What fibroids are
Fibroids are growths made of muscle and fibrous tissue that form in or on the wall of the uterus. They are almost always non-cancerous. They are very common, especially between the ages of 30 and 50, and many women have them without knowing. A fibroid can be as small as a pea or as large as a melon, and you may have one or several.
Fibroids grow under the influence of the hormones oestrogen and progesterone. This is why they often shrink after menopause. Not every fibroid needs treatment. The decision depends on your symptoms, the size and position of the fibroids, your age and whether you want children in future.
Symptoms and types
- heavy or long periods, sometimes with clots
- tiredness and breathlessness from anaemia
- a feeling of pressure or heaviness in the lower abdomen
- passing urine often, or difficulty emptying the bladder
- constipation or backache
- pain during sex
- a visible swelling of the abdomen
Where fibroids grow
Doctors name fibroids by their position. Submucosal fibroids bulge into the cavity of the uterus and tend to cause the heaviest bleeding and trouble with conceiving. Intramural fibroids sit within the muscle wall. Subserosal fibroids grow on the outer surface and mainly cause pressure symptoms.
How fibroids are found
- The doctor asks about your periods, pain, urine and bowel habits and pregnancy plans.
- An abdominal and pelvic examination checks whether the uterus feels enlarged or irregular.
- An ultrasound scan confirms the number, size and position of the fibroids.
- A blood test measures haemoglobin to look for anaemia.
- An MRI or a look inside the uterus with a thin telescope, called hysteroscopy, is added only when more detail is needed.
- If bleeding is irregular or you are over 40, a sample of the uterus lining may be taken to rule out other causes.
Treatment options
There is no single right treatment. The table gives a broad picture, and your doctor will advise what suits your case.
| Option | What it involves | Often considered when |
|---|---|---|
| Watchful waiting | Review and scan at intervals | Fibroids are small with few symptoms |
| Medicines | Tablets, injections or a hormonal intrauterine device | Bleeding is the main problem |
| Uterine artery embolisation | Blocking the blood supply through a thin tube | Surgery is to be avoided |
| Myomectomy | Removing fibroids, keeping the uterus | You wish to have children |
| Hysterectomy | Removing the uterus | Family is complete and symptoms are severe |
Watchful waiting
If your fibroids were found by chance and do not trouble you, the doctor may simply repeat a scan after some months to see whether they are growing. Keep a note of how many days you bleed and how many pads you use, as this record helps at each review.
Medicines
Medicines do not remove fibroids. Some reduce bleeding and pain during periods, and iron treats anaemia. Hormone-based medicines can shrink fibroids for a while and are sometimes given for a few months before surgery. The fibroids usually grow back when these are stopped. Your doctor chooses the medicine and decides how long it is safe to continue.
Procedures and surgery
Myomectomy can be done through the vagina with a hysteroscope, by keyhole laparoscopic surgery or by an open operation, depending on the size, number and position of the fibroids. New fibroids can form later. Hysterectomy is the only treatment after which fibroids cannot return, but it ends the ability to carry a pregnancy and is a major operation. Embolisation and newer methods that use heat or focused ultrasound are available in some centres and are not suitable for everyone. Ask about the benefits, risks, recovery time and alternatives for each choice.
Fibroids, fertility and pregnancy
Most women with fibroids conceive and deliver normally. Fibroids that distort the cavity of the uterus can make it harder to conceive or raise the chance of miscarriage, and removing them may help. In pregnancy fibroids can sometimes cause pain, an early birth or a baby lying in an unusual position, so tell your obstetrician about them. They are generally not removed during pregnancy.
Recovery and follow-up
Recovery depends on the procedure. After hysteroscopic or keyhole surgery many women go home within a day or two and return to routine work in a few weeks. Open surgery needs a longer hospital stay and around six weeks of rest from heavy work. After myomectomy, ask how long to wait before trying for a pregnancy and whether a caesarean will be advised later. Even without treatment, a review every six to twelve months is common. Costs vary by city, hospital and the method chosen.
Before you agree to an operation, it is reasonable to ask why it is being advised, what would happen if you waited, and whether the uterus can be kept. A second opinion is your right, and a good doctor will not mind.
When to see a gynecologist
Get examined soon if you notice:
- periods that last more than seven days or soak through pads every hour or two
- bleeding between periods or after menopause
- constant tiredness, paleness or breathlessness
- a lump or swelling in the lower abdomen that is growing
- trouble passing urine or frequent urinary infections
- sudden, sharp pain in the abdomen that does not settle
- difficulty in conceiving or repeated miscarriage
A fibroid that grows quickly, especially after menopause, should always be checked.
This page is general information for readers in India. It is not medical advice. Speak to a qualified gynecologist about your own health.