All about fibroids

Woman holding her stomach to illustrate fibroids

What are they? Also known as myomas or leiomyomas, fibroids are non-cancerous tumours that grown in or around the womb. They are composed of muscle and fibrous tissue, and can vary in size. They are linked to high levels of the female reproductive hormone, oestrogen.

There are five main types of fibroid. The most common are intramural fibroids, which develop in the muscle wall of the womb. Subserosal fibroids grow outside the womb wall. Submucosal fibroids develop in the muscle beneath the womb wall's inner lining. Pedunculated fibroids grow from the outside wall of the womb and are attached by a narrow stalk. Cervical fibroids develop in the wall of the cervix (neck of the womb).

What are the risk factors? Fibroids mainly affect women of child-bearing age - particularly between 35 and 50, prior to the menopause. They are more common - and can potentially cause more of a problem - for women of Afro-Caribbean origin. Women who have given birth appear to be a slightly lower risk than those who haven't.

Fibroids are also slightly more likely to occur in women who are overweight or obese. It's thought this is due to higher oestrogen levels. Reaching and maintaining a healthy weight via a sensible diet and exercise regime is vital for all-round good health. This will put you at lower risk of many serious illnesses and ensure you bounce back quicker from any health problems.

What are the symptoms? In many cases, fibroids are symptom-free and do not pose a problem: they will eventually shrink and disappear naturally. However, one in three women with fibroids will experience some symptoms. These can include: heavy and/or painful periods, which in extreme cases can lead to anaemia; stomach pain; bloating; painful bowel movements, which may lead to constipation; frequent urination, due to the fibroid pressing on the bladder; and pain during sex.

In very rare cases, complications caused by fibroids may lead to miscarriage and premature birth: this is because fibroids are stimulated by high levels of oestrogen during pregnancy, so can grow to five times their normal size and get in the way of a growing foetus. Large fibroids can also lead to fertility problems - possibly because they interfere with the way in which the fertilised egg implants into the lining of the womb.

How are they treated? There are a variety of treatment options for women with fibroids - ranging from 'watchful waiting' to hysterectomy. Which option is right for you can depend on a number of factors, including the severity of your symptoms and whether you wish to remain fertile.

Hormone treatments can stem the amount of bleeding and help shrink fibroids. Examples include: levonorgestrel intrauterine system (LNG-IUS), a small plastic device that's placed into the womb and slowly releases a progestogen hormone; gonadotropin-releasing hormone analogues (GnRHas), which are given by injection and work by releasing a small amount of oestrogen to temporarily stop your periods; and the contraceptive pill, which stops the ovaries from releasing an egg, leading to lighter bleeding and less pain.

Alternatively, you may opt for tranexamic acid tablets, which work by encouraging the blood in your womb to clot. Anti-inflammatory painkillers, such as ibuprofen, may also help. All of the aforementioned medication has possible side effects, which your doctor should discuss with you to help you make an informed choice.

There are also several surgical options. Myomectomy is an operation to remove fibroids from the wall of the womb, while leaving the rest of the womb intact. Usually performed via keyhole surgery, this is often the preferred option for women who still want to have children - although there is a risk of recurrence. Women who do not wish to have children or are nearing menopause may opt for hysterectomy - an operation to remove the entire womb.

Endometrial ablation is another surgical procedure, which involves removing the lining of the womb using laser energy, a heated wire loop, microwave heating or a thermal balloon.

Uterine artery embolisation (UAE) involves blocking the blood supply to the fibroids by injecting a chemical through a catheter, guided by X-ray scans. This is carried out under local anaesthetic.

Two newer techniques - MRI-guided percutaneous laser ablation and MRI-guided transcutaneous focused ultrasound - use magnetic resonance imaging (MRI) to guide small needles into the fibroids, then destroy them using laser energy. Research is still ongoing into the possible risks and success rates attached to MRI treatments.

Finally, it's worth bearing in mind that changing your diet may ease the severity of symptoms and slow the growth of fibroids. Oestrogen is broken down in the liver - so it's important to steer clear of foods that put the liver under pressure and hinder the body's natural detox process. Avoid processed food, saturated fats, alcohol and caffeine. Opt instead for unrefined foods, plenty of fruit and vegetables and water.

And if you suffer from anaemia, try upping your intake of iron-rich foods, such as dark leafy vegetables, wholegrains, apricots and nuts. You may also consider taking an iron supplement.

Where can I find out more? For more information, advice and support, contact the British Fibroid Trust.

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