Fibroids

Fibroids are the most common

growths in a woman's
reproductive system. Many
women with fibroids have no
symptoms at all, while others Fibroids — what are they?
have symptoms ranging from Fibroids — symptoms
heavy bleeding and pain to Finding out if you have fibroids
incontinence or infertility. These information pages Living with fibroids
explain what fibroids are, how they can affect your Resources and links
health and what your options are for treatment.
Next
For more information on heavy bleeding or
hysterectomy, visit our pages on these topics.

What are fibroids?

Fibroids are tumours that grow in the uterus (womb).

They are benign, which means they are not cancerous,
and are made up of muscle fibre. Fibroids can be as
small as a pea and can grow as large as a melon. It is
estimated that 20-50% of women have, or will have,
fibroids at some time in their lives. They are rare in
women under the age of 20, most common in women in
their 30s and 40s, and tend to shrink after the
menopause.

Although the exact cause of fibroids is unknown, they

seem to be influenced by oestrogen. This would
explain why they appear during a woman's middle
years (when oestrogen levels are high) and stop
growing after the menopause (when oestrogen levels
drop).

According to US studies, fibroids occur up to nine

times more often in black women than in white
women, and tend to appear earlier*. The reason for
this is unclear. Also women who weigh over 70kg may be more likely to have fibroids. This is
thought to be due to higher levels of oestrogen in heavier women.

In the past, the contraceptive pill was thought to increase the risk of fibroids, but that was when
the pill contained higher levels of oestrogen than it does today. Some studies suggest that the
newer combined pill (oestrogen and progestogen) and the mini pill (progestogen only) may
actually help prevent or slow the growth of fibroids.

Types of fibroids

Fibroids are categorised by where they grow in the uterus (see illustration -->):

Intramural — these grow in the wall of the womb and are the most common type of fibroid.

Subserous—- these fibroids grow from the outer layer of the womb wall and sometimes grow
 on stalks (called pedunculated fibroids). Subserous fibroids
can grow to be very large.

Submucous — submucous fibroids develop in the muscle underneath the inner lining of the
womb. They grow into the womb and can also grow on stalks which, if long enough, can hang
through the cervix.

Cervical — cervical fibroids grow in the wall of the cervix (neck of the womb) and are difficult
to remove without damaging the surrounding area.

If you have fibroids, you may have one or many. You may also have one type of fibroid or a
number of different types.

Fibroids — prevention

As the cause of fibroids is still unknown, there are no clear guidelines for preventing them.
However, there are some things you could do that may help reduce your risk:

• Keep your weight in check. This will minimise oestrogen levels in your body.
• Eat green vegetables and fruit, and avoid red meat. An Italian study found that women
who eat little meat but a lot of green vegetables and fruit seem to be less likely to
develop fibroids than women who eat a lot of red meat and few vegetables.
• Some studies suggest the combined pill may protect against fibroids by keeping
hormone levels from peaking and falling. The pill comes with its own set of side effects,
however, so talk to your doctor about whether it’s right for you.

* This information is based on studies involving black and African American women. The papers
do not identify more specific ethnic backgrounds. We found no similar UK studies.

Fibroids — Symptoms
It is estimated that 75% of women
with fibroids do not have symptoms,
therefore many women don't know
they have fibroids. Whether or not
you have symptoms depends on the Fibroids — what are they?
size of the fibroids and where they Fibroids — symptoms
are in your womb. This also affects Finding out if you have fibroids
the types of symptoms you are likely Living with fibroids
to have. For example, a small fibroid Resources and links
in the wall of your womb probably
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won't cause any problems, whereas a large fibroid
growing outward from your womb might press against
your bladder, causing bladder problems.

The most common symptom of fibroids is heavy

menstrual bleeding. Other symptoms include abdominal
pain or pressure, changes in bladder and bowel patterns
and, in some cases, infertility.
Heavy menstrual bleeding (menorrhagia)

Heavy bleeding may involve flooding (a sudden gush of blood), long periods or passing large
clots of blood. Heavy bleeding is not always due to fibroids, but when it is, it is usually
associated with fibroids that grow into the womb (submucous). Although it is unclear exactly
why fibroids cause bleeding, it may be that they stretch the lining of the womb, creating more
lining to be shed during a period.

Heavy bleeding can be distressing and can make every day activities difficult. You will need to
use extra sanitary protection and will probably need to change towels or tampons frequently.
Some women with heavy bleeding feel they need to stay near a toilet during their periods. This
can greatly restrict activity and may be frustrating or tiring.

Anaemia (iron deficiency)

Some women with fibroids and heavy bleeding develop anaemia as a result of blood loss.
Anaemia can make you feel weak, dizzy and tired. If blood tests show that you have anaemia,
ask your doctor about supplements or changes in your diet that might help. Foods such as liver,
leafy green vegetables, dried fruit and even red wine can help boost your iron levels.

Pain and pressure

Some women with fibroids experience painful periods, dull aches in their thighs, back pain or
constant pressure in the abdominal area that feels like bloating or fullness.

Pain during your period may be due to large clots of blood pushing through your cervix. Cramps
could also be caused by the womb trying to force out a submucous fibroid that is growing on a
stalk in the cavity of the womb.

Large fibroids can make the womb big and bulky, which can lead to lower back pain or pelvic
discomfort. Some women with fibroids feel a dull ache in their thighs or develop varicose veins
in their legs. This happens when fibroids become so large they press on nerves and blood
vessels that extend to the legs.

Occasionally, fibroids can cause sudden severe pain in the pelvic area or lower back. This may
be due to a fibroid on a stalk (pedunculated) that has become twisted. This kinks the blood
vessels in the stalk and cuts off the blood supply to the fibroid. If you feel sudden severe pain
and also have a fever or feel sick, you should see your doctor. The fibroid may need to be
removed or your doctor may recommend bed rest and painkillers until the pain stops on its own.

Pain during sex

Fibroids that press on the cervix or hang through the cervix into the vagina can make
penetrative sex painful and can also cause bleeding during sex.

Bladder and bowel symptoms

Large subserous fibroids (on the outer part of the womb) can press on your bladder or bowel,
leading to one or more of the following symptoms:

• Bladder
o frequent need to urinate
o leaking or dribbling urine
 o urgent need to urinate, often passing only a small amount
o difficulty or inability to pass urine – this is very serious and you should tell your
doctor as you may need urgent care. A tube, called a catheter, will be put into
your bladder to empty it
o cystitis caused by trapped urine that becomes infected
• Bowel
o constipation
o haemorrhoids (piles)

Fibroids and pregnancy

Most fibroids do not get in the way of a pregnancy. They may cause discomfort, but they
generally do not cause any other problems. Some fibroids in certain areas, however, can make
conception difficult or lead to miscarriage. Fibroids may press against, or block the entrance to,
the fallopian tubes, thus preventing the egg from reaching the uterus. Submucous fibroids that
grow inwards into the womb are thought to cause recurrent miscarriage.

A fibroid can also interfere with labour and birth if it blocks the passage to the birth canal. If this
is the case, your doctor may recommend a Caesarean section. Fibroids may increase your risk
of bleeding heavily after birth, and can increase the time it takes for your womb to return to its
normal size.

Just as fibroids can affect pregnancy, pregnancy can affect fibroids. It is thought that fibroids
grow during pregnancy because of higher levels of oestrogen, but there is little evidence to
support this. Another effect of pregnancy on fibroids is something called 'red degeneration.' This
is when a fibroid’s blood supply is cut off, causing it to turn red and die. It can also happen
outside of pregnancy but it usually occurs in the middle weeks of a pregnancy. Red
degeneration can cause intense abdominal pains and contractions of the womb, which could
lead to early labour or miscarriage. If you feel these symptoms, tell your doctor. The pain and
contractions usually stop on their own but your doctor may give you drugs to ease the pain and
stop the contractions more quickly.

Fibroids are never removed during a pregnancy because of the risk of haemorrhage (bleeding).

How to find out if you have

fibroids
Because there are often no symptoms, you may only find
out you have fibroids when you go for an internal
examination. If you have symptoms and think you might Fibroids — what are they?
have fibroids, see your doctor. You may be referred to a Fibroids — symptoms
gynaecologist who should be able to diagnose whether
Finding out if you have fibroids
you have fibroids or another condition. The doctor will
give you a vaginal examination to feel your uterus for
Living with fibroids
lumps or bulges. Resources and links
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If your doctor says you do have fibroids, ask if there is
more than one, where they are and how large they are.
This will help you better understand your symptoms and
decide what action to take, if any. Your doctor may want
to confirm a fibroid diagnosis with additional tests:
 • Ultrasound scan

An ultrasound uses sound waves to get an image of your internal organs. This can help
determine if the lumps are fibroids or another type of tumour. It can also provide more
detailed information about the size and location of fibroids.

You may be given an abdominal ultrasound, a vaginal ultrasound or both. An abdominal

ultrasound is best at finding large fibroids. Before your appointment you will be asked to
drink up to a litre of liquid so that you have a full bladder for the test. The scan itself is
not painful (the doctor simply moves the probe over your belly), but waiting for your
appointment with a full bladder may be uncomfortable.

A vaginal ultrasound is used to find small fibroids. The scanner (probe) will be put into
your vagina and may be a little uncomfortable. You do not need to have a full bladder
for this scan and it should not be painful.

If the ultrasound results are unclear, your doctor may suggest a hysteroscopy or
laparoscopy.

• Hysteroscopy

A hysteroscopy examines the inside of your womb by using a small telescope

(hysteroscope) which is inserted into your womb through your vagina. Hysteroscopy can
also be used to take a biopsy (tissue sample) of the lining of the womb. You may be
given a local anaesthetic, general anaesthetic or in some cases, neither. If you do not
have an anaesthetic, the procedure may be slightly painful. Hysteroscopy is done in
hospital and you can usually go home the same day.

• Laparoscopy

Where a hysteroscopy (see above) looks at the inside of the womb, a laparoscopy looks
at the size and shape of the outside of the womb. It can also be used to take tissue
samples. The procedure involves making a small cut (about 1cm wide) in the lower
abdomen, just below the belly button, and inserting a thin telescope (the laparoscope).
You may also have a probe inserted into your vagina to help move your womb so the
laparoscope can see it from different angles.

The operation usually takes about 30 minutes and is done in hospital. You will be given
a general anaesthetic before the procedure and will have a few stitches afterwards.
Sometimes air is pumped into the abdomen as part of the procedure and this may leave
you feeling bloated.
Living with fibroids
The most common approach to fibroids that are causing
heavy bleeding is to monitor rather than treat them.
You will probably be asked to have regular check-ups,
but you may still want help with your symptoms.
Fibroids — what are they?
Self-help Fibroids — symptoms
Finding out if you have fibroids
Although a healthy diet may not reduce your fibroids, it Living with fibroids
may help reduce some of the symptoms: Resources and links
Previous | Next
• Avoid alcohol, sugar and saturated fats. They
 make it difficult for your body to regulate
hormones. This can increase cramps and
bloating.
• Eat fruits and vegetables, particularly broccoli
and spinach – they also may help your body
regulate its oestrogen levels.

• Get plenty of B vitamins, calcium, magnesium

and potassium – thought to help reduce cramps
and bloating.

Treatments

If you have fibroids that are not causing you any problems, you don’t need
treatment. Your doctor may suggest you keep an eye out for any changes,
or s/he may ask you to have regular ultrasounds to check if the fibroids are
growing. If your doctor does suggest treatment, it will depend on several
factors, including the severity of your symptoms, the size and position of
your fibroid(s), your age and whether or not you want to have children in
the future. If you are nearing the menopause, for example, when fibroids
tend to shrink on their own, you may want to wait and see if your symptoms
improve without treatment.

Treating fibroids has traditionally meant undergoing major surgery, but now there are other
options to consider (see table below). Talk to your doctor about treatment options. Ask for a full
explanation of each approach, including the risks, benefits and success rates. You may also
want to talk with women who have had the treatment you are considering. (Women’s Health
may be able to put you in touch with a woman who has been in a similar situation. Call our
Helpline).

Drug treatments – GnRH analogues

A group of drugs, called GnRH analogues, reduce oestrogen levels in your body and, as a result,
cause fibroids to shrink. Studies have shown that when taken for six months, GnRH analogues
can reduce the size of fibroids by up to 50%. They also stop menstrual bleeding and pelvic pain.
But GnRH analogues should not be taken for more than six months in total and there are a
number of side effects. These include menopause-like symptoms such as hot flushes, vaginal
dryness and bone loss (osteoporosis).

Once you stop taking the drugs, fibroids begin to grow again.Your periods should also return
within a few weeks, although some women may no longer ovulate after treatment.

GnRH analogues are most commonly used to reduce the size of fibroids before surgery. In some
cases, doctors may recommend them as a temporary treatment for women who are nearing the
menopause, when fibroids should begin to shrink naturally.

Surgical and non-surgical procedures

The main treatments for fibroids are:

• Myomectomy (removing fibroids individually, leaving the womb intact)

• Hysterectomy (removing the womb entirely)
 • Uterine artery embolisation (blocking the blood supply to the fibroids)

These are discussed in detail below.

There is also a new procedure that is not included in the treatment chart because it is still
undergoing trials. The procedure involves inserting four specially designed needles through the
abdomen. Magnetic resonance imaging (MRI) is then used to guide the needles directly to the
fibroid. The MRI is also used to monitor the effects on normal tissue around the fibroid in order
to prevent any damage during the procedure. Once in place, the needles release laser energy
into the centre of the fibroid, burning its tissue and halting its growth. Results so far suggest
this procedure is effective in reducing symptoms and fibroid size, is minimally invasive and is
without complications. These are, however, only the first set of results. More research and
longer follow-up is needed to fully understand the benefits, risks and long-term effects.

Treatment options for fibroids

Questions Abdominal Myomectomy

What is it? Open surgery to remove fibroids (also called laparotomy)

What types of Can remove fibroids in the wall of the womb (intramural) and in
fibroids does it treat? the outer layer of the womb (subserous)

How is it done? A 15cm cut is made in the abdomen for the doctor to shell out
the fibroids. This is done with a looped wire, knife or laser. Once
the fibroids have been removed, the uterus and abdomen are
stitched up. The operation requires general anaesthetic and you
will be in hospital for a few days.

What is the recovery It will take about a month or more to recover at home. You will
period afterwards? probably feel tired and weak and will need to regain your
strength by walking and doing specific exercises. Do not lift
heavy objects while recovering.

Will the fibroids come Some studies show a 10 to 15% chance of fibroid regrowth,
back? while others estimate 30%. In black women, regrowth may be
as high as 50%.

Will I still be able to Most women can still become pregnant after a myomectomy,
get pregnant? but in some cases scarring in the womb can cause fertility
problems.

What are the Advantages: your womb is left intact and you may still be able
advantages of this to have children.
procedure?

What are the possible Complications: bleeding that can lead to an emergency
complications and hysterectomy. Infection; damage to surrounding organs.
other disadvantages? Disadvantages: 20 to 25% of women undergo additional
surgery, usually hysterectomy, to stop symptoms. Possible
weakening of the womb wall and scarring may cause
complications during pregnancy such as rupturing of the womb
wall.

Questions Laparoscopic Myomectomy

What is it? Keyhole surgery (through the abdomen) to remove fibroids.

What types of Recommended for fewer than four fibroids and fibroids that are
fibroids does it treat? less than 10cm wide.

How is it done? A laparoscope (telescope) is inserted into the womb through a

tiny cut in the abdomen. Other small cuts are made in the same
area to insert instruments that slice up and remove the fibroids.
This is done under general anaesthetic and you will be in
hospital for a day or two. It is a difficult, often long, procedure
and requires a highly skilled surgeon.

What is the recovery The surgery may take longer but recovery is much quicker than
period afterwards? abdominal myomectomy. Recovery at home takes 7 to 14 days.

Will the fibroids come This procedure may not remove all fibroids. Any missed fibroids
back? are likely to continue to grow. New fibroids may also develop.

Will I still be able to Laparoscopic myomectomy does not usually interfere with
get pregnant? fertility.

What are the Advantages: less invasive than other surgical options; small
advantages of this abdominal scars and little scarring inside the womb.
procedure?

What are the possible Complications: unexpected complications may require an

complications and abdominal myomectomy or emergency hysterectomy.
other disadvantages? Disadvantages: there may be an increased risk of your womb
rupturing during pregnancy.

Questions Hysteroscopic Myomectomy

What is it? Removal of small fibroids through the vagina.

What types of Can remove only small submucous fibroids.

fibroids does it treat?

How is it done? A small hysteroscope (telescope) is inserted into the womb

through the vagina and cervix. A laser or wire loop is then
inserted through the hysteroscope to remove the fibroids. You
will be given a general or local anaesthetic and will probably be
able to go home the same day.

What is the recovery It should take 2 to 7 days to recover at home.

period afterwards?

Will the fibroids come There is a 20 to 30% chance of fibroids growing back.
back?

Will I still be able to Hysteroscopic myomectomy does not usually interfere with
get pregnant? fertility.

What are the Advantages: no incisions; recovery is less than a week; little
advantages of this scarring. You will still have your womb and may be able to have
procedure? children.

What are the possible Complications: possible damage to the womb wall.
complications and Disadvantages: symptoms may continue: one study showed
other disadvantages? that after three years, heavy bleeding had returned in 30% of
women who had a hysteroscopic myomectomy.

Questions Uterine Artery Embolisation

What is it? A new procedure that blocks the blood supply to the fibroids.
 This reduces rather than removes fibroids.

What types of There has not been enough research to determine which types
fibroids does it treat? of fibroids respond best to embolisation.

How is it done? The radiologist (doctor) threads a fine tube into the right and
left uterine arteries and injects a dye to locate the arteries that
are feeding the fibroids. A special substance is then injected to
block (embolise) the blood supply. This is done under a local
anaesthetic and you will be in hospital for a couple of days.

What is the recovery Recovery at home should take 1 to 2 weeks.

period afterwards?

Will the fibroids come There is little information about fibroid regrowth after
back? embolisation.

Will I still be able to Some women have become pregnant after embolisation, but it
get pregnant? can also lead to ovarian failure. More research is needed.

What are the Advantages: minimally invasive; no incisions or scars; quick

advantages of this recovery period. You will still have your womb and may be able
procedure? to have children.

What are the possible Complications: risk of infection that requires a hysterectomy;
complications and risk of ovarian failure; radiation exposure.
other disadvantages? Disadvantages: may cause ovarian failure. This is a very new
procedure and long-term effects are still unkown.

Questions Hysterectomy

What is it? Removal of the uterus (womb). In some cases, the fallopian
tubes, cervix and/or ovaries are also removed.

What types of Removes all fibroids. Should only be done if fibroids are very
fibroids does it treat? large or cause problems that cannot be treated in other ways.

How is it done? The uterus is removed either through a cut in the abdomen (if
fibroids are large) or through the vagina (if fibroids are small).
Both are major operations. Abdominal hysterectomy can take
one hour or several depending on the size of fibroids. You will
be in hospital for 5 to 7 days. Vaginal hysterectomy takes about
an hour and you will be in hospital for 2 to 3 days.

What is the recovery Abdominal hysterectomy — Recovery will take 6 to 8 weeks at

period afterwards? home.
Vaginal hysterectomy — Recovery should take about five weeks
at home.
You will feel tired, but try to walk as much as possible.

Will the fibroids come Fibroids will not grow back.

back?

Will I still be able to If you have a hysterectomy you will not be able to have
get pregnant? children.

What are the Advantages: all of your fibroids will be gone and will never grow
advantages of this back.
procedure?

What are the possible Complications: possible damage to your bladder or bowel;
 complications and infection; risk of bleeding heavily during or after the operation,
other disadvantages? which may require a blood transfusion.
Disadvantages: you will no longer have your womb or be able to
have children. Can lead to an early menopause.

I am 47 yr old lady with ideal weight , no complications ( diabetis, BP,) but i suddenly
suffer with severe stomachache along with vomitings and loss of appetite, is it connected
to fibroids ??