Fibroids, heavy periods and hormone therapy: What every woman should know

Fibroids and heavy periods are common gynaecological concerns that affect many women, often disrupting daily life and impacting physical and emotional wellbeing. Fortunately, a variety of effective treatments are now available - from lifestyle-friendly medications to minimally invasive procedures.

In this article, Ms Heena Mehra, highly experienced consultant gynaecologist, offers her expert insight into fibroids, the causes of heavy periods, and how treatments like hormone therapy, Ryeqo, Sonata® treatment and TCRF can help.

- What are fibroids?

Fibroids are non-cancerous growths made of muscle and fibrous tissue that develop in or around the uterus. They can vary in size, ranging from tiny nodules to large masses that distort the uterus. Although often harmless, fibroids can cause various symptoms depending on their size, number and location.

Types of fibroids

• Intramural fibroids, which grow within the muscular wall of the uterus and often cause heavy bleeding, pain, or pelvic pressure.
• Submucosal fibroids, which develop beneath the uterine lining and may protrude into the cavity, often causing very heavy periods and fertility issues.
• Subserosal fibroids, which appear on the outer surface of the uterus and may press on nearby organs, causing bloating or urinary problems.
• Pedunculated fibroids, which are attached by a stalk inside or outside the uterus. These can cause sharp pain if the stalk twists.

- Why do heavy periods happen?

Heavy menstrual bleeding (menorrhagia) can be caused by several underlying conditions, including:

• Fibroids, particularly submucosal ones, which distort the uterine lining.
• Hormonal imbalances, such as excess oestrogen or low progesterone.
• Endometriosis, where tissue similar to the uterine lining grows outside the womb.
• Adenomyosis, when the uterine lining grows into the muscle layer of the uterus.

Heavy periods can lead to iron-deficiency anaemia, as well as fatigue, and can also seriously impact quality of life if left untreated.

- What are the treatment options?

Treatment depends on your symptoms, fibroid size/location, general health, and future fertility plans.

Medical treatments

• NSAIDs (non-steroidal anti-inflammatory drugs) like ibuprofen to alleviate pain and reduce inflammation.
• Tranexamic acid, which helps reduce bleeding during menstruation.
• Hormone therapy to correct hormonal imbalances or reduce the growth of fibroids.

Ryeqo

A newer, once-daily oral treatment for moderate to severe fibroid symptoms. Ryeqo combines:

• Relugolix (a GnRH antagonist), which suppresses hormone levels to shrink fibroids and reduce bleeding.
• Oestradiol and norethisterone acetate, which replace essential hormones to reduce menopause-like side effects.

Ryeqo offers a non-surgical option that is effective in reducing bleeding and fibroid size, particularly useful for women who wish to avoid surgery.

- Minimally invasive procedures for fibroids and heavy bleeding

Sonata® treatment

The Sonata® treatment is a non-invasive, uterus-preserving procedure for fibroids. It uses a device with high-resolution ultrasound to locate fibroids within the uterus, followed by radiofrequency energy to shrink the fibroids over time.

Benefits of the Sonata® treatment:

1. No cuts or scars.
2. Outpatient/day-case procedure.
3. Preserves the uterus.
4. Fast recovery (often within a couple of days).

It’s suitable for a wide range of fibroid types. Multiple fibroids can also be treated in one session.

Transcervical resection of fibroids (TCRF)

This is a hysteroscopic procedure used to remove submucosal fibroids through the cervix with a small surgical instrument.

Benefits of the TCRF:

1. Minimally invasive.
2. Uterus-sparing.
3. Typically done as a day-case.
4. Offers rapid symptom relief, particularly for heavy bleeding.

Other options

• Uterine artery embolisation (UAE), which blocks blood supply to fibroids, causing them to shrink.
• Endometrial ablation, which destroys the uterine lining to reduce or stop bleeding (not suitable if future fertility is desired).

- Surgical treatments for fibroids and heavy bleeding

Myomectomy

A myomectomy removes fibroids while preserving the uterus, making it suitable for women wishing to conceive.

Hysterectomy

A hysterectomy is the complete removal of the uterus. It’s considered when other treatments have failed or are unsuitable.

- When to seek help

It’s important to speak with your gynaecologist if you experience:

• very heavy or prolonged periods
• pelvic pain or pressure
• difficulty conceiving
• disruptions to daily life due to your menstrual cycle

With the wide range of treatment options now available - from medications like Ryeqo to modern techniques like the Sonata® treatment - you can find an approach that aligns with your health needs and lifestyle goals.

For expert advice, diagnosis and treatment, reach out to Ms Heena Mehra via her Top Doctors profile today.