Fibroids, also known as uterine leiomyomas or fibromyomas, are benign (non-cancerous) tumours that grow in and around your uterus. Fibroids can be found in up to 40% of women. Most of these women will not experience any symptoms.  In some women, due to the fibroid’s size or location, it may cause problems requiring treatment. Fibroids grow at a very slow rate and will often have been present for many years before they are diagnosed. They will continue to grow slowly until the menopause after which they usually shrink in size.

Fibroids are categorized by their location, which includes:

  • Intramural – growing in the uterine wall. Intramural fibroids are the most common variety
  • Submucosal – growing in the uterine lining (endometrium). This type tends to cause excessive menstrual bleeding and period pain
  • Subserosal – growing on the exterior wall of the uterus. They sometimes appear like balloon on a stick

The most common fibroid symptoms are heavy, prolonged or painful periods and a feeling of pressure in your lower abdomen. Other symptoms include:

  • Bleeding between periods
  • Abdominal swelling or bloating
  • Feeling pressure in the lower part of your abdomen
  • Frequent urination
  • Lower back pain
  • Constipation, as fibroids can sometimes press against the rectum
  • Haemorrhoids
  • Pain during sex

Diagnosis of fibroids

When a clinical history or examination suggests fibroids, an ultrasound will be organised to confirm the diagnosis.

Other investigations, such as hysteroscopy (video imagining of the uterine cavity), Computed Tomography (CT) scan or Magnetic Resonance Imaging (MRI) may be required.

Treatment of Fibroids

  • Treatment of fibroids depends on the age of the patient, their location, and the symptoms they cause.
  • Most women will require no treatment at all.
  • If the presenting problem is menstrual irregularities then it is usual to investigate for other causes of heavy periods. When these have been ruled out, a trial of medication may be used as first line management.
  • Women who have a very large fibroid or multiple fibroids that are causing symptoms, and who have completed their family, will usually be offered a hysterectomy. This is usually performed via laparoscopic or robotic surgery.
  • Women with large fibroids who are symptomatic and who still want children may be offered a myomectomy. In case of submucosal fibroids, a hysteroscopic excision is performed. For intramural or subserosal fibroids, the myomectomy is usually carried out via laparoscopic or robotic surgery.