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Fibroids


Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
Next review due August 2022

Fibroids are benign (non-cancerous) growths that can develop in the walls of your womb (uterus). You can have one or more fibroids and they can vary in size. They can cause a range of symptoms including heavy or painful periods and abdominal (tummy) pain.

If you have fibroids but they’re not causing you any symptoms, you probably won’t need any treatment. But if you do need treatment, options include medicines and surgical procedures, and may depend on whether or not you plan to have children in the future.

Image showing the different types of fibroid

About fibroids

Fibroids are very common. It’s thought that as many as eight in every 10 women get them. Your chance of getting fibroids increases as you get older.

Fibroids are benign tumours made up of muscle and fibrous tissues. They usually grow very slowly over years, and new fibroids can develop over time. Your hormones (oestrogen and progesterone) cause them to grow and develop. When you reach the menopause, they usually begin to shrink as your hormones change.

Types of fibroids

There are different types of fibroid, named according to where they’re growing in your womb.

  • Subserous fibroids grow from the outside wall of your womb into the space in your pelvis.
  • Intramural fibroids grow inside the muscle wall of your womb.
  • Submucous fibroids grow from the inner wall of your womb into the space inside your womb.

Subserous and submucous fibroids can grow on a stalk. These are called pedunculated fibroids.

Symptoms of fibroids

You may not have any symptoms from fibroids, so you may not know you have them. Whether or not you have any symptoms from fibroids usually depends on how big your fibroids are and where they are. Symptoms can also vary depending on where you are in your menstrual cycle.

Possible symptoms of fibroids include:

  • heavy periods that can last a long time – if this happens, you can become anaemic, which may cause you to feel tired, dizzy and short of breath.
  • painful periods (dysmenorrhoea)
  • swelling in your abdomen
  • pain or a feeling of pressure in your pelvis
  • bloating or constipation
  • needing to pass urine more often or go very urgently
  • problems with fertility (finding it difficult to become pregnant)

If you think you may have symptoms of fibroids, contact your GP.

Diagnosis of fibroids

Fibroids are sometimes found when you’re having a gynaecological (vaginal) examination or investigations for other problems, such as heavy periods.

Your GP will ask about your symptoms and your medical history. They’ll examine your lower abdomen and do a vaginal examination.

For a vaginal examination, your GP will put gloved, lubricated fingers into your vagina to gently feel for anything different in your womb or cervix. At the same time, they’ll use their other hand to press on the lower part of your abdomen. You can ask to have someone with you while the examination takes place.

If your doctor thinks you may have fibroids, they may suggest some tests. Depending on what these show, they may also refer you to a gynaecologist (a doctor who specialises in women’s reproductive health). Your gynaecologist may then offer further tests.

Tests your GP or gynaecologist may recommend include the following.

  • A blood test to check if you have anaemia.
  • An ultrasound scan. You’ll probably have a scan that looks at your womb from the outside, through your lower abdomen, and from the inside using a device that goes into your vagina. The scan may feel uncomfortable but it shouldn’t be painful.
  • A hysteroscopy. A hysteroscopy is a procedure to look inside your womb using a narrow tube-like telescope with a camera called a hysteroscope. Your doctor can take a small sample or tissue (biopsy) at the same time. Small fibroids in the inside of your womb can sometimes be removed.
  • A magnetic resonance imaging (MRI) scan. An MRI scan can show a lot of detail about your fibroids and can be a useful test to have before surgery.

Treatment options for fibroids

There are several treatments for fibroids. The treatment that’s best for you will depend on your symptoms, how bad these are, and if you want to have children in the future.

Your treatment choices will also depend on where your fibroids are, how big they are and how many you have. If you don't have any symptoms or if your symptoms are mild, you may not need any treatment. But if you have more severe symptoms, there’s a range of treatment options that may help.

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.

Medicines

Medicines can’t cure fibroids, but they can help to ease your symptoms. The following types of medicine may help.

  • Over-the-counter painkillers. Non-steroidal anti-inflammatory (NSAID) medicines, such as ibuprofen, can help to ease your pain.
  • Medicines that reduce heavy bleeding. These include tranexamic acid, the contraceptive pill, progesterone and the levonorgestrel-releasing intrauterine system (an IUS or coil). See our FAQ on contraception below for more information about how the contraceptive pill or an IUS can help if you have fibroids.
  • Medicines that shrink your fibroids. Medicines called gonadotropin-releasing hormone analogues (GnRH analogues) can lower your oestrogen levels, which usually shrinks fibroids. If you're having an operation to remove your fibroids, your doctor may prescribe these for a few months beforehand. Another type of medicine which can shrink your fibroids and so may be an option for you, is called ulipristal. It works by partly blocking the effects of progesterone.

However, these medicines can cause a number of side-effects. So, if your doctor offers you any of these medicines to ease your symptoms, ask them to explain the risks and benefits to you. Always read the patient information leaflet that comes with your medicine and, if you have any queries, ask your pharmacist or your doctor.

Surgery

There are a number of different operations and procedures that can either treat or remove fibroids. These may be the best option for you if:

  • your symptoms of heavy bleeding or pain aren’t controlled by medicines
  • your fibroid is very large or getting larger rapidly
  • you’re getting symptoms due to pressure on the organs around your womb
  • you want to increase your chances of becoming pregnant and avoiding miscarriage

Operations and procedures for treating fibroids include the following.

  • A myomectomy. This is an operation to remove your fibroids, but which leaves your womb in place. It may be an option for you if you wish to become pregnant in future. It’s done either through a cut in your abdomen (tummy), or through keyhole (laparoscopic) surgery. Your fibroids can return after this type of surgery.
  • A hysterectomy. This is an operation to remove your womb so you will no longer be able to get pregnant. It can be done through a cut in your abdomen, using keyhole surgery or through your vagina. Having a hysterectomy means you will get rid of all your fibroids and they won’t grow back.
  • Endometrial ablation. This is a procedure which removes the lining of your womb to reduce heavy bleeding when you have your period. It can treat small fibroids on the inside wall of your womb. It’s still possible to become pregnant after ablation, but this is dangerous. So, you should only have this treatment if you no longer want to become pregnant.
  • Uterine artery embolisation (UAE). This procedure is where small particles are injected into the blood vessels that supply your fibroids. These block the blood supply and the fibroid then shrinks. The effects of the surgery on your fertility or any pregnancy aren’t certain. So, it may be less likely to be used as an option if you want to have a baby. If you have this procedure, it’s advisable not to get pregnant for six months afterwards.
  • Magnetic resonance imaging-guided ultrasound surgery. This is a relatively new procedure, where ultrasound waves are used to destroy fibroids. It’s not certain yet how this procedure affects future pregnancies.

  • If you have surgery for fibroids, your doctor will explain what this involves, including how long it may take you to recover afterwards.

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Causes of fibroids

Doctors 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:

  • as you grow older – your risk increases the closer you are to the menopause
  • if you go through puberty at an early age
  • if you’re overweight
  • if you’re African-Caribbean – women of this background are three times more likely than white women to get fibroids
  • if you haven’t been pregnant

Complications of fibroids

Complications can include:

  • constipation and problems passing urine, caused by large fibroids pressing on your bladder or bowel
  • anaemia, caused by long-term heavy bleeding
  • difficulty getting pregnant (infertility)
  • miscarriage
  • difficulties when you’re giving birth to a baby, such as breech position
  • fibroids that are on stalks can twist and this can be painful – you may need an operation to remove the fibroid

Most women don’t get any symptoms or complications from their fibroids.

Frequently asked questions

  • Yes, probably. 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.

  • There are two different types of contraception that can be used to help with the symptoms of fibroids. These may be useful if you have small fibroids which lie inside the muscle of the womb, and if you need contraception.

    • Levonorgestrel-releasing intrauterine system (LNG-IUS). Also known as an IUS or coil, this is a small device that’s placed in your womb and can stay there for up to five years. The LNG-IUS prevents the lining of your womb from growing quickly, which in turn reduces the amount of bleeding during your periods. It can also make your periods less painful.
    • Combined hormonal contraception (‘the pill’) can help to make your periods lighter and shorter. It contains the hormones oestrogen and progesterone. It’s not as effective at treating the symptoms of fibroids as the LNG-IUS.

    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.


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Related information

    • Uterine fibroids. BMJ Best practice. bestpractice.bmj.com, last reviewed July 2019
    • Patient. patient.info/doctor, last edited January 2015
    • NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2018
    • Uterine fibroids. The MSD Manuals. www.msdmanuals.com, last full review/revision May 2019
    • Menopause. BMJ Best practice. bestpractice.bmj.com, last reviewed July 2019
    • Pelvic examination. Medscape. emedicine.medscape.com, updated September 2018
    • Medscape. emedicine.medscape.com, updated August 2018
    • Endometrial ablation. Medscape. emedicine.medscape.com, updated November 2016
    • Uterine artery embolisation for fibroids. National Institute for Health and Care Excellence (NICE), November 2010.
    • Contraception – general overview. Patient. patient.info/doctor, last edited November 2015
    • Combined oral contraceptive pill. Patient. patient.info/doctor, last edited November 2015
    • Ulipristal acetate. NICE British National Formulary. bnf.nice.org.uk, accessed August 2019
    • Personal communication, Miss Shirin Irani, Consultant Gynaecologist, August 2019
  • Reviewed by Dr Kristina Routh, Freelance Health Editor, August 2019
    Expert reviewer, Miss Shirin Irani, Consultant Gynaecologist
    Next review due August 2022



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