Fibroids are benign swellings, made up of muscle fibres, which grow in the wall of the uterus (womb). They are very common, and occur in about 15% of women. They are more likely to occur in older women. They can be very small (the size of a pea), or quite large (the size of a melon).
Fibroids maybe multiple or single. Not all fibroids cause symptoms and many women who have fibroids are not aware of them. The significance of the fibroids depends not only on the size but also the position.
Types of fibroids
Fibroids may be found in three different positions:
1. Fibroids which involve the inner wall of the uterus and protrude into the cavity of the uterus are called submucous fibroids
2. Fibroids which lie within the wall of the uterus are called intramural fibroids
3. Fibroids which lie on the outer wall of the uterus are called subserosal fibroids
Submucous fibroids cause more problems than the other two varieties.
What causes fibroids?
No one really knows what causes fibroids. However, we do know that fibroids require oestrogen (a female hormone) for growth. For example, during pregnancy, fibroids often grow and become larger. After the menopause, when oestrogen levels drop, fibroids may shrink.
What problems do fibroids cause?
For many women, uterine fibroids do not cause any problem. In some women, fibroids may cause the following:
1. Heavy, painful periods
2. Pain in pelvis, low back or low abdomen
3. Pressure on the various pelvic organs such as the bladder, ureters and rectum. Pressure on the bladder may produce frequent desire to pass urine, incontinence, difficulty in passing urine and retention of urine. Pressure on the ureters may damage the kidney. Pressure on the rectum may produce constipation and haemorrhoids.
Infertility and miscarriage
Fibroids may sometimes contribute to infertility or miscarriage, especially if they distort the uterine cavity, or if they are very large. During pregnancy, fibroids may grow rapidly or may degenerate, both of which may cause pain, sometimes severe, requiring hospital admission. Fibroids may also cause premature labour, increase the chance of breech presentation and haemorrhage after delivery
Ultrasound is a very useful investigation in women with fibroids. It helps to determine the number, size and location of the fibroids. The information is of clinical importance in planning the treatment. For example, fibroids which protrude into the cavity of the uterus may be removed by hysteroscopic means, which is often carried out as a day case, with full recovery in a matter of several days.
What are treatment options?
The various treatment options of fibroid include:
1. Periodic examinations
2. Hormone treatment
3. Surgical removal of fibroids (myomectomy)
“key hole” approach which may be laparoscopic, or hysteroscopic
conventional “open” approach (laparotomy)
4. Surgical removal of fibroid and uterus (hysterectomy)
5. Embolisation: blocking blood supply to fibroid
If you have fibroids you will not necessarily need surgery. If you are not experiencing pain or excessive bleeding, periodic examinations are generally sufficient to find out if the fibroid has grown significantly in size. This approach is often considered in women approaching the menopause when fibroids generally (but not always) regress.
Sometimes, it is possible to use progestogen tablets or progestogen coil (Mirena) to control the heavy periods. Hormone treatment is not likely to work if the fibroid is big, or if it involves the inner wall of the uterus and distorts the cavity. Insertion or removal of the coil may be difficult if the fibroid distorts the cavity.
Myomectomy refers to the removal of only the fibroids but leaving the uterus behind. This procedure is particularly suitable for women who want to have children. The size and location of the fibroids will determine the choice of surgical technique which include:
1. Hysteroscopic resection – for fibroid involving the inner wall of the uterus and bulge into the cavity. It usually takes two or three days for you to return to normal activities.
2. Laparoscopic removal – for fibroids involving the outer wall of the uterus. It usually takes a week or two for complete recovery.
3. Laparotomy for fibroid deeply buried in the wall of the uterus. In this situation, a cut (incision) will be made in the abdominal wall, after which the fibroids will be removed from the uterus, and the uterus then reconstructed. It usually takes six weeks or so for a complete recovery.
If you have a large fibroid, or fibroid causing problems, and you do not desire a future pregnancy, a hysterectomy i.e. surgical removal of the uterus, is usually recommended. If the fibroid is small, vaginal hysterectomy is possible. However, if the fibroid is big, abdominal hysterectomy is necessary.
This is a rather new form of treatment. It involves the passage of a fine catheter into the artery supplying the fibroid and introducing a substance to block the artery. The blood supply to the fibroid stops, with the result that the fibroid shrinks in size. However, our experience with this new approach is limited. It is still considered as “experimental”. The procedure is carried out without anaesthetic. However, there may be significant pain after the procedure.
A copy of the following papers may be obtained from Prof Li’s secretary.
“Microsurgical myomectomy: a retrospective study to examine reproductive performance before and after surgery” written by TC Li, R Mortimer and ID Cooke which discuss the results of 51 cases based at the Jessop Hospital for Women.
“Uterine fibroids and Reproductive Failure” by D Yu, TC Li, M Metwally and E Xia
Prof T C Li
7 Williamson Road
Tel: 0114 2550365