The lowdown on fibroids

Uterine fibroids are very common. Up to 70 per cent¹ of women have fibroids by the time they’re 50, but many don't experience any symptoms and are often unaware that they are even there.

In some women, however, fibroids can cause symptoms such as heavy menstrual bleeding, bleeding between periods, very painful periods, swelling in the tummy area and pelvic discomfort.

After menopause, fibroids usually shrink and may disappear completely.

Fibroids are non-cancerous growths in and on the uterus (they don’t spread to other parts of the body). They are also known as uterine myomas or leiomyomas.

You may have only one fibroid, or you may have many fibroids of different sizes. They range from being too tiny to be seen with the naked eye to around the size of a basketball in rare cases.

There are 3 main types of fibroids^2:

• Intramural fibroids grow within the muscular wall of your womb. These are the most common type.
• Submucosal fibroids grow from the inner wall of the uterus into the space inside. This is the rarest type of fibroid.
• Subserosal fibroids grow from the outside wall of your womb into your pelvic cavity. These fibroids are the ones that can become very large.

Up to 30 per cent of women with fibroids will experience no symptoms at all.³

However, you may experience one or more of the symptoms listed below, depending on where the fibroid is, how many you have and how large they are.

• Heavy periods, sometimes leading to anaemia
• Prolonged periods
• Bleeding in between periods
• Pain in your pelvic area
• Swelling in your pelvic area
• A need to pee more often than usual, if a fibroid is pressing on your bladder
• Constipation, if a fibroid is pressing on your rectum

Most fibroids don’t affect a woman’s fertility⁴. In fact, one of the most common reasons women find out they even have fibroids is during an ultrasound scan.

The vast majority of fibroids don’t affect conception, pregnancy or delivery and do not need treatment. The only situations where fibroids interfere with fertility are if they are very large, or the submucosal type that grows on the inner wall of the uterus.

This can affect the environment of your womb and make it more difficult for a fertilised egg to implant. In this case, your doctor may advise removal via a surgical procedure.

The exact reasons why women develop fibroids aren't known, although the female sex hormones, oestrogen and progesterone, seem to stimulate their growth.

Women of childbearing age are therefore most likely to have fibroids, especially if they have never been pregnant.

Other documented contributing factors are:

• A family history of fibroids
• Race. The incidence of fibroids is higher in Black women than Caucasian.
• Starting your periods early (before 10)
• Being overweight or obese
• Having polycystic ovary syndrome (POS)

Most women with fibroids have no symptoms, so the fibroids go undetected. Often they are ‘stumbled upon’ during a routine gynaecological examination, pelvic ultrasound or during unrelated surgery.

If you have symptoms such as pelvic pain or heavy periods, your doctor may do an internal examination to check the size of your womb (an enlarged womb may indicate the presence of fibroids).

An ultrasound scan should confirm if you have fibroids. You may then be advised to undergo a hysteroscopy, which looks inside the womb with a small telescope.

If you don't have any symptoms or if your symptoms are mild, treatment may not be required.

In most cases, fibroids will spontaneously shrink and may disappear altogether when starved of hormones post-menopause. If you have symptoms that are impacting your daily life, your doctor will recommend the best treatment for you⁵.

If you are suffering heavy periods or pain due to fibroids, the first course of action is often anti-inflammatory pain relief such as Ibuprofen, or a contraceptive such as an IUD or birth control pills that will help manage the symptoms.

If that doesn’t sort things out, your GP will refer you to a gynaecologist, who may prescribe an injection of gonadotropin releasing hormone analogues (GnRHas), which are known to help temporarily shrink fibroids.

There are several surgical options for treating fibroids⁶, including:

• Uterine artery embolisation (UAE) is a procedure that reduces the blood supply to the fibroid, causing it to shrink. It's performed under local anaesthetic.
• Endometrial ablation is a procedure that removes the lining of your uterus, or an individual fibroid, using energy such as microwaves or heat. Also called an endometrial resection, it will help to stop heavy and prolonged periods.
• Myomectomy is a surgical procedure to remove uterine fibroids. It is a major surgical procedure, so you’ll be in hospital for a night or two. Myomectomy is usually offered to women who want the option to become pregnant in the future. There is a chance that more fibroids will grow, so you may need to have further treatment.
• Hysterectomy is a major operation to remove your entire womb. This may be recommended if fibroids are causing serious symptoms or when other treatments have been unsuccessful. If the fibroids aren't too large, this can be done through the vagina, or otherwise via a 'bikini-line' cut in your abdomen. You and your doctor may also choose to remove your fallopian tubes and ovaries at the same time.

If you’re experiencing symptoms or have concerns about fibroids, speak to your doctor to explore the best options for you.

Jean Hailes for Women's Health has information on fibroids, including symptoms, treatment options and management.

IVF Australia has information for women concerned about fibroids and fertility.