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Fibroids

Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
Next review due December 2024

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. If you don’t have any symptoms from fibroids, you probably won’t need any treatment. If you do need treatment for fibroids, options include medicines and surgery.

Image showing the different types of fibroid

About fibroids

Fibroids are very common – around eight in every 10 women get them. Fibroids are made up of muscle and fibrous tissue. They usually grow very slowly over years, and new fibroids can develop over time.

When you reach the menopause, fibroids usually begin to shrink as your hormones change.

Fibroids don’t usually cause any symptoms or complications.

Types of fibroids

There are different types of fibroid, depending on where they grow in your womb.

  • Intramural fibroids grow inside the muscle wall of your womb.
  • Subserous fibroids grow from the outside wall of your womb into the space in your pelvis.
  • 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, and these are called pedunculated fibroids.

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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, may encourage them to grow.

You're more likely to get fibroids:

  • as you grow older – your risk increases the closer you are to your forties
  • if you go through puberty at an early age (before 12)
  • if you’re overweight
  • if you’re a black woman; you’re three times more likely to get fibroids than if you’re a white woman
  • if you have an unhealthy diet, or drink more than the recommended limits of alcohol
  • if you have high blood pressure

Symptoms of fibroids

You might not have any symptoms from fibroids, so may not know you have them before you have a scan for something else. Whether you have any symptoms from fibroids usually depends on how big the fibroids are, and where they are.

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
  • irregular periods
  • painful periods (dysmenorrhoea)
  • swelling in your tummy
  • pain, or a feeling of pressure in your pelvis
  • bloating or constipation
  • needing to pee more often, or go very urgently
  • problems with fertility (difficulty getting pregnant)

Fibroids are likely to cause more symptoms, such as discomfort, bloating, pressure and pain in your lower tummy closer to your period.

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

Diagnosis of fibroids

You may find out you have fibroids if you have a gynaecological (vaginal) examination or investigations for other problems, such as heavy periods. Or you may have symptoms and go and see a GP.

Your GP will ask about your symptoms and your medical history. They’ll examine your tummy and do a vaginal examination. During this, your GP will put on some gloves and use some lubrication to put their 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 tummy (abdomen). You can ask to have someone with you during the examination if you wish.

Your GP may suggest you have some tests, and depending on the results, may refer you to a gynaecologist (a doctor who specialises in female reproductive health). Your gynaecologist may then offer you some further tests, which may include the following.

  • A blood test to check if you have anaemia.
  • An ultrasound scan. You’ll probably have two types of ultrasound scan. One looks at your womb and ovaries through your tummy using a probe. The other is a vaginal scan that uses 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. And they may be able to remove small fibroids from inside of your womb.
  • 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. You may also have an MRI scan if your gynaecologist needs more information about your condition.

Treatment of fibroids

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

Your treatment choice 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 these with you to help you make a decision that’s right for you.

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). The coil prevents the lining of your womb from growing quickly, which in turn reduces the amount of bleeding during your periods. And the pill can help to make your periods lighter and shorter.
  • Medicines that shrink your fibroids. Medicines called gonadotropin-releasing hormone analogues (GnRH analogues) can lower your oestrogen levels, which usually shrink 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 that can shrink your fibroids is called ulipristal. This is an option if you haven’t been through the menopause yet. You can take this medicine for a short time to ease your symptoms, and while you’re waiting to have surgery.
  • Some of these medicines can cause side-effects. Ask your doctor to explain the risks and benefits to you. And 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:

    • medicines don’t help to control your symptoms of heavy bleeding or pain
    • your fibroids are large
    • you’re getting symptoms due to pressure of fibroids on the organs around your womb
    • you want to increase your chances of getting pregnant and lower your chances of a miscarriage

    Operations and procedures for treating fibroids include the following.

    Myomectomy

    • Myomectomy surgery 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 the future. It’s done either through a cut in your tummy, or through keyhole (laparoscopic) surgery. New fibroids can grow after this type of surgery.

    Hysterectomy

    • A hysterectomy 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 tummy, using keyhole surgery, or through your vagina. A hysterectomy will get rid of all your fibroids and they won’t grow back.

    Transcervical resection

    • Transcervical resection is an operation to remove any fibroid that’s growing into the inside of your womb. It’s done using a hysteroscope, which is a narrow telescope with a light and camera at the end. This treatment won’t affect your chances of getting pregnant in future.

    Endometrial ablation

    • During endometrial ablation, your surgeon will remove the lining of your womb to reduce heavy bleeding when you have your period. At the same time, your surgeon can do a transcervical resection (see above). You should only have endometrial ablation if you no longer want children.

    Uterine artery embolisation (UAE)

    • During UAE, a specialist in doing scans, called an interventional radiologist, will inject small particles 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, your doctor may not recommend it if you want to have a baby. If you do go ahead and have this procedure, it’s best not to get pregnant for six months afterwards.

    Magnetic resonance imaging-guided ultrasound surgery

    • During magnetic resonance imaging-guided ultrasound surgery, ultrasound waves are used to remove fibroids. It’s not certain yet how this procedure affects future pregnancies.

    Your doctor will explain what your options are and that they involve, including how long it may take you to recover afterwards.

    Complications of fibroids

    Complications of fibroids can include:

    • constipation and problems peeing, if large fibroids press 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 your baby being in a 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



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    Related information

    • Discover other helpful health information websites.

      • Uterine fibroids. BMJ Best Practice. bestpractice.bmj.com, last reviewed 17 October 2021
      • Fibroids. Patient. patient.info, last edited 27 September 2021
      • Fibroids. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised December 2018
      • Personal communication, Dr Madhavi Vellayan, Consultant Gynaecologist, 20 December 2021
      • Anaemia – iron deficiency. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised October 2021
      • Pelvic examination technique. Medscape. emedicine.medscape.com, updated 25 September 2018
      • Genital examination in women. Royal College of Nursing. www.rcn.org.uk, published June 2020
      • Heavy menstrual bleeding: assessment and management. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, last updated 24 May 2021
      • Combined oral contraceptive pill. Patient. patient.info, last edited 31 August 2021
      • Ulipristal acetate. NICE British National Formulary. bnf.nice.org.uk, last updated 10 November 2021
      • Hysteroscopic resection (TCRF). British Fibroid Trust. www.britishfibroidtrust.org.uk, last modified 1 February 2021
      • Endometrial ablation. Medscape. emedicine.medscape.com, updated 16 April 2021
      • Uterine artery embolisation for fibroids. National Institute for Health and Care Excellence (NICE). www.nice.org.uk, published 24 November 2010
      • Ibitoye M, Choi C, Tai H, et al. Early menarche: a systematic review of its effect on sexual and reproductive health in low-and middle-income countries. PLoS One 2017; 12(6):e0178884. doi: 10.1371/journal.pone.0178884
    • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2021
      Expert reviewer, Dr Madhavi Vellayan, Consultant Gynaecologist
      Next review due December 2024

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