Fibroids are benign tumours of the uterus. Myomas and fibromyomas are also the same. Depending on their location, fibroids can range in size from the size of a pea to a full term pregnant abdomen. Women between the ages of 30 and 50 are most at risk for developing fibroid growth.

Types of fibroids

Fibroids are referred to by their location in the womb. The four types of fibroids are:

Intramural fibroids
fibroids that develop in the uterine muscle. These are the most prevalent type of uterine fibroids.

Subserosal fibroids
It is possible for fibroids to grow outside the womb's wall and to become extremely large, known as subserosal fibroids. They are called pedunculated fibroids when they grow on a stalk

Submucosal fibroids
These are located in the cavity of the uterus and are often the cause of heavy and irregular bleeding

Cervical fibroids
Cervical fibroids are lumps that develop in the neck of the womb.

Can fibroids become cancerous?

Cancers arising from fibroids are very rare. This is more common in women who are in the perimenopausal stage of their reproductive cycle.

What are the Symptoms of fibroids?

Some patients may not have any symptoms, especially if the fibroid is small or growing on the outside of the uterus. Some common symptoms may include:

  • Heavy and/or painful periods, which can lead to anaemia in some situations.
  • If your fibroids are large, you may experience pain or swelling in your abdomen.
  • Leg pain or a backache.
  • Urinary incontinence or frequent urination is a sign that your fibroid is pressing on your bladder and causing you discomfort.
  • Your rectum (large intestine leading to your anus) may get constipated due to the fibroids pressing on it.
  • You may experience infertility or recurrent miscarriages in some instances, especially if the fibroid is in the cavity of the uterus.
  • Pregnancy and childbirth can be dangerous for women with fibroids. This happens when fibroids are large. Sometimes they can undergo degeneration which can cause abdominal pain
  • In pregnancy, fibroids can get much bigger, so they are likely to cause some problems (see below)

What Are the Causes of Fibroids?

Fibroids have an unknown origin, although no one knows what causes them exactly. There is a genetic tendency to fibroids in some populations, and they are more common in particular ethnic groups. They are more prevalent among women of colour from the Caribbean. Endometriosis and polycystic ovary syndrome (PCOS) are common co-occurring disorders. They are hormone-dependent. When oestrogen levels are high, fibroids tend to swell, such as during pregnancy. After a woman has gone through menopause, her oestrogen levels are known to be unusually low.

Fibroids and pregnancy

Fibroids are usually not a problem when it comes to conceiving. Fibroids, particularly submucosal fibroids, have the potential to cause infertility or miscarriage. Some pregnancy issues, such as bleeding, the aberrant position of the baby, preterm labour and more significant blood loss during delivery, may potentially be exacerbated by fibroids. During pregnancy, they are more likely to degenerate and cause pain.

How is it diagnosed?

  • Clinical examination can reveal larger fibroids.
  • Fibroids can be easily detected with ultrasound imaging.
  • An MRI scan may also be recommended by your doctor in certain scenarios.

How can it be treated?

Treatment for fibroids may not be essential if you are not experiencing any symptoms. Heavy menstrual flow is a minor symptom for some women. Thus, they prefer not to seek medical treatment. When you reach menopause, your fibroids are likely to shrink, and your symptoms will either go away entirely or get better.

What are the Medical treatments for fibroids?

This comprises of oral contraceptives, injectable contraceptives, and the implantable hormonal contraceptive Mirena ( hormonal IUD). These are useful to control the bleeding from fibroids. They do not cause the fibroids to shrink.

Gonadotropin-releasing hormone agonist (GnRHa), on the other hand, is a powerful hormone that causes the shrinkage of fibroids. It is usually used limited to 6 months due to side effects. This treatment is therefore considered prior to surgery.

What are the surgical treatments available?

Surgery is sometimes the best solution for many women with large fibroids and refractory symptoms. Myomectomy is the procedure where the fibroid is removed from the womb. This is usually performed laparoscopically if the fibroid is less than 10cm. If there are larger or multiple fibroids, then an open myomectomy may be required. Hysteroscopic resection of fibroid is a day case procedure for removing fibroids from the cavity of the uterus (submucous). Please the link below regarding morcellation ( relevant to laparoscopic removal of fibroids)

Hysterectomy (removal of the womb) is often recommended if a family is complete. This can be performed via laparoscopy, VNOTE or open.

Embolisation is another therapeutic option that includes inserting a device into the blood vessel that feeds the fibroid in order to cut off the fibroid's blood supply. This is performed in specialist centres by an interventional radiologist. This procedure will help shrink the fibroids and reduce symptoms.

Other helpful links