroids
Some women are given a gonadotropin releasing hormone (GnRH) analogue. This is a hormone medicine that causes you to have a very low level of oestrogen in your body. Fibroids shrink if the level of oestrogen falls. This can ease heavy periods and pressure symptoms due to fibroids. However, a low oestrogen level can cause symptoms similar to going through the menopause (hot flushes, etc). It may also increase the risk of osteoporosis. Therefore, this treatment is given for a maximum of six months.
Surgery
There are now several different operations available to remove and treat fibroids.
Hysterectomy
This is the traditional and commonest treatment for fibroids which cause symptoms. Hysterectomy is the removal of the entire uterus. This is either done by making a bikini scar in the lower abdomen or with laparoscopy.
Myomectomy
This is a possible alternative, especially in women who may wish to have children in the future. In this operation the fibroids are removed and the uterus is left. This procedure is not always possible. This operation can be done through an incision (cut) in the abdomen, via "keyhole" surgery (laparoscopically) or through the vagina (hysteroscopically). The type of operation depends on the size, number and position of the fibroids.