Uterine Fibroids

Uterine fibroids are benign (non-cancerous) growths of the womb. They are very common in women and we believe they affect more than 50% of all women at some stage of life.

What causes fibroids?

We do not know what causes fibroids. They are more common in older women and in women who have never had children. Fibroids are also more common in certain ethnic groups particularly Africans. They tend to be more common in some families suggesting a genetic influence.

Problems of uterine fibroids

Fibroids can give rise to a variety of problems including:

Heavy menstrual periods: fibroids are one of the commonest causes of heavy menstrual periods that might be severe enough to cause flooding and passage of large clots with the consequence of anaemia.

Pelvic pain: fibroids typically cause painful menstrual periods but can also cause non-cyclical pelvic pain as well as pain during sex.

Abdominal swelling: fibroids can grow to enormous sizes and lead to swelling of the abdomen. They have been confused for pregnancy in the past.

Infertility: because fibroids are more common in women who have not had children and in those with difficulty conceiving, we think they might interfere with the process of conception. It is not clear how they do this but we think some fibroids might cause a blockage of the fallopian tubes or a distortion of the lining of the womb that interferes with implantation.

Pressure on other organs: large fibroids can cause pressure symptoms on other pelvic organs. In the bladder this could cause frequent passage of urine, urinary leakage and rarely retention of urine. In the ureters this could cause obstruction to the flow of urine and lead to urinary infection and pain; this could ultimately damage the kidneys if not corrected. Pressure on the rectum could cause constipation and rarely intestinal obstruction.

Cancer (rare): very rarely fibroids can undergo malignant change and become cancers. The scenarios that favour this occurrence are fibroids found in older women (around the time of the menopause), the presence of persistent non-cyclical pain and rapid growth of the fibroid over a short space of time.

How we investigate uterine fibroids?

Detailed history and abdominal/pelvic examination coupled with pelvic ultrasound scan is the main way of diagnosing fibroids. We check blood count to exclude anaemia. It is occasionally necessary to perform an MRI scan in situations where ultrasound is not very informative. Rarely, other investigations (such as investigations of the urinary and intestinal tracts) are warranted to rule out other conditions.

How we treat uterine fibroids?

There are several options for treating fibroids dependent on the woman’s age, symptoms, reproductive expectations and state of health as well as on the number, size and locations of the fibroids.

Medical measures: the pain associated with fibroids can be managed with painkillers (usually anti-inflammatory drugs) and heavy menstrual bleeding can be reduced by drugs like tranexamic acid, mefenamic acid and progesterones. The size of fibroids (and so symptoms arising from them) can be reduced by drugs that temporarily suppress ovarian function. All these measures can provide temporary relief pending a permanent solution but all have the disadvantage of interference with fertility.

Myomectomy: this is the most common way of treating fibroids. It refers to an operation to remove fibroids without removing the womb and so preserves fertility. There are three ways of achieving myomectomy; hysteroscopic, laparoscopic and by laparotomy.

Every myomectomy operation carries a small risk of hysterectomy.

Hysterectomy: this is suitable for older women who have completed their families and/or have no further need to retain their uterus. It is normally undertaken through a laparotomy and so entails a 5 day hospital stay and six week recuperation period.

Uterine artery embolisation (UAE): this is a procedure whereby the arteries that supply the fibroids are blocked off leading to shrinkage of the fibroids. This is successful in reducing symptoms in many women and can reduce the size of the womb by about half. The currently available evidence suggests it is not the best option for women contemplating pregnancies in future.

Radiofrequency ablation of fibroids: this treatment is currently being evaluated and may be available in certain situations.

Focused ultrasound ablation of fibroids: this treatment is currently being evaluated and may be available in certain situations.

Complimentary therapies

There is no evidence that complimentary therapies are effective in treating fibroids but they may be useful for controlling some of its symptoms (such as painful periods).