Fibroids: diagnosis and treatment

A fibroid is a non-cancerous growth that occurs in or around your womb (uterus). You can have more than one and they can vary in the size, from pea-sized to the size of a melon. Around one in three women will develop fibroids, usually when aged between 30 and 50. 

Fibroids are made of fibrous tissue and muscle and can develop in the wall of the womb (intramural fibroids), outside of the womb wall (subserosal fibroids) or under the inner lining of the womb (submucosal fibroids).

Risk factors

Your risk of developing fibroids is higher if you:

• Are of African or Afro-Caribbean descent
• Are overweight
• Don’t eat enough fruit and vegetables
• Have family members who have had fibroids
• Haven’t had any children
• Take the contraceptive pill

Symptoms

Many women with fibroids don’t develop any symptoms. However, if you do get symptoms, they may include:

• Constipation
• Heavy and/or painful periods
• Needing to urinate more than usual
• Pain in your lower back
• Pain during sex
• Stomach pain

Sometimes, fibroids can cause complications. In rare cases, fibroids can affect your fertility by preventing an egg from attaching to your womb. Large or multiple fibroids can sometimes affect the growth of a baby and make childbirth difficult.

Diagnosing fibroids

Fibroids can be picked up during a pelvic examination, where your doctor inserts a gloved and lubricated finger into your vagina to feel your womb. Fibroids can make your womb feel larger or unusually shaped. If your doctor thinks you might have fibroids, the next step is usually an ultrasound scan.

An ultrasound scan is a safe and reliable scan that uses sound waves to create an image of the inside of your body. Unlike an X-ray, no radiation is used.

An ultrasound scan for fibroids involves two steps. During the first step, a clear gel is spread over your abdomen and a device called a transducer placed on top — this device produces the ultrasound energy. This part of the scan is similar to a pregnancy ultrasound scan. 

During the second step, an ultrasound probe is gently inserted into your vagina. It is a little bigger than a tampon and you may feel some pressure and/or mild discomfort. The probe takes images of your womb and ovaries. The whole scan takes between 30 and 60 minutes.

The images will enable your radiologist and doctor to see whether you have fibroids and where they are.

An ultrasound scan is the most common way to diagnose fibroids. In some cases, your doctor might want to carry out a different type of scan, such as a:

• Hysteroscopy — a long, thin telescope-like tube is inserted through your vagina and cervix (the neck of your womb) to allow your doctor to inspect your womb; you may have cramps during the examination but painkillers can help with this
• Magnetic Resonance Imaging (MRI) scan — this produces a detailed image of your womb using powerful magnets and radio waves, and helps your doctor determine the number, size and location of your fibroids
• Saline hysterosonography — another type of ultrasound scan that involves inserting a small catheter into your cervix and injecting a sterile saline solution that fills your womb, which helps create a clearer outline of its walls 

Treatments for fibroids

Fibroids will go away naturally when you reach the menopause, but there are treatments you can have if you’re experiencing severe symptoms before menopause.

Medications

Medications are available that can reduce the heaviness and pain of your periods caused by fibroids. However, they are less effective if you have larger fibroids. Medications include:

• Anti-inflammatories such as ibuprofen
• Progesterone — this can be taken orally or injected and stops your womb lining growing so quickly
• The contraceptive pill

There are also medications available that can shrink your fibroids.

Surgery

If your symptoms are severe and medications aren’t relieving them, surgery might be considered. The two most common types of surgery used to treat fibroids are a hysterectomy and myomectomy.

A hysterectomy involves removing your womb and is an option if you have large fibroids or severe symptoms. It is the most effective way to stop fibroids returning. After a hysterectomy, you won’t be able to have children.

You’ll usually have an epidural anaesthetic or a general anaesthetic and you’ll need to stay in hospital for a few days after the surgery. It will take about six to eight weeks for you to recover after surgery and you will need to rest as much as you can.

A myomectomy is a smaller operation compared to a hysterectomy and is an option if you still want to have children. It involves removing the fibroids from the wall of your womb while leaving your womb intact. It can be done using keyhole surgery (where a number of small incisions are made in your stomach) or open surgery (where one, larger incision is made).

You will have a general anaesthetic so that you’re not conscious throughout the operation. Recovery takes a few weeks and you will need to make sure that you get plenty of rest.  

A myomectomy isn’t suitable for all types of fibroids; your doctor can tell you if it’s an option for you. While it removes any fibroids you have, it doesn’t guarantee that they won’t return.