While often carrying no symptoms, fibroids can be a painful yet invisible condition. Learn about who gets fibroids, what the warning signs are and how you can treat them with WUKA.
What is a Fibroid?
A uterine fibroid – also known as uterine myomas or leiomyomas – is a non-cancerous growth, made up of muscle and fibrous tissue, found growing in or around the uterus. They are fairly common, affecting around 1 in 3 women at some point in their lives, mainly between the ages of 30 to 50 (NHS).
These growths can vary in size; some can be very small and only detectable on a scan, while some can be a lot larger. Many women do not experience symptoms, so they are often discovered during routine examinations or scans.
Causes of Fibroids
According to the NHS, doctors do not know exactly what causes uterine myomas, but it is thought that oestrogen and progesterone – hormones produced by the ovaries – can impact their growth.
During your lifetime, the levels of oestrogen and progesterone in your body fluctuates, and this occurs throughout your menstrual cycle too.
Experts believe that myomas develop when oestrogen levels are at their highest, and that you’re less likely to get them after menopause.
Doctors also believe that there are some conditions that could make it more likely for you to develop them.
Increased levels of oestrogen during pregnancy could trigger the development of myomas, and this is most likely to occur during the first trimester.
There could be a greater chance of developing uterine myomas if your mother or grandmother had them, and they are more commonly found in women of Afro-Caribbean origin.
When working in sync, oestrogen and progesterone are essential for your menstrual cycle. Oestrogen is a steroid hormone that takes care of the growth of the uterus, and the replacement of its lining each month. Progesterone works to prepare the body for a potential pregnancy, ensuring that conditions are prime for a fertilised egg.
A hormonal imbalance can cause disruptions to this natural cycle. When oestrogen levels in the body rise, but progesterone levels remain static, myomas are more likely to develop. The body needs a balance of both hormones, as progesterone works to limit the growth induced by oestrogen.
Less progesterone and more oestrogen means uterine growths can be unrestricted.
Environmental and lifestyle factors also have an impact on uterine myomas. Being overweight and/or having high blood pressure can increase the likelihood of developing them.
How to Tell You Have Fibroids
Around 1 in every 3 women experiencing uterine myomas will not have any symptoms at all. For some women, they are only detected only during a routine exam, and for others the symptoms may be more obvious.
Mr Hemant Vakharia, consultant gynaecologist at London Gynaecology, tells us more about the symptoms associated with uterine myomas:
Long & Heavy Periods
‘Some patients may begin to experience a change in their periods and typically this is noticing that they have become heavier. Approximately 1 in 5 women have heavy periods and uterine myomas are recognised as a cause.’
A heavy period is typically classed as such if you need to change your period product every 1-2 hours, or if you need to combine your methods of protection. Some women also experience bleeding for longer than 7 days and sometimes experience leaks through to their clothing too.
In very rare cases, it is possible to pass fibroid tissue during your period, but in most cases this will not happen.
It is also worth noting that as period blood has a lower pH level than your vagina, heavy periods could also potentially disrupt your vaginal pH balance.
If you are experiencing heavy periods, we recommend our either our Heavy Flow period pants or our Super Heavy Flow period pants. They are moisture wicking, so will keep you more comfortable during your period.
Pain During Sex
‘Depending on the size and location of the myomas, some patients may experience pain with intercourse also known as dyspareunia. Dyspareunia can also be caused by other conditions like endometriosis and therefore should be investigated.’
Lower Back or Pelvic Pain
‘Pain can also be a presenting symptom, with some patients experiencing pain during their period or at other times. There can be many different causes of pelvic pain but any unusual pains that are not in keeping with the patient's typical experiences during their period or otherwise should prompt a medical review.’
‘In some patients they may start to experience pressure symptoms on either their bladder or bowel. The uterus, bladder and bowel are all in close relation and myomas, typically large ones, can press on these structures. Where the bladder is being compressed, this can lead to an urgency to pass urine.’
Additionally, this pressure on the bladder could possibly lead to a UTI, which would require treatment to resolve.
Bleeding Between Periods
‘In addition, some myomas can cause bleeding after sex or between periods. Patients that experience this should see their doctor.’
Bleeding between periods should always be taken seriously. Some women also experience a change in their vaginal discharge with a pinkish, watery secretion.
If you suspect you might have uterine myomas, your first port of call should always be your healthcare provider, who will usually carry out a pelvic exam. You may then be referred to hospital for further tests and treatment.
There are a few different ways that uterine myomas can be diagnosed.
An MRI (Magnetic Resonance Imaging) scan might be performed to diagnose uterine growths via detailed images of your internal organs. Using MRI, doctors are able to find the exact location of the growths and can plan for the best course of treatment for you.
An ultrasound scan is one of the main methods that doctors in the UK use to diagnose uterine myomas (NHS). Ultrasound scans don’t hurt at all; they use high frequency sound waves to create an image of whats going on inside your body and are a very effective diagnostic tool.
You may be offered either an abdominal ultrasound (where the ultrasound probe is moved along the outside of your tummy) or a transvaginal ultrasound (where a smaller probe is inserted inside your vagina).
A laparoscopy is sometimes used to diagnose uterine myomas. During the procedure, your doctor will insert a small camera inside your abdomen, under general anaesthetic, to determine the location of the growth.
Every woman is different and each case should be looked at individually, so its important to speak to your doctor about your options.
Mr Narendra Pisal, consultant gynaecologist at London Gynaecology, explains:
‘Treatment depends on size and location of growths and symptoms caused. Typically, growths smaller than 6cm can be left alone, unless within the uterine cavity.’
There are some medicines that your doctor might prescribe to reduce the symptoms you are experiencing, such as heavy periods.
Levonorgestrel Intrauterine System (LNG-iUS) may be used to slowly release progesterone into your body via a small plastic T-shaped device that is placed inside your uterus. There are side effects to this medicine, so always discuss this with your doctor.
You may also be prescribed Tranexamic Acid, which are tablets that are taken orally to stop the blood vessels inside the uterus from bleeding.
Anti-inflammatory medicines may also be prescribed to reduce your body’s levels of prostaglandin, which helps to reduce heavy bleeding during your period.
Contraceptive medicines are also commonly used to stop the ovary from releasing an egg, resulting in a lighter period.
Your doctor may also prescribe progesterone as either an oral tablet or as an injection, to help reduce heavy bleeding during your period.
Gonadotropin releasing hormone analogues (GnRHas) may be prescribed if medicines used to treat the symptoms aren’t successful. These are given via injection and they work by stimulating the pituitary gland, which restricts the ovaries from producing oestrogen. GnRHas will stop your period while you are on this medication, but it is not a contraceptive and will not affect your fertility.
GnRHas are sometimes used alongside a low dose of hormone replacement therapy to reduce side effects. Speak to your healthcare provider if you are concerned about this.
Another medicine that is sometimes prescribed is called Ulipristal acetate.
You can find more information on all of these medicines on the NHS website.
For some women, medicines may not be effective and symptoms may linger, in which case surgery will be recommended.
Mr Narendra Pisal explains:
‘Some growths may be small, but within the uterine cavity, and can cause heavy bleeding or difficulty conceiving. These can be removed by Hysteroscopic surgery. Some are large and can cause pressure on organs such as the bladder or bowel. These can be removed by Laparoscopic or Open Myomectomy operation.’
There are also a few non-invasive surgical procedures that can be carried out.
Uterine artery embolisation (UAE) may be offered for larger growths, and is carried out by a radiologist, who will block the blood vessels that supply the fibroids. This will be performed under local anaesthetic and will require a short stay in hospital, followed by 1-2 weeks of rest at home.
Endometrial Ablation is often recommended to treat smaller growths in the lining of the uterus. This is a quick procedure that is carried out under either general or local aesthetic, and involves the removal of the lining via a simple procedure that you can discuss with your doctor.
The Bottom Line About Fibroids
The bottom line is, for some women uterine myomas can result in a variety of unpleasant symptoms, and, if left untreated, these can potentially cause issues further down the line.
Paying attention to changes in your cycle is a good idea, especially if you normally experience a light period flow.
During pregnancy, uterine myomas can sometimes lead to problems with the development of the baby, or issues during labour. In some case, they can affect your ability to get pregnant.
Rest assured that terine myomas are not cancerous, and the risk of them turning cancerous is very small: less than 0.1%.
A great resource for further advice is the British Fibroids Trust, which is a not-for-profit patient support group with lots of articles and advice.
About London Gynaecology:
London Gynaecology is an established private gynaecology practice providing daily services to women. Led by a team of consultant gynaecologists who hold senior positions in the NHS and bring a wealth of knowledge and expertise to London Gynaecology.