What Are Fibroids?
Fibroids are benign, non-cancerous growths within the muscles of the uterus. While many women can be affected, they are most common in women over fifty. It is not completely understood why fibroids form, though it has been suggested that they are abnormal muscle cells multiplying too rapidly in the presence of oestrogen. They can be divided into three main types:
- Intramural, or growing inside the wall of the uterus.
- Submucosal, or growing inside the lining of the uterus.
- Sub-serosal, or growing on the outside wall of the uterus.
Functionally, this means the growths can bulge from inside or outside the uterus itself, causing excessive menstrual bleeding, pelvic pain, problems with fertility and pressure on the body. Though most fibroids are small, some even microscopic, they can grow almost as large as a grapefruit in some circumstances— as a result, it is a good idea to get them treated.
How Are Fibroids Diagnosed?
Fibroids are typically either diagnosed through a visual examination, as they are physical growths and unlikely to require any rigorous testing. Depending on the type or size of the fibroid, you might undergo an ultrasound or a hysteroscopy. An ultrasound can scan your uterus and ovaries to detect abnormalities without the need for anaesthesia or surgery. Though able to be performed externally, it will most likely be performed vaginally. In this case, a wand-like device called a transducer is inserted into your vagina to send out sound waves and gather the reflections, which your doctor can then examine more closely.
A hysteroscopy is a procedure involving a small, narrow telescope inserted through the vagina to examine your uterus. This can be performed while awake or under anaesthetic; whichever you are more comfortable with. The main advantage of the hysteroscopy is that it allows your doctor to remove small fibroids at the same time as they are discovered, with small tools being inserted through the telescope to cut the growths out.
How Are Fibroids Treated?
Generally speaking, fibroids may be removed surgically or relieved with medications. Smaller fibroids (and their symptoms) are more easily treated with medicine, while larger ones may necessitate surgery to have them removed.
Medications for fibroids target the hormones that regulate your menstrual cycle, treating symptoms such as heavy menstrual bleeding and pelvic pain. These can include:
- Gonadotropin-releasing hormone (GnRH) agonists. In simple terms, these block production of oestrogen and progesterone, inducing a temporary menopause-like state. As a result, menstruation stops, fibroids shrink, and anaemia will often improve.
- Intra-uterine devices (IUDs), which can relieve heavy bleeding caused by the growths. It should be noted that this provides relief only, and will not remove or shrink the fibroids.
- Tranexamic acid, which allows blood to clot more effectively. In this way, it blocks the loss of blood from the uterus and reduces flow by approximately half, and can ease discomfort.
- Other medications, such as anti-inflammatory painkillers, may reduce pain caused by fibroids. Your doctor might recommend other medications such as oral contraceptives, which can help control heavy bleeding, but don’t affect the fibroids themselves. Discuss alternate options with your health professional.
Where medical treatment has not worked, or more permanent solutions are desired, there are several surgical options, ranging from minimally invasive procedures to major surgeries:
- Small fibroids can easily be removed at the same time as a hysteroscopy is performed.
- Laparoscopy can be used to remove larger fibroids, or those in unusual positions. This can be done through keyhole surgery like a hysteroscopy, or through open surgery.
- Uterine artery embolization, where small particles are injected into the arteries supplying the uterus. This cuts off the blood flow to the fibroids, causing them to shrink and eventually die.
- Endometrial ablation, where heat is used to destroy the lining of the uterus, and the growths with it. This can be done as a day procedure, and many women return to normal activity the next day. This option is only suitable if you don’t plan on becoming pregnant, as it significantly reduces your chances.
- A hysterectomy, or total removal of the uterus, is a permanent cure. Through keyhole, vaginal or abdominal surgery, this is likely only considered if this is your preferred treatment, or no other option has worked.
Like with any surgical procedures, there are always potential risks and complications. Discuss with your doctor what surgery is recommended for you, and what the potential things to be aware of might be. Though fibroids are non-cancerous, they can easily become uncomfortable, painful, or impact your quality of life— don’t hesitate to enquire about treatment options that suit you.