What are fibroids?

Fibroids are an extremely common condition affecting about 1 in 3 women. They are benign growths of the muscle wall of the womb and can be found either within the wall (intramural) or protruding internally into the cavity of the womb (submucosal) or externally into the abdomen (subserosal). They vary considerably in size from few mm to a huge size filling the whole abdomen. They can also be found in different parts of the womb including front, back, side, top or bottom. A woman could have a single or multiple fibroids (more than 10).

What problems can fibroids cause?

In many women, fibroids do not cause any problems and are only detected during a routine examination or ultrasound scan. Common symptoms caused by fibroids include heavy periods, pressure symptoms and swelling of the lower abdomen. Pressure symptoms depend on the organs affected. For instance pressure on the bladder could cause frequency of urination, pressure on the bowel could cause indigestion and constipation and pressure on nerves could give rise to pains. Very large fibroids could press on the lungs causing difficult in breathing. Fibroids close to the fallopian tubes could cause mechanical obstruction of tubes resulting in infertility. However, the majority of women with fibroids are able to conceive naturally.

How can fibroids be diagnosed?

Fibroids are usually easily detected either during an internal examination if they are large enough, or by an ultrasound examination of the womb. The latter is usually required to determine the number, size, exact location and type of the fibroids.

How can fibroids be treated?

Fibroids need treatment only if they are causing distressing symptoms, otherwise they are better left alone. They are completely benign and will shrink after menopause.

Women with small fibroids presenting with heavy periods could be offered the same non-surgical treatment options described under “heavy periods” such as non-hormonal medications, hormonal treatment and mirena coil. Larger fibroids are less likely to respond to medical treatment. In young women desiring fertility, the fibroids could be removed surgically by an operation called “myomectomy”. In the majority of cases myomectomy requires open surgery, but in selected cases with a single fibroid, the procedure could be carried out with keyhole surgery. In women who have completed their family, hysterectomy is the ideal way of eradicating the fibroids.

More recently, less invasive procedures have been developed to treat fibroids in selected patients keen to preserve their womb. These include uterine artery embolsation and MR guided focused ultrasound treatment of the fibroid. However, these procedures are not widely available and are not suitable for every patient.

Saad Amer

Saad Amer MSc., FRCOG, MD
Consultant Gynaecologist

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