What are fibroids?
Fibroids are a really common problem with 1 in 3 women of child-bearing age having them. So, we see lots of women in our clinics with this condition and we offer a range of successful treatments.
Many women are unaware they have fibroids and they do not affect their daily lives; some have one or more of the symptoms listed below, but do not know what is causing them.
Fibroids are different sizes and vary from pea size to large melon size. Women can have single or multiple fibroids. Fibroids are benign (non-cancerous) growths of muscle-like tissue that occur in the uterus (womb).
What causes fibroids?
The exact cause of fibroids is unknown. Women of African and Asian origin tend to be more affected then other ethnic groups. They link to hormone oestrogen and they tend to shrink after menopause.
What symptoms do fibroids cause?
Three out of four women with small fibroids(<3cm) do not have any symptoms. Sometimes the doctor may find one during a routine examination by chance during a scan which may be for another reason.
Symptoms –
- Heavy periods leading to anaemia
- Painful periods
- Pelvic or back pain
- Bloating or swelling
- Problems passing urine and constipation
- Pain during sexual intercourse
- Problems during pregnancy; early onset (premature labour) and pain.
- Miscarriage or subfertility: If the fibroids grow into the cavity of womb, they can affect the fertility. Rarely, fibroids can be a cause of miscarriage.
How are fibroids diagnosed?
Diagnosis is usually confirmed by pelvic ultrasound. Fibroids are usually described according to their size and location. Submucosal (growing in the womb lining), intramural (growing in the wall of the womb) and sub-serosal (growing on the outside wall of the womb). Some fibroids grow on stalks (pedunculated). Other tests may include an MRI scan.
What are the treatment options for fibroids?
The treatment has to be individual. This depends upon the wishes of the women, desire for fertility, size, location symptoms of fibroids.
Conservative/no treatment. If the fibroids are not causing any symptoms, then treatment is usually not needed. After menopause, fibroids often shrink, and symptoms tend to get less.
Medical treatment
Non-hormonal – Anti-inflammatory drugs (Ibuprofen and Mefenamic acid) to treat period pain and /or Tranexamic acid for heavy periods.
Hormonal mediations –These work on you sex hormones and aim to shrink fibroids. Women are often given gonadotropin-releasing hormone (GnRH analogue). It can cause symptoms like going through menopause. It may also increase the risk of ‘thinning’ of the bones (osteoporosis). Therefore, this treatment lasts for a maximum of six months or before surgery to shrink fibroids.
Surgery
Myomectomy (surgical removal of fibroid) is usually done as an abdominal operation (open or keyhole). This operation can also happen through a tiny camera inserted in the uterus from the vagina (hysteroscope).
Hysterectomy removes the womb that contains the fibroids. This is the best treatment option for women who do not wish to preserve their uterus or fertility and who wish a permanent definite cure.
Endometrial ablation. This treatment involves inserting a special fan like device in the uterus from the vagina. This then applies heat energy directly to the inner lining of the uterus. This treatment is very quick (usually 2-3 mins) and is effective at treating heavy periods. After this treatment fertility isn’t guaranteed.
Uterine artery embolization (UAE). This treatment involves inserting a fine plastic tube (less than 2 mm) into the blood vessels to send special pellets which blocks the blood supply of fibroids. The fibroids shrink around 20%-40% over the next six months but one in three women will need further treatment. After this treatment fertility isn’t guaranteed. (Ref:https://www.rcr.ac.uk/)
MRI- guided focused ultrasound therapy (MRgFUS). This is available to women with fibroids less than 10cm in size and less than 5 in number. This is available in selected centres only