Overview
Fibroids are growths made of muscle and fibrous tissue. They form in the wall of the womb, and can also push into the cavity inside it or sit on the outer surface. They can be as small as a pea or large enough to change the shape of the lower tummy.
They are common during the years when a woman has periods, and are often found by chance on a scan done for another reason. Fibroids grow in response to the body's own hormones, so they usually shrink after the menopause.
Symptoms
Most fibroids cause no symptoms at all. When they do, what a woman notices depends on where the fibroids sit and how big they are, more than on how many there are.
- Heavy periods, sometimes with clots, or periods that go on longer than before
- Period pain, or a dull ache low in the tummy or in the lower back
- A feeling of fullness, heaviness or swelling low in the tummy
- Needing to pass urine often, or difficulty emptying the bladder
- Constipation or bloating
- Pain during sex
- Difficulty becoming pregnant, in some women
When to see a doctor
See a doctor in the next few days if periods affect work, study or sleep, if painkillers are not helping, if there is new pressure low in the tummy, if there is bleeding between periods or after sex, or if tiredness and breathlessness suggest a low blood count.
Causes
The exact cause is not known. A fibroid grows from a single muscle cell in the wall of the womb, and the hormones of the monthly cycle, oestrogen and progesterone, encourage it to grow. That is why fibroids appear during the years of periods and shrink afterwards. They also run in families. Nothing a woman has eaten or done causes them.
Risk factors
- Being of an age when periods still happen
- A mother or sister with fibroids
- Black or Asian background
- Never having carried a pregnancy to term
- Being overweight
- High or diabetes
- Periods that started at a young age
Complications
Most fibroids stay quiet. Problems, when they come, are mainly from the bleeding and from pressure on nearby organs.
- Iron deficiency anaemia, with tiredness, breathlessness and pale skin
- Urine infections, or difficulty passing urine
- Pain if a fibroid outgrows its blood supply
- Difficulty conceiving, and uncommonly a higher chance of miscarriage
Prevention
There is no proven way to prevent fibroids. Keeping to a healthy weight and having and blood sugar checked are linked with a lower chance of them. Reporting heavy periods early does not stop fibroids forming, but it does prevent the anaemia that so often goes with them.
Diagnosis
The doctor asks about periods and pressure symptoms and examines the tummy and the pelvis. An scan, over the tummy or with a small probe inside the vagina, shows how many fibroids there are, how large they are and where they sit. A blood count checks for anaemia. When surgery is planned, a look inside the womb with a thin camera or an may be added.
Treatment
Fibroids that cause no symptoms usually need no treatment, only a review if symptoms appear.
When the periods are the problem, treatment usually starts with medicines: anti-inflammatory pain relief, a medicine taken during the period to reduce the flow, or hormonal treatment such as a hormone-releasing coil or the contraceptive pill. Iron is given if the blood count is low.
If medicines are not enough, procedures are considered. The fibroids can be removed while the womb is kept, their blood supply can be blocked through a fine tube passed into an artery, the lining of the womb can be treated to reduce bleeding, or the womb can be removed. The right choice depends on the fibroids, the symptoms and whether a pregnancy is planned, so it helps to say what matters most to you.
Myths and facts
Things people often say about this. Open each one to see what is true.
Myth“Fibroids are a kind of cancer, or they will turn into cancer one day.”What is true?
Fact
Fibroids are not cancer and they do not become cancer. They are growths of ordinary muscle and fibrous tissue. Symptoms still deserve attention, but a diagnosis of fibroids is not a diagnosis of cancer.
Myth“If you have fibroids, the womb has to be removed.”What is true?
Fact
Removing the womb is only one of several options, and many women never need it. Fibroids without symptoms are often just watched, medicines control the bleeding for many women, and there are procedures that remove or shrink fibroids while keeping the womb.
Myth“Fibroids mean you cannot have children.”What is true?
Fact
Most women with fibroids can become pregnant. Fibroids that bulge into the cavity of the womb are the ones most likely to affect fertility or raise the chance of miscarriage, and those can often be treated. Tell the doctor if a pregnancy is planned, because it changes which treatments are suitable.
Myth“Heavy periods are just part of being a woman, so there is nothing to see a doctor about.”What is true?
Fact
Periods heavy enough to soak a pad every hour or two, to last more than seven days or to keep you at home are not something to put up with. The cause can usually be found, the bleeding can usually be reduced, and the low blood count that often comes with it can be treated.
Questions to ask your doctor
Tick the ones you want answered and take them with you.
Common questions
Are fibroids cancer?
No. Fibroids are benign growths and they do not turn into cancer. Bleeding between periods or after sex still needs to be checked, because that has its own list of causes and deserves an explanation of its own.
Will I be able to have a baby?
Most women with fibroids conceive without difficulty. The fibroids most likely to affect fertility are those pressing into the cavity of the womb, and these can often be removed. If you are planning a pregnancy, say so early, because it changes which treatments are suitable.
Will I need my womb removed?
Usually not. Removing the womb is the one treatment that stops fibroids returning, but it is not the first step and it is not the only option. Many women are managed with medicines alone, and several procedures remove or shrink fibroids while keeping the womb.
Do fibroids disappear after the menopause?
They usually shrink once hormone levels fall after the menopause, and symptoms often settle on their own. Any bleeding after the menopause is a separate matter and should always be checked.
