Fibroids: Causes, symptoms, diagnosis, and treatments

Fibroids are common benign tumours that develop within the uterus. Despite their prevalence, affecting up to 80% of women at some point, the exact causes of fibroids remain unclear. In his latest online article, Mr Michael Magro explores what fibroids are, their potential causes, symptoms, diagnostic methods, and treatment options. Understanding fibroids is crucial for managing their impact on women's health effectively.

What are fibroids?

Fibroids are benign fibromuscular masses, essentially non-cancerous tumours. These growths, composed of fatty muscular tissue, develop within the uterus. Fibroids can form in various locations: within the uterine muscle (the body of the womb), inside the uterine lining, outside the uterine lining, and less commonly, on the cervix or neck of the womb.

What causes fibroids?

We don't precisely know what causes fibroids. It is estimated that 60 to 80% of women will develop fibroids at some point in their lives. There likely is a genetic or hereditary component, as they are more common in women with family members who have fibroids. Oestrogen, the hormone, is also known to promote their growth and development. However, the exact cause remains unknown. Additionally, certain ethnic groups, such as women with black skin, are more prone to fibroids compared to Caucasian women, though the reasons for this disparity are not yet clear.

What are the symptoms of fibroids?

The symptoms of fibroids can vary significantly depending on their location within the uterus. Many women discover they have fibroids incidentally during scans conducted for other reasons. Often, these fibroids do not require treatment because they do not cause any symptoms.

When symptoms do occur, they can include heavy or irregular periods or heavy and regular vaginal bleeding, especially if the fibroids protrude into the uterine lining. Painful periods are common when fibroids are located within the uterine muscle. Additionally, fibroids can cause pressure symptoms; if the fibroids enlarge the uterus, it may press on the bladder or bowel. In some cases, women may even appear pregnant if the enlarged uterus becomes noticeable through the abdomen.

How are fibroids diagnosed?

The diagnosis of fibroids begins with a thorough medical history, which may lead a gynaecologist to suspect their presence. This is followed by an abdominal and pelvic examination, where fibroids might be physically detected. To confirm the diagnosis, a pelvic scan is typically performed, usually an ultrasound. In some cases, an MRI scan may be necessary to precisely map the fibroids, especially if treatment is being considered.

For women experiencing irregular or heavy bleeding, a hysteroscopy might be required. This procedure involves passing a camera through the vagina to directly visualise the inside of the uterine lining and check for fibroids.

What are the treatment options for fibroids?

Treatment for fibroids depends on whether removal or symptom management is needed.

• Small submucosal fibroids: Contraceptive pill or Mirena coil.

• Large submucosal fibroids: Transvaginal resection (TCRF) removes fibroids through the vagina.

• Fibroids in other locations: Myomectomy surgically removes fibroids, done via keyhole or open surgery.

• Non-invasive option: Uterine artery embolisation (UAE) blocks blood supply to shrink fibroids.

• Medical treatment: Ryeqo induces temporary menopause to shrink fibroids, with hormone replacement therapy.

Consult a gynaecologist to determine the safest and most suitable treatment.

Mr Michael Magro is an esteemed consultant gynaecologist. You can schedule an appointment with Mr Magro on his Top Doctors profile.