What Are Fibroids And What Are The Symptoms?
Fibroids are non-cancerous growths that can develop in the muscular wall of the womb.
There are many different types of fibroid and they are named according to their location (see diagram). The combination of the size and location of the fibroid determines the symptoms that a woman may experience.
For example, submucosal fibroids grow from the innermost lining of the womb and might present with symptoms of heavy menstrual bleeding, menstrual cramps and fertility issues whereas fibroids on the outermost lining of the wall may present with pressure symptoms due to compression of surrounding organs (e.g. bladder).
Fibroids are usually confirmed by ultrasound but can also be viewed by magnetic resonance imaging (MRI) and hysteroscopy (camera looking into the womb).
How Common Are Fibroids?
Fibroids are very common – approximately 40%+ women have them. Some women may not even know that they have them because they are not causing any symptoms. They are most common in women of African and Caribbean descent and tend to be multiple.
How Can Fibroids Be Treated?
There are many different treatments for fibroids depending on their size, location and whether a woman wants to conserve her fertility:
- Conservative Management:
- Fibroids can be left alone if they are not causing any symptoms or complications.
- Non-Hormonal Treatments:
- Non-steroidal anti-inflammatories (NSAIDs) (e.g. mefenamic acid, ibuprofen, naproxen…etc) and tranexemic acid can be taken at the time of menstruation to reduce the amount of blood loss if a woman is experiencing heavy menstrual bleeding. NSAIDs can also provide pain relief for menstrual pain.
- Medical Treatments:
- The combined pill can help by suppressing ovulation and subsequent blood loss but is not recommended in women over the age of 50 years.
- The Mirena (levornorgestrel releasing intrauterine system) thins the inner lining of the womb very effectively so could be helpful in women who have fibroids in the inner wall of the womb but might not be effective if the fibroid(s) are large and distorting the womb cavity. Ulipristal Acetate works by blocking progesterone from stimulating the fibroid, which can in turn help to reduce the size of the fibroid however, it can affect liver function so this option is not recommended.
- Gonadotrophic releasing hormone (GnRH) analogues are administered as an injection and act by switching off ovulation at the brain level. This essentially causes a “chemical menopause” and significantly reduces all hormones released by the ovaries leading to a reduction in fibroid size and improved blood loss. However, it can only be used for a limited time as it can have an adverse effect on bone density. Add-back hormone replacement therapy (HRT) is required when GNRH analogues are used to not only provide symptomatic relief from menopausal symptoms but also the additional benefits of protecting the bones, brain and heart.
- Surgical Treatments:
- Surgical treatments are considered when conservative and medical treatments are not working or are not feasible which is usually because the fibroid is large or they are multiple.
- Uterine artery embolisation (UAE) is where the blood supply to the fibroid is blocked by a special injection and this in turn, leads to the fibroid shrinking. Hysterectomy is the removal of the womb. Myomectomy is the removal of the fibroid only which is preferable if future fertility needs to be preserved.
- Myosure is a minimally-invasive procedure reserved for smaller fibroids located in the inner lining of the womb. They can be removed by placing a tiny camera through the vagina and into the womb (hysteroscopy) and using a special device to remove the fibroid.
What Happens To Fibroids After The Menopause?
Oestrogen and progesterone are thought to play a role in fibroid growth so a significant reduction in these hormones after the menopause leads to a reduction in size and no further growth in most women.
Can I Have HRT If I Have Fibroids?
Yes you can – fibroids are not a contraindication to having HRT.
The amount of hormone contained in HRT is less than what is produced in natural cycles so it is possible that a fibroid may shrink to a lesser extent when taking HRT.
In some women, taking HRT may lead to slight growth of their fibroid however, this should not necessarily stop a woman from having HRT as the benefits of HRT generally outweigh the risks in most women. In this situation, it is important to review the management options of the fibroid itself and to try a different option if the current fibroid management is providing suboptimal relief.
** Please kindly refrain from requesting personal medical advice in the comments section as we are not indemnified to provide advice to people who are not formally under our care and will not be able to respond to these comments. If you are in need of specialist advice, please book an appointment with our Menopause Specialist here. **