Fibroids
Fibroids are common growths in the wall of the uterus. Many cause no problems, but some lead to heavy periods, pressure or pain. Dr Anu Mahadik looks at your symptoms and helps you weigh up the options. She consults at Westmead and Kogarah.
Overview
Understanding uterine fibroids
Uterine fibroids are common growths that develop in or on the wall of the uterus. They are not cancer. You may also hear them called leiomyomas or myomas.
Fibroids are made of muscle and fibrous tissue. They can be as small as a pea or, less often, as large as a melon. You can have one fibroid or several at the same time.
Types of fibroids
Where a fibroid grows affects the symptoms it may cause. There are three main types:
- Submucosal fibroids grow into the space inside the uterus (the cavity). Even when small, these can cause heavy periods.
- Intramural fibroids grow within the muscle wall of the uterus. These are the most common type.
- Subserosal fibroids grow on the outer wall of the uterus. Large ones can press on nearby organs, such as the bladder or bowel.
How common they are
Fibroids are very common. Many women have them without ever knowing, because they cause no symptoms. It is estimated that about 1 in 3 women with fibroids notice symptoms at some point.
Fibroids are more common as you get older, up to menopause. The female hormones oestrogen and progesterone are linked to their growth. After menopause, when hormone levels drop, fibroids usually shrink and symptoms often ease.
Fibroids very rarely turn into cancer. Having fibroids does not raise your risk of other cancers of the uterus.
Symptoms
Symptoms of fibroids
Many fibroids cause no symptoms and need no treatment. When symptoms do happen, they depend on the size, number and position of the fibroids.
Bleeding
- Heavy periods
- Longer periods than usual
- Heavy bleeding that can lead to low iron (anaemia)
Pressure
- A feeling of fullness or pressure in the lower stomach
- Needing to pass urine more often, if a fibroid presses on the bladder
- Constipation or pressure in the back passage, if a fibroid presses on the bowel
- Lower back pain
Pain
- Painful periods
- Pain or discomfort during sex
Other causes to consider
Heavy or painful periods have several possible causes, including fibroids, adenomyosis and endometriosis. Adenomyosis is a related condition where tissue similar to the lining of the uterus grows into the muscle wall. It can cause similar symptoms and can occur alongside fibroids. Because the causes overlap, it is worth having ongoing symptoms checked.
Diagnosis
How fibroids are diagnosed
Fibroids are sometimes found during a routine pelvic examination, or on a scan done for another reason. If you have symptoms, Dr Mahadik will ask about them and examine you.
Tests
- Ultrasound is the main test used to look for fibroids. It shows their size, number and position. It can be done over the lower stomach or through the vagina.
- Hysteroscopy may be used to look inside the uterus. A thin camera is passed through the vagina and cervix. No cut is needed.
- MRI may be used in some cases to map fibroids more closely, for example when planning surgery.
You do not need keyhole surgery to find out whether you have fibroids. Imaging is usually enough to plan your care.
Treatment
Treatment options for fibroids
The right treatment depends on a few things. These include your symptoms, the size and position of the fibroids, your age, and whether you would like to become pregnant later. Dr Mahadik talks through the options with you so you can decide together.
When treatment is needed
If your fibroids cause no symptoms, you may not need any treatment. Instead, Dr Mahadik may suggest keeping an eye on them and reviewing if anything changes.
Medicines
Some medicines help with the symptoms of fibroids, mainly heavy bleeding. It helps to know that most of these ease bleeding rather than shrink the fibroids:
- Tranexamic acid and anti-inflammatory pain relief (NSAIDs) can reduce heavy bleeding and period pain. They are taken during your period.
- Hormonal options such as the pill, progestogens or a hormonal IUD can make periods lighter. A hormonal IUD can help with heavy bleeding, though it does not shrink the fibroids.
- Iron may be advised if heavy periods have led to low iron.
- GnRH medicines can shrink fibroids for a while by lowering hormone levels. Because the effect is temporary and they have side effects, they are mostly used for a short time before surgery. Do not stop or change any prescribed medicine without medical advice.
Procedures and surgery
- Uterine artery embolisation (UAE) blocks the blood supply to the fibroids, which makes them shrink. It is carried out by an interventional radiologist and keeps the uterus in place.
- Myomectomy removes the fibroids while keeping the uterus. It can often be done by keyhole surgery or through the vagina, depending on the fibroids. It is an option if you may want to become pregnant. New fibroids can still grow later.
- Hysterectomy removes the uterus. It is the only treatment that stops fibroids coming back. It is usually considered for severe symptoms when you do not want to become pregnant in the future. It is major surgery.
Fertility
Fibroids, fertility and pregnancy
Most women with fibroids can become pregnant and have a normal pregnancy. Whether fibroids affect fertility depends on their size and position. Fibroids that grow into the cavity of the uterus are the most likely to matter.
If you are planning a pregnancy and have fibroids, it is worth talking through your options first. Dr Mahadik can look at whether the fibroids are likely to cause problems, and whether treatment before pregnancy would help. If you are having trouble falling pregnant, she can talk with you about the next steps and, where helpful, referral to a fertility specialist.
Common questions
Fibroids — common questions
The exact cause is not known. Fibroids are linked to the female hormones oestrogen and progesterone. This is why they tend to grow during your reproductive years and shrink after menopause. You may be more likely to develop fibroids if others in your family have had them.
Many women have fibroids without any symptoms, and only find out during a scan or examination done for another reason. If you do have symptoms, such as heavy periods or pressure in the lower stomach, an ultrasound can usually confirm whether fibroids are the cause.
Not always. If your fibroids cause no symptoms, you may not need any treatment. Treatment is usually considered when symptoms such as heavy bleeding, pain or pressure get in the way of daily life.
Yes, in many cases. Medicines can help with heavy bleeding, and uterine artery embolisation can shrink fibroids without surgery. Which options suit you depends on your symptoms and your plans for pregnancy.
Most women with fibroids can become pregnant and have a normal pregnancy. Some fibroids, especially those inside the cavity of the uterus, can affect fertility or pregnancy. If you are planning a pregnancy or having trouble falling pregnant, it is worth discussing this. See also fertility and infertility.
Fibroids are not cancer, and it is very rare for a fibroid to become cancerous. Having fibroids does not raise your risk of other cancers of the uterus.
Fibroids often shrink after menopause, as hormone levels fall, and symptoms may ease. New fibroids are unlikely to develop after menopause.
Yes. As with all specialist care, you need a referral from your GP. Your GP can refer you to Dr Mahadik. A referral also means you can claim a Medicare rebate on part of the consultation fee. The rooms can talk you through the current fees.
Talk through your fibroid symptoms
If heavy periods, pressure or pain are getting in the way of daily life, a consultation can help you understand what is going on and what your options are.
