What causes fibroids?
A fibroid is like an 'overgrowth' of smooth muscle cells. (The uterus is mainly made of smooth muscle.) It is not clear why they develop. Like the uterus, fibroids are sensitive to oestrogen. This is 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.
What symptoms and problems are caused by fibroids?
Usually none
No symptoms or problems occur in most women who have 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 sometimes develop
One or more of the following are possible symptoms or problems.
- Heavy or more painful periods.
- If a fibroid is large you may have discomfort or swelling in the lower abdomen.
- Occasionally, a fibroid may press on the bladder. You may then pass urine more often than usual. Rarely, pressure on the rectum may cause constipation.
- Repeated miscarriage or infertility is an uncommon complication.
- Rarely, large fibroids cause complications of pregnancy and labour.
How are fibroids diagnosed?
Some fibroids can be felt during an internal (vaginal) examination by a doctor. Sometimes 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?
Not treating may be an option
Treatment is not needed if fibroids cause no symptoms. Many women chose to do nothing even 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.
Treatment with medication
The most effective medication is a gonadotropin releasing hormone agonist (GnRHa). 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 not given long-term. It may be used to shrink large fibroids prior to surgery (to make surgery easier). More recently a combination of a GnRHa plus 'add back' Hormone Replacement Therapy (HRT) with low dose oestrogen has been used to shrink the fibroids, but prevents the menopausal side effects.
The following medicines are also used to treat heavy periods whatever the cause. They may not be so effective if fibroids are large. However, they may be worth as try if periods are heavy and fibroids are small.
-
Tranexamic acid. This is taken 3-4 times a day, for 3-4 days each period. It works by reducing the breakdown of blood clots in the uterus.
-
Anti-inflammatory medicines such as ibuprofen and mefanamic acid. These also help to ease period pain. They are taken for a few days each period. They work by reducing the high level of prostaglandin in the uterus lining which seems to contribute to heavy periods.
-
The contraceptive pill may help, and often helps with period pain too.
-
Levonorgestrel intrauterine system (LNG-IUS) is similar to an intrauterine device (IUD) used for contraception. It is inserted into the uterus and slowly releases a regular small amount of progestogen hormone called levonorgestrel. It works by making the lining of the uterus very thin (atrophied) so bleeding is lighter.
Surgical treatments
-
Hysterectomy is the traditional treatment for fibroids which cause symptoms. This is the removal of the uterus (womb). It is a fairly major operation.
-
Myomectomy is a possible alternative. In this operation the fibroids are 'shelled out' of the uterus. This procedure is not always possible. It depends on the size, number and position of the fibroids. Most myomectomies are done through a cut (incision) in the abdomen. Some fibroids near the lining of the uterus can be removed through the vagina without an abdominal cut. Recurrence of the fibroid may occur after myomectomy.
-
Uterine Artery Embolization is a newer technique used to treat large fibroids. It involves putting a catheter (a thin flexible tube) into an artery (blood vessel) in the leg. It is guided using x-ray pictures to the arteries of the uterus. Once there, a chemical is injected along the catheter to the uterine arteries. This causes a blockage in the these arteries. The fibroid then loses its blood supply and it shrinks. As this treatment is quite new, the long term safety and effectiveness are not clear. However, early reports are encouraging. It may only be available in certain hospitals, but is likely to become more widely available in the future.
In summary
- Fibroids are common. They usually cause no problems or symptoms.
- Treatment is not needed if symptoms do not occur.
- Heavy periods is the commonest symptom. Medication may ease this.
- Hysterectomy is the traditional cure if symptoms persist.
- Myomectomy ('shelling out of the fibroids') is sometimes an alternative.
- Uterine Artery Embolization is a newer technique that may become more popular.
Further information
Women's Health
52 Featherstone Street, London, EC1Y 8RT
Helpline: 0845 125 5254 Web: www.womenshealthlondon.org.uk
Operates a UK-wide enquiry service providing information on a wide range of gynaecological and sexual health issues including fibroids.
Fibroids Embolisation Website
www.fibroids.co.uk
A website that seeks to provide all of the current information available on fibroids, together with a synopsis of the various forms of treatment, in particular uterine artery embolisation. Written by a UK doctor.
©EMIS and PIP 2004
