Fibroids – When Are They a Problem, and What Are the Options?
Fibroids are one of the most common gynaecological conditions for women, but they are quite often misunderstood; many women are surprised when they find out they have fibroids, especially as the condition can go for a long period of time without any noticeable symptoms. Whilst fibroids are usually benign, they can still have a big impact on a woman’s quality of life, fertility, and overall health and wellbeing.
Understanding exactly what fibroids are, when they become something to be concerned about, and the treatment options available can help women feel more confident about seeking medical advice and making informed decisions about their care.
What Are Fibroids?
Fibroids are growths that develop from the muscle tissue of the uterus. They can grow in the uterine wall, uterine cavity or grow on the outer surface of the uterus. They can vary in size, ranging from tiny growths that are barely visible on imaging, to larger masses that can affect the shape of the uterus. Some women have a single fibroid, whilst others may have several fibroids of different sizes.
Fibroids are extremely common during the reproductive years, and it’s thought that they are influenced by hormones like oestrogen and progesterone. It’s been estimated that up to 70-80% of women will develop fibroids by the age of 50, but most will never experience symptoms and may only discover their existence through routine appointments like pelvic examinations, pregnancy scans, or investigations for a completely unrelated health concern.
When Do Fibroids Become a Problem?
For lots of women, fibroids don’t cause any problems and therefore don’t need any treatment. But their size, number, and location can sometimes lead to symptoms that interfere with quality of life.
One of the most common issues with fibroids is heavy periods. Women might find that their periods last longer than usual too, and sometimes they can pass large blood clots. If this happens for a length of time it can lead to iron deficiency and anaemia which can cause fatigue, dizziness, and low energy levels.
Fibroids can give the sensation of ‘pressure’, which can feel uncomfortable. As they enlarge, they may create a feeling of heaviness in the lower abdomen. Some women may notice that their tummy appears bloated, swollen, or enlarged, especially if larger fibroids are involved. They can become painful, especially if they outgrow their blood supply; they can begin to degenerate which can cause sudden discomfort and pain.
The Impact of Fibroids
The location of a fibroid can affect the symptoms it causes; if a fibroid is near the bladder it may make you urinate more often, or persistently give you the feeling that you need to go. Others may press against the bowel, causing constipation, bloating, or discomfort in the abdomen.
Some women might also feel paid during intercourse, especially if fibroids are in a certain part of the uterus. These symptoms can have a negative effect on physical comfort, confidence,
relationships, and overall wellbeing, which makes it all the more important to get medical advice if they become more problematic or disrupt your daily life.
Fibroids and Fertility
Fibroids can occasionally affect fertility and pregnancy, but many women with fibroids conceive with no problems and go on to have healthy pregnancies. Sometimes fibroids can interfere with implantation, alter the shape of the uterine cavity, or increase the risk of complications like miscarriage, early labour, or difficulties during delivery.
For women who are trying to get pregnant or who have some experience of fertility challenges, a specialist assessment will tell you whether fibroids may be contributing to the problem and whether treatment could improve your chances.
How are Fibroids Diagnosed?
It’s usually quite straightforward to diagnose fibroids. If they are suspected by a healthcare professional, imaging is usually needed to confirm the diagnosis and show their exact size and location.
Ultrasound is usually the first investigation and can be carried out either through the abdomen or transvaginally, which gives greater detail. An MRI might be recommended in some cases, particularly when planning treatment or assessing larger fibroids. Further investigations using a small camera to investigate the inside of the uterus (hysteroscopy) can also be useful in some situations.
Do Fibroids Always Need Treatment?
If fibroids are small and not causing symptoms then the answer is no. Sometimes you have to ‘wait and see’ if any symptoms do occur, but regular monitoring allows time to assess whether the fibroids are stable or if changes have happened between check-ups.
For lots of women, reassurance and periodic reviews are all that are needed; it’s only when symptoms become troublesome, fertility is affected, or fibroids continue to grow that treatment should be sought.
Treatments for Fibroids
When treatment is needed, the most suitable one will depend on different factors including severity of symptoms, age, future fertility, and the size and location of the fibroids.
Medication is often used as an initial treatment to manage symptoms. Hormonal therapies can help reduce heavy bleeding, and other medications may temporarily shrink fibroids by altering hormone levels. These treatments aren’t usually a permanent fix, but they can give relief.
Fibroids can be removed using advanced keyhole surgery techniques, which offer many advantages over the traditional open abdominal approach including enhanced recovery, a shorter hospital stay and reduced scarring.
In cases where symptoms are severe and women have finished having children, a hysterectomy may be an option.
When Should You Get Medical Help?
You shouldn’t ignore symptoms that could indicate fibroids or any other underlying gynaecological condition. Heavy periods, ongoing pelvic pain, swelling of the abdomen, urinary symptoms, or difficulty in getting pregnant should prompt you to seek a medical assessment.
Early diagnosis can help prevent complications, improve symptoms, as well as making sure that treatment options can be discussed before those symptoms become severe.