Uterine fibroids are a common, benign growth in the uterus. They occur in about 25% of women and can be asymptomatic. Whilst they generally aren’t dangerous, they can cause significant discomfort and serious symptoms for some.
Fibroids can distort the lining of the uterus, leading to heavy or abnormal bleeding, pelvic pain, and iron deficiency anaemia. Very large fibroids can also put pressure on the surrounding organs, causing pain and bloating as well as bladder problems.
What causes fibroids?
We don’t know for sure what causes uterine fibroids, but we do know that some women are more likely to get them than others. Factors which can increase your risk include:
- Family history – if your mother, sister, or grandmother have fibroids, you may have a higher risk
- Pregnancy – hormone changes during pregnancy can cause fibroids to develop and grow quickly
- Obesity – obesity is a risk factor for a wide variety of health conditions, and some studies have shown that an unhealthy weight may affect the development of uterine fibroids
- Blood pressure – having a higher than average blood pressure for your age has been shown to have a relationship to uterine fibroids.
- Age – women over age 40 are much more likely to develop fibroids
- Diet – a diet high in red meat and alcohol and low in green vegetables, fruit, and dairy may increase the risk of developing fibroids, although this is yet to be conclusively proven
- Early onset of puberty – some studies have found that women who entered puberty at an earlier than average age have an increased chance of developing fibroids.
Are fibroids cancerous?
Uterine fibroids are a type of tumour, but they are benign (non-cancerous). Unlike cancers, they cannot spread to other parts of the body and can generally be treated in a single procedure. However, it is possible for a uterine fibroid (or leiomyoma) to develop into a malignant growth (a leiomyosarcoma). This is sometimes picked up on an MRI scan, or may be signalled if a patient doesn’t respond to a uterine fibroid embolisation (UFE) or other fibroid treatment as expected.
Do fibroids affect fertility?
Depending on their size and position, fibroids can make it difficult to conceive by blocking embryos from attaching to the uterine wall and may affect your ability to carry and deliver naturally. As a result, having them removed may improve your ability to become pregnant.
Studies have shown that surgical removal and embolization treatments can improve fertility outcomes. This evidence shows that there is no clear difference in ability to conceive between patients who have undergone myomectomy and uterine fibroid embolisation, and the most idea procedure for tour case will be discussed at your consultation.
How are uterine fibroids treated?
The first line of treatment is usually conservative management, such as pain control through medication. Many women find this to be effective in managing their symptoms, but it may not benefit all cases, particularly if fibroids are affecting your fertility, or if you have allergies to certain medications.
If medication fails, the size, location, and number of fibroids is assessed to determine the next course of action, as well as your symptoms, menopausal status, and whether or not you wish to become pregnant in the future.
If it’s seen as in your best interest, it may be recommended that your fibroids be removed surgically (either by myomectomy or hysterectomy), or by uterine fibroid embolisation (UFE) Your interventional radiologist will only recommend treatment options that are thought to be best for you as an individual and your unique case.
How do I know if I have uterine fibroids?
If you show signs of having uterine fibroids, your GP may recommend a series of tests to determine a diagnosis. Signs to watch out for include:
- Heavy periods – you may soak through pads or tampons very quickly (within 1-2 hours)
- Passing large clots – regularly passing clots more than 2cm wide is worth mentioning to your doctor
- Tiredness – having a constantly heavy period can lead to iron deficiency anaemia
- Painful periods and/or sex – fibroids can make any contractions or pressure painful, especially if they form near the cervix.
- Infertility – fibroids can impact the way the uterus functions, making it harder to conceive
- A feeling of pressure in the pelvis – this can be caused by uterine fibroids putting pressure on other organs
- Frequent urination and difficulty emptying the bladder – large fibroids may put pressure on the bladder.
- Constipation – this can happen if fibroids begin to put pressure on the colon.
- Leg or back pain – very large fibroids at the back of the uterus can put pressure on or pinch the nerves at the base of the spine
- Incontinence – you may urinate a little when you laugh or sneeze
What tests are used to diagnose UF?
- Ultrasound – while ultrasounds are useful for detecting abnormal growths in the uterus, they often have trouble differentiating uterine fibroids from other gynaecological conditions (such as adenomyosis, which can also be treated by UFE).
- MRI – MRI scans are used to give the full picture in regards to your uterine fibroids. This helps us to determine whether they’re best managed through medication, surgery, or embolisation.
- Hysteroscopy – this procedure uses a small camera to examine the inside of the uterus and look for abnormalities.
Do I need treatment?
Even though fibroids affect about ¼ of women, only about 40% of the affected will need treatment. Since they only need medical intervention if they produce symptoms, you may not need medical intervention if your fibroids aren’t negatively affecting you or impacting your ability to do what you love.
What happens if fibroids go untreated?
For most women, untreated fibroids don’t cause major symptoms. However, they may continue to grow and multiply, leading to concerns such as heavy bleeding, anaemia, pelvic pain or pressure, and complications in fertility and pregnancy.