Understanding uterine fibroids
Uterine fibroids are a common gynaecological condition affecting many patients, particularly during their reproductive years. While often harmless, they can sometimes cause significant discomfort or lead to complications if left untreated. This article by a consultant gynaecologist Mrs Anjali Ahluwalia provides an overview of fibroids, including their causes, symptoms, diagnosis, and treatment options, to help patients better understand and manage this condition.
What are uterine fibroids?
Uterine fibroids, also known as leiomyomas or myomas, are non-cancerous growths that develop from the muscle tissue of the uterus. They vary widely in size, from small nodules that are barely detectable to large masses that can distort and enlarge the uterus. A patient may have a single fibroid or multiple fibroids at the same time.
Fibroids are classified based on their location in the uterus. Intramural fibroids grow within the muscular wall, subserosal fibroids project outward from the uterus, and submucosal fibroids grow into the uterine cavity. The location and size of fibroids often determine the type and severity of symptoms experienced.
Causes and risk factors
The exact cause of uterine fibroids is not fully understood, but their development appears to be influenced by a combination of genetic, hormonal, and environmental factors. Oestrogen and progesterone, the hormones that regulate the menstrual cycle, are thought to promote fibroid growth. This is why fibroids tend to shrink after the menopause when hormone levels naturally decline.
Certain factors increase the likelihood of developing fibroids. These include:
- Age: Fibroids are most common in patients aged 30 to 50.
- Family history: Having a close relative with fibroids increases risk.
- Obesity: Being overweight is associated with a higher risk.
- Lifestyle factors: Diets high in red meat and low in green vegetables may contribute.
Symptoms and possible complications
Many patients with fibroids experience no symptoms at all, and the condition is often discovered incidentally during a pelvic examination or scan. However, when symptoms do occur, they may include:
- Heavy or prolonged menstrual bleeding
- Pelvic pain or pressure
- Frequent urination or difficulty emptying the bladder
- Pain during intercourse
- Lower back pain
- Bloating or abdominal swelling
In some cases, fibroids can lead to complications. These may include anaemia from chronic heavy bleeding, fertility problems, or issues during pregnancy such as miscarriage, preterm birth, or obstruction during labour. Large fibroids can also cause pressure effects on nearby organs, such as the bladder or bowel.
Diagnosis of uterine fibroids
Diagnosis typically begins with a thorough medical history and physical examination. A pelvic examination may reveal an enlarged or irregular uterus. To confirm the presence, size, and location of fibroids, imaging tests are usually required. The most common diagnostic tools include:
- Ultrasound scan, a simple and effective first-line imaging technique
- MRI scan, used for more detailed assessment or surgical planning
- Hysteroscopy, a procedure that allows visualisation of the uterine cavity for submucosal fibroids
Occasionally, other investigations such as blood tests may be needed, especially to assess for anaemia or rule out other causes of symptoms.
Treatment options for uterine fibroids
Treatment depends on the severity of symptoms, the size and location of fibroids, the patient’s age, and her wish to preserve fertility. Options range from conservative monitoring to medical and surgical interventions.
- Watchful waiting is appropriate for patients with small, asymptomatic fibroids.
- Medical treatment may include hormone-based therapies such as the combined pill, progestogen-only methods, or GnRH analogues, which help to shrink fibroids and control bleeding.
- Non-surgical procedures, such as uterine artery embolisation (UAE), cut off the blood supply to fibroids, causing them to shrink.
- Surgical options include myomectomy, which removes fibroids while preserving the uterus, and hysterectomy, the complete removal of the uterus, which is usually reserved for severe cases or when fertility is no longer a concern.
With proper assessment and treatment, most patients with uterine fibroids can manage their symptoms effectively and maintain a good quality of life. If you have concerns or symptoms suggestive of fibroids, seeking timely advice from your GP or gynaecologist is highly recommended.