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Fibroids

Fibroids are benign (non-cancerous) growths that can occur in your womb (uterus). They are also known as myomas or leiomyomas.

Fibroids are very common – around one in two women will be affected at some point in their lives. Your chance of getting fibroids increases with age – they tend to develop after puberty up until the age of menopause.

Although fibroids are very common, you may not have any symptoms. Fibroids that do cause symptoms usually occur in women over the age of 30.

You may only have one fibroid or you might have many fibroids of different sizes. They don't spread to other parts of your body, except in very rare circumstances.

Fibroids are named according to where they are found in your womb.

  • Subserous fibroids grow from the outside wall of your womb into the space in your pelvis. They can become very large.
  • Intramural fibroids grow within the muscular wall of your womb.
  • Submucosal fibroids grow from the inner wall of your womb into the space inside your womb.
  • Pedunculated fibroids grow from the outside of your womb. These fibroids are almost free of the wall of your womb and are only attached by a narrow stalk.

Fibroids grow very slowly, but hormones, especially oestrogen, can speed up how quickly they grow. Fibroids tend to become smaller and reduce in number when your oestrogen levels fall, such as after the menopause.

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Image showing the different types of fibroid

Details

  • Symptoms Symptoms of fibroids

    Fibroids may not cause you any symptoms. You may get one or more of the symptoms listed below, often depending on where the fibroid is within your womb. You may:

    • have heavy periods, sometimes leading to anaemia
    • have swelling in your tummy (abdomen)
    • feel pain in your pelvis
    • pass urine more often, or feel an urgent need to pass urine – this happens if a fibroid is pressing on your bladder
    • have constipation – this happens if a fibroid is pressing on your bowel

    You can get severe pain if your fibroid twists or outgrows its blood supply causing it to break down, but this is rare.

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  • Diagnosis Diagnosis of fibroids

    Fibroids are sometimes found during a routine gynaecological (vaginal) examination.

    Your GP will ask about your symptoms and your medical history. You may be advised to have a vaginal examination if they think you have fibroids. This involves your GP inserting gloved, lubricated fingers into your vagina to gently feel for any abnormalities in your womb or cervix. At the same time, they will use their other hand to lightly press on your tummy.

    Your GP will be able to check the size of your womb. This is important because fibroids can make your womb larger than normal. If your doctor thinks you may have fibroids, they may suggest you have further tests. These may include the following.

    • An ultrasound scan. This uses sound waves to produce an image of your pelvis and can confirm if you have fibroids.
    • Hysteroscopy. This is a test that involves your doctor putting a small camera into your vagina to look inside your womb. It can diagnose if you have submucosal fibroids. At the same time a biopsy of the lining of your womb can also be taken. A biopsy is when a small sample of tissue is taken.
    • An MRI scan. This uses magnets and radio waves to produce an image of your lower abdomen. An MRI scan can show how many fibroids you have, how big they are and where they are in your womb.
    • Laparoscopy. This is a test that also involves using a small camera, but it’s inserted through a small cut into your abdomen under general anaesthetic. This means you’ll be asleep during your procedure. A laparoscopy is used to look at your womb and your other organs within your pelvis. It’s usually used to see if you have any other problems other than fibroids.
    • Blood tests. These can check if you have anaemia.
  • Treatment Treatment options for fibroids

    There are a number of treatment options for fibroids. Which treatments you’re offered will depend on a number of things.

    It’s important to let your doctor know if you’re planning on having a baby in the future. This is because some of the treatments for fibroids can affect your chances of getting pregnant. Speaking to your doctor about your wish to have a baby can help them suggest the most suitable treatment options for you.

    Your treatment choices will also depend on:

    • the size of your fibroids
    • how many fibroids you have
    • the location of your fibroids
    • the symptoms you’re having

    Your doctor will discuss your treatment options with you to help you make a decision that’s right for you. Your decision will be based on your doctor’s expert opinion and your own personal values and preferences.

    If you don't have any symptoms, or if your symptoms are mild, you may not need treatment. But if you have more severe symptoms, there’s a range of treatment options that may help.

    Medicines

    Medicines can’t cure fibroids, but hormone-based treatments may help to relieve your symptoms.

    Medicines to help relieve pain

    Non steroidal anti-inflammatory (NSAID) medicines such as ibuprofen may help to relieve any pain you have. You can buy ibuprofen from a pharmacy, supermarket or other shops, without a prescription from your GP. NSAIDs can cause side-effects such as feeling sick (nausea), headache and diarrhoea. If you’re finding you need to take these medicines for a long period of time, or they aren’t helping to ease your pain, see your doctor.

    Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist or your doctor for advice.

    Medicines that reduce heavy bleeding

    There are a number of different medicines that can be used to reduce heavy bleeding during your periods. Some of these also act as contraception. For example, the levonorgestrel-releasing intrauterine system is a small device that’s placed in your womb. It stops the lining of your womb from growing quickly, making the bleeding lighter during your periods.

    If you have very heavy or painful periods, you doctor might suggest that you take a medicine called tranexamic acid or mefenamic acid. Alternatively, your doctor may offer you the combined oral contraceptive pill.

    A type of contraceptive medicine called progestogen may help to treat heavy bleeding during your periods. You can have this as an injection once every 12 weeks for as long as you need it. For more information about contraception, see our FAQ.

    Medicines that shrink your fibroids

    Treatment with medicines called gonadotropin-releasing hormone analogues (GnRH analogues) can lower your oestrogen levels, which usually shrinks fibroids.

    If you're having surgery to remove fibroids, your doctor may prescribe you GnRH analogues such as goserelin or leuprorelin acetate. You take these for three to four months before your surgery to make it easier for your surgeon to remove your fibroids.

    GnRH analogues can cause you to have symptoms similar to the menopause whilst you take them. Symptoms may include hot flushes and, if used in the long-term, osteoporosis (thinning of your bones). Therefore, you can only take GnRH analogues for a maximum of six months.

    Surgery

    There are a number of surgical options for treating fibroids.

    Surgical treatment options if you want to have a baby in the future

    Myomectomy

    Myomectomy is a procedure that removes your fibroids but leaves your womb in place. It may be done through a cut in your abdomen (tummy), or sometimes it may be possible for your surgeon to use keyhole (laparoscopic) surgery. A myomectomy is done under general anaesthetic so you will be asleep during the procedure.

    You may be offered a myomectomy if you would like the option to become pregnant in the future. However, as your womb isn't removed there’s a chance that more fibroids will grow. This means there’s a chance that you may need to have further treatment.

    Uterine artery embolisation (UAE)

    In this procedure, a small tube is guided from a vessel in your leg into the blood supply of your fibroid. A chemical is then injected through this tube, which blocks the blood supply to your fibroid, causing it to shrink.

    You will be offered a local anaesthetic if you have UAE. This means that feeling in the affected area is completely blocked, but you will stay awake during the procedure. You might also be offered a sedative to help you relax.

    UAE may help to relieve your symptoms for up to two years. However, your symptoms might return, so you may need to have more treatment.

    Although it may be possible to become pregnant after you’ve had UAE, doctors aren’t sure about how the procedure affects fertility and pregnancy. Therefore, if you wish to become pregnant in the future, it’s important that you talk to your doctor about the potential risks of having this procedure. They will help you decide whether UAE is the best option for you.

    Surgical treatment options if you don’t want to have a baby in the future

    Hysterectomy

    This is a major procedure to remove your entire womb and can be done as open or keyhole surgery. Usually, your surgeon will remove your womb and/or your ovaries through your abdomen or your vagina. If you have a hysterectomy, your symptoms will get better and you won’t get any more fibroids. It's not possible to get pregnant after having a hysterectomy.

    Endometrial ablation

    Endometrial ablation is a procedure which removes the lining of your womb. This is done using energy, such as microwaves, or heat. If you decide to have this procedure, you will be offered either a general or a local anaesthetic.

    Endometrial ablation is typically used to treat heavy bleeding during your periods. It’s important to remember that, your symptoms may return after having this procedure and so you might need to have further treatment. Becoming pregnant after an endometrial ablation is unlikely, but can still happen. However, this procedure isn’t suitable if you’d like to have a baby. This is because you’re more likely to have a miscarriage or other complications after you’ve had an endometrial ablation. It’s important to remember that you’ll need to use contraception after your treatment. If you would like more information about this, talk to your doctor about your treatment options.

  • Fibroid removal on demand

    You can access a range of our health and wellbeing services on a pay-as-you-go basis, including fibroid removal.

  • Causes Causes of fibroids

    We don’t know for sure what causes fibroids. But it’s thought that certain hormones, such as oestrogen and progesterone may encourage them to grow.

    You're more likely to get fibroids if you:

    • are aged 30 to 50
    • go through puberty at an early age
    • are overweight
    • are African-Caribbean – women of this background are three times more likely than Caucasian women to get fibroids
    • don’t have any children
  • Complications Complications of fibroids

    Most women with fibroids can have a normal pregnancy and delivery, but, there can be some complications. For example, submucosal fibroids can affect your womb, which can make it more difficult for you to become pregnant.

    In later pregnancy, fibroids can cause your baby to lie in the breech position (with their feet or bottom first rather than their head downwards). Because of this, you may need to have a caesarean section to deliver your baby. Sometimes fibroids can cause other problems such as miscarriage, premature labour and bleeding.

    If you're pregnant and have fibroids, your GP may refer you to an obstetrician (a doctor who specialises in pregnancy and childbirth) for specialist care. It’s very rare for fibroids to become cancerous. However, if you’re getting increasing abdominal pain or swelling that happens very suddenly, see your doctor.

  • FAQs FAQs

    Is it possible for fibroids to come back after surgery?

    Answer

    Yes, there’s a chance that they will come back after surgery, unless you have a hysterectomy.

    Explanation

    The only way to completely get rid of fibroids is to have a hysterectomy. This is a procedure which removes your entire womb.

    After having a hysterectomy you won't be able to have any children. If you plan on having a baby you’ll need to consider having a different type of surgery, such as a myomectomy, or a non-surgical treatment instead. Speak to your GP or gynaecologist (a doctor specialising in women's reproductive health) for advice on which treatment is the most suitable for you.

    Will the symptoms of fibroids improve after I’ve gone through the menopause?

    Answer

    Yes, fibroids tend to shrink after the menopause so your symptoms should improve.

    Explanation

    After the menopause, the amount of the hormone oestrogen in your body decreases. This will usually cause your fibroids to gradually shrink, and in turn, your symptoms should lessen or go away completely.

    If you're approaching the menopause you might want to wait and see if your symptoms get better before you consider having any surgery. Speak to your GP or gynaecologist for advice as to what might be the best option for you.

    Can contraception treat the symptoms of fibroids?

    Answer

    Yes, contraception can be used to treat some of the symptoms of fibroids.

    Explanation

    There are different types of contraception that can be used to help with the symptoms of fibroids. It’s important to talk to your GP about your treatment options and whether you wish to have a baby in the future. This can help your GP advise you on the best treatment for you.

    The combined contraceptive pill can be used to help with the symptoms of fibroids, such as heavy, painful periods. It contains the hormones oestrogen and progesterone and comes as tablets that you take every day for 21 days and then you have a seven day break.

    The combined contraception pill is suitable if you’re not trying or planning to have a baby. There are other reasons why it may not be suitable, including if:

    • you’re overweight
    • you’re over the age of 35
    • you smoke
    • you have high blood pressure

    The levonorgestrel-releasing intrauterine system (LNG-IUS) is another type of contraception that can help reduce the symptoms of fibroids. It’s a small device that’s placed in your womb for at least 12 months. The LNG-IUS prevents the lining of your womb from growing quickly, which in turn reduces the amount of bleeding during your periods.

    Progestogen is also a type of contraception that may be used to reduce heavy bleeding during your periods. If your GP thinks that this might be a good treatment option for you, you may be given this as an injection. You can have this injection once every 12 weeks for as long as you need it. It’s worth bearing in mind that it can take a few months for your fertility to get back to normal after stopping the injections.

    Speak to your GP for more information about the treatments that are available.

  • Resources Resources

    Further information

    Sources

    • Fibroids. NICE Clinical Knowledge Summaries. cks.nice.org,uk, published February 2013
    • Uterine fibroids. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Fibroids. British Society of Interventional Radiology. www.bsr.org, accessed 7 July 2014
    • Fibroids. PatientPlus. www.patient.co.uk/patientplus.asp, published 13 January 2013
    • Menorrhagia. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published August 2012
    • Uterine fibroids. BMJ Best Practice. www.bestpractice.bmj.com, published 1 December 2014
    • Breech presentation. Medscape. www.emedicine.medscape.com, published 9 July 2012
    • Pregnancy. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014
    • Gyneacological history and examination. PatientPlus. www.patient.co.uk/patientplus.asp, published 18 March 2011
    • Martin, EA. Concise colour medical dictionary. 3rd ed. Oxford: Oxford University Press; 2002: 715, 401 (printed version)
    • Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 10 December 2014
    • Contraception - IUS/IUD. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2012
    • Intrauterine system. PatientPlus. www.patient.co.uk/patientplus.asp, published 2 April 2014
    • Progestogen-only injectable contraceptives. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 October 2011
    • Heavy menstrual bleeding. National Institute for Health and Care Excellence (NICE), 2007. www.nice.org.uk
    • Uterine artery embolisation for fibroids. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
    • Uterine artery embolisation in the management of fibroids. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published 23 December 2013
    • Uterine artery embolism for fibroids. National Institute for Health and Care Excellence (NICE), 2010. www.nice.org.uk
    • Information for you after an endometrial ablation. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published 9 July 2010
    • Endometrial ablation. American Society for Reproductive Medicine. www.asrm.org, published 2011
    • Endometrial ablation. American College of Obstetricians and Gyneacologists. www.acog.org, accessed 10 September 2014
    • Menopause. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published June 2013
    • Contraception – general overview. PatientPlus. www.patient.co.uk/patientplus.asp, published 5 November 2012
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    Reviewed by Hemali Bedi, Bupa Health Information Team, December 2014

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