Fibroids

Definition
Fibroids are a benign (non-cancerous) growth of the muscle of the uterus (womb). They can be small (pea sized) or large (the size of a melon) but most are somewhere in between. There may be just one fibroid but more often multiple fibroids exist. 

Incidence
Fibroids are very common and probably affect about a quarter of all women. They are more frequent amongst black women. 

Causes/prevention
Some women have an underlying tendency for the development of fibroids and there is little that can be done to prevent them. They are however more common in obese women and in those who have never had children. They can increase in size with hormone replacement therapy. 

Signs and Symptoms
Many women have fibroids and have no symptoms at all. It all depends on where in the womb the fibroids are located and their size. The fibroids can be found inside the womb cavity (called sub-mucosal), in the wall of the womb (called intra-mural) and on the outer aspect of the womb (called sub-serosal). Symptoms caused by fibroids might include:

• Heavy periods
  
• Lower tummy pain
  
• Bladder problems
  
• Infertility
  
• Miscarriage

Complications of disorder
Heavy periods can cause anaemia and ill-health. Sometimes they are associated with difficulties in becoming pregnant but they are not a major cause of infertility. If they grow very large, then the bladder (which is situated in front of the womb) gets squashed and this can cause the problem of passing water more often. 

Very occasionally (1:1000 risk) fibroids can become cancerous (fibrosarcoma). This is more likely with large fibroids and fibroids getting bigger rapidly or developing pain should be removed.

Most fibroids cause no problems with pregnancy but in some women they can degenerate and cause pain, cause miscarriage or premature labour and some prevent the baby delivering normally.

Tests
Fibroids are usually detected by an internal examination carried out by the doctor. The diagnosis can be confirmed by carrying out an ultrasound scan. In some circumstances a hysteroscopy and/or a laparoscopy would be performed.

Treatment
The treatment carried out depends on what problems the fibroids are causing, the size of the fibroids and where in the womb they are located. If they are small and causing no problems no treatment is necessary. Other treatments include:

Medical – risks & complications
If the fibroids are causing heavy periods it is still worth trying medication. A group of drugs (Gonadotrophin releasing hormone analogues, GnRHa) are effective in shrinking fibroids but after discontinuing therapy, fibroids grow back. These drugs are useful before surgery to remove the fibroid (myomectomy) 

Surgical – refer to operation
Myomectomy – this is an operation to remove the fibroids only. It is usually reserved for women who wish to maintain their fertility. The fibroids are removed and the womb reconstructed. It is a major operation and carries a 1% risk of serious bleeding during the operation, which could result in a life saving hysterectomy being necessary. Pregnancy rates following myomectomy are in the region of 60% and for heavy periods in the region of 80%. In subsequent pregnancies the gynaecologist might recommend a Caesarian section but normal delivery is possible in some circumstances. 

Hysterectomy - if you have completed your family this is the more common procedure.

Hysteroscopic Resection – if the fibroids project into the cavity of the womb, it may be p