Uterine fibroids: When is treatment necessary?

Although not all patients experience symptoms of uterine fibroids, they can be behind a range of health issues, from bladder problems to heavy or painful periods. When these health problems begin to affect a woman’s quality of life, treatment may be necessary to resolve any troublesome symptoms. In this informative guide, highly respected consultant gynaecologist Mr Stephen Quinn details how uterine fibroids can develop over time and when treatment is required. The leading specialist also offers expert insight on the various approaches to treatment and their suitability for different patients.

What are uterine fibroids?

Uterine fibroids are a type of benign (non-cancerous) tumour found within the uterus. They are the most common type of tumour found in women and are composed of many types of tissues including smooth muscle, elastin, collagen and extracellular matrix proteins.

What happens if fibroids go untreated?

Fibroids grow in size but the extent of their growth varies a great deal from case to case. On average, fibroids grow by around one centimetre every year but they can sometimes grow more quickly or slowly. Over time, they continue to grow until the time around the menopause. After the menopause, they can then decrease in size but they don’t ever completely go away.

Can uterine fibroids go away without treatment?

No, sadly not. Sometimes fibroids can prolapse through the cervix and after detaching from the inside of the womb. This, however, is exceptionally rare and thankfully so because that can be quite traumatic to experience. More commonly, fibroids will stay in place until they are either surgically removed or treated in another way.

When do uterine fibroids need to be treated?

As fibroids are benign, the indications for removal tend to be based on a woman’s symptoms and quality of life. When fibroids become large enough, they can affect quality of life in a number of ways, such as:

• painful and heavy periods
• pressure on the bladder which causes related symptoms
• pressure on the bowel which affect its functioning
• generalised abdominal discomfort

When fibroids are causing troublesome symptoms and affecting daily life, we tend to recommend some form of treatment. Also, if fibroids are affecting fertility, this may be an indication for removal.

How are uterine fibroids treated?

There are several treatment options for uterine fibroids, with some approaches being more suitable for each individual patient.

If symptoms are mild, medical management of those symptoms by medications such as Tranexamic Acid (a medication that reduces blood loss during periods), Mefenamic Acid (a medication that can reduce pain and bleeding), or hormones such as Norethisterone and other forms of progesterone, and devices such as the intrauterine system (e.g. the Mirena coil), can be used.

Surgical options may include removing fibroids by keyhole surgery or open surgery depending on the size, number and location of the fibroids. Surgical removal of the fibroids is one option but there are other types of treatment which aim to shrink rather than remove the fibroids. This can be done with some types of hormonal treatments and interventional radiological treatments, such as uterine artery embolization or radiofrequency ablation of fibroids.

What is the best treatment for uterine fibroids?

This depends very much on the individual so there isn’t a single treatment which is best for all women. In some cases, because of other medical problems or concerns about surgery, the best treatment might be interventional radiological procedures such as uterine fibroid embolization or radiofrequency ablation. If the priority is fertility and restoring normal anatomy, then surgical treatments to remove the fibroids may be the best option, particularly when there are many fibroids or they are very large in size. On the other hand, for women who have completed their families and don’t have any future fertility wishes, then hysterectomy may be the best option. The decision about which course of treatment is best is made with the patient based on their preferences, medical history and individualised risk factors. If you are seeking out treatment for uterine fibroids and wish to discuss your options, you can schedule a consultation with Mr Quinn by visiting his Top Doctors profile.