Fibroids are benign (non-cancerous) tumours. They occur in the uterus (womb). The womb is a hollow, pear shaped muscle.
Women worldwide have been faced with the unexpected news that they have fibroids. Most women have never heard of them prior to their diagnosis. For a woman the idea of a tumour occupying their womb is frightening especially in the absence of information about this benign problem. Some women feel a mixture of emotions, they are sometimes scared, sometimes embarrassed to discuss it with friends & family. Unfortunately the lack of information leads women to accept a hysterectomy (removal of the womb) for this treatable condition.
For reasons that are currently being researched, a single muscle cell in the uterus may begin to grow & multiply rapidly. The resulting tumour is called a fibroid. (The word ‘tumour’ often evokes fear because it is commonly associated with cancer, but ‘tumour’ in medical terminology simply means “new growth” or overgrowth of cells). The medical term for them is Leiomyomata (Leio= smooth myo=muscle). They are also called uterine myomas, fibromyomas or leiomyomas. Their size can vary. Some are microscopic or the same size as a pea and some can be as big as a melon. Fibroids can increase in size, decrease in size or even go away with time. They can occur anywhere in the womb and are named according to where they grow:
Intramural fibroids grow within the muscle tissue of the womb. This is the most common place for fibroids to form.
Subserous fibroids grow from the outside wall of the womb into the pelvis.
Submucous fibroids grow from the inner wall into the middle of the womb.
Pedunculated fibroids grow from the outside wall of the womb and are attached to it by a narrow stalk.
The fibroid location is often connected to whether or not there are symptoms.
How common are fibroids?
Fibroids are a multicultural issue. Fibroids affect up to 70% of women of all races, however up to 80% of Afro-Caribbean, Indo-Asian & Jewish women are affected by this problem.
It is common to have several fibroids of various sizes, although some women just have one. They are more likely to be diagnosed during your childbearing years, if they cause symptoms
Large fibroids may put pressure on the bladder or intestines. When that happens, symptoms such as frequent urination, constipation or pelvic pain may develop. Approximately 1 in 3 women may suffer from heavy menstrual bleeding . On rare occasions, a large fibroid may block the opening of the uterus. However, women with fibroids, are as fertile as other women in the general population. Fibroids are often first diagnosed during pregnancy.
It is not uncommon for there to be more than one. In Afro-Caribbean women, they are diagnosed more frequently at younger ages and they have a tendency, to be larger & more symptomatic. However, this does not make them more likely to be cancerous. In large studies on Fibroids 99.97% of them are non cancerous & do not become cancerous, irrespective of size and number. Your Doctor can carry out tests to confirm this
Wait & See approach
Fibroids may not need to be treated, as they may not be causing symptoms.
What are the symptoms?
Many women have fibroids, even large ones, and experience no symptoms. Others experience many unpleasant symptoms such as heavy bleeding or pain, even with small fibroids.
Fibroids may cause None, or some of these symptoms:
Constantly feeling heavy or bloated in the abdomen, feeling as if you have a foreign object in your abdomen
Abdominal swelling that makes you look bloated or pregnant
Extremely heavy bleeding during periods, large clots expelled with menstrual blood, unusually long periods, spotting and bleeding between periods, unusually severe menstrual cramps
Anemia caused by the excess bleeding
Pressure on the bladder, frequent urination, difficulty urinating
Pressure on other abdominal organs, & rarely damage to organs
Constipation
Backache
Painful intercourse,
Infertility, miscarriage . (Hower , most fibroids do not cause infertility, & are often 1st diagnosed during pregnancy).
Be aware that all of these symptoms may be caused by other conditions or even medications used for other conditions. Do not attempt to diagnose yourself and do not assume that you have fibroids based on symptoms alone. It is important to get a diagnosis from a qualified health professional.
Diagnosis? How do I know whether I have them?
Fibroids can only be diagnosed by a Medical Doctor. The symptoms above can also apply to other medical conditions. It is important to get a correct initial diagnosis to obtain the best treatment for your needs.
A gynaecologist will often start by performing a manual pelvic exam. In many cases the doctor will be able to feel and recognise the fibroids at this time.
The next step is to confirm the diagnosis with a (ultrasound). This is an easy, painless procedure. The radiologist will insert a special probe into the vagina to view your uterus, and will also run another probe over the outside of your abdomen to get a different point of view.
The doctor should count the fibroids, note their locations, and take their measurements. Be aware that an exact count may not be possible. Ultrasounds can show the size number & locations of fibroids. They can also show the endometrial thickness & the condition of the ovaries. It can also show what position the womb is in.
MRI Diagnosis
Some doctors may use MRI to look for fibroids, but this is an expensive, time-consuming procedure It provides much clearer images of the fibroids and the womb lining. MRI may be used when other conditions are suspected such adenomyosis.
Hysteroscopy or Laparoscopy
Another diagnostic procedure is hysteroscopy or laparoscopy. Both involve inserting a tubular instrument either by entry through the vagina and cervix, into the uterus (Hysteroscopically), a disadvantage of this is the Dr can only see fibroids or polyps in the womb lining. Intramural (in the muscle layer or fibroids attached on the outside of the womb, can’t be seen or measured, this can sometimes lead to an underestimate of the number of fibroids). A light shining through the tube allows the doctor to view the interior of the uterus. You may experience spotting and cramps for a couple of days following the procedure. The procedure is not used on pregnant women. Entering laparascopically often means entering the womb area via 1 inch incisions in the abdomen with an instrument containing a camera. Hysteroscopy has never had its outcomes fully audited in the UK. It is not clear from research whether Hysteroscopic Myomectomy with Open Morcellation, improves pregnancy outcomes. Patient feedback includes more Fibroids developing after its use & having many repeat operations for symptomatic return after fibroids are cut out in small pieces/ Endometrial Resection. It is prone to complications.
These techniques are also sometimes used to remove fibroids.
The use of unconfined Morcellation, to shred removed benign fibroid tissue, is controversial & has led in some cases to left fibroid fragments regrowing in a few reported cases. It’s is not clear how often this happens, as Longterm patient follow up is poor.
Another newer type of Myomectomy is Robotic Myomectomy. Trials are currently going on to see if early results improve compared to Abdominal & Laparoscopic Myomectomy. Some Trial results show there are more complications than the original surgeries, where there are large ie over 7cm or Multiple Fibroids, There is also no clear consensus on how best to remove a large valoume of fibroid tissue , through small incisions. This can often increase the operating time. Often 5 x 1 inch incisions are made with laparascopic instruments vs 1 long incision with abdominal myomectomy.
Outside of the UK, alot of progress has been made to determine the cause and best treatment for this issue. Although, Uterine fibroids are the most common reason for women to undergo hysterectomy in both the United Kingdom and the USA
Whilst hysterectomy is undoubtedly the correct management in a small minority of cases, there are modern, much less invasive and disfiguring alternatives available from surgeons and radiologists with the appropriate training. . Many Doctor’s fail to explain that fibroids are not a life-threatening condition and in fact 99.97% are benign and they will never become cancerous even if they grow in size.
According to Dr Stanley Birnbaum a gynaecologist at the Cornell medical centre/ New York hospital, the problem is “doctors are spending more time performing unnecessary hysterectomies and not enough time familiarising themselves with more effective and less invasive alternatives ……. if the doctor doesn’t know how to perform the new surgery then they will neither attempt nor advocate it.”
Dr William Ledger an authority on gynaecology at the New York hospital stated that doctors do respond to what patients want. When patients ask for a treatment, that is appropriate for them, they generally received it. However when patients are unaware of the all of the available treatments, less effective treatments were offered to them. However, with the current trend of women obtaining up to date information from reliable internet sources such as Pubmed, Patient info etc doctors are finding that patients sometimes know more about their treatments then they do, this forces them to keep up to date or lose the patients. Some Doctors have gaps in their knowledge as many new treatments are being introduced for many gynecological conditions.
Treatments
There are many Treatments that are no longer recommended for Fibroids as they are not as effective as other treatment options.
Medical Treatments
There are many Medical and Surgical Treatments for Fibroids. The Medical Treatments give temporary relief from symptoms,whilst they are being used, if there are symptoms, , such as Heavy Bleeding. However, there isn’t a medical treatment at present that removes the fibroids. Some medical treatments can temporarily shrink the fibroids. Many medical treatments are synthetic hormones . Increasingly, contraceptive pills or Mirena IUS (Intra-uterine contraceptive devices) are used to provide both contraception & relief from heavy bleeding symptoms for those women who desire both of these features. The Mirena IUS is inserted in the womb for 5 years. Therefore, it would not be suitable if you are planning to become pregnant, within that period of time. It should not be inserted into the womb if fibroids/polyps, distort the womb cavity as there is a higher risk of perforation.
Medical Treatments are not recommended, whilst actively trying to conceive a child.
There may also be side effects from either medical or surgical treatments. Read the Patient Information leaflet supplied with medications to see the known side effects.
Surgical Treatments
Endometrial Ablation, is an operation to remove the fibroids and part of the the womb lining. However, this is more suitable for women who have completed their child bearing and or have small fibroids. Results are poorer in younger women.
Fibroids can also be removed by an operation called Myomectomy (ectomy=removal) or shrunk by embolization (blocking the blood supply to the fibroid). There are various types of Myomectomy. They have different outcomes. Your Doctor should give you a leaflet which explains the Risks of Benefits of each type of Myomectomy and the full range of Fibroids Treatments, so you can have Informed Choice. All of thes operations are available on the NHS or privately. Removing fibroids, can help to remove bulky fibroids, and may assist where women have found the the size & location of the fibroid(s) , are preventing pregnancy. There are many new ways of removing fibroids which are minimal surgery, which have shorter recovery times. Some, however, have higher symptomatic recurrence of fibroids, longterm. For large & multiple fibroids, abdominal opem myomectomy has the best longterm outcomes, but recovery time is a few weeks longer than minimal surgery. There are also less Drs skilled in Open Myomectomy.
Hysterectomy – The Last Resort
If all other treatments have failed, then a Hysterectomy , could be a last resort. This is the removal of the entire womb, leading in younger women to a premature, surgical menopause.
Why are hysterectomies controversial?
Critics contend that in the past some doctors, with the goal of preventing uterine cancer, have performed hysterectomies on women who didn’t need them. In very rare cases, doctors have been charged with using hysterectomies as a form of birth control or involuntary sterilization, especially for women of color. There have also been cases where hysterectomies were performed without the knowledge or consent of the patient.
For many women, the biggest drawback to a hysterectomy is the loss of fertility or having to face menopause, earlier than expected.. Once you have a hysterectomy, you cannot conceive, and for many women of childbearing age, this is a significant loss. Some women experience a loss of sexual desire, although this problem appears treatable with hormone therapy. Women who feel pushed into a hysterectomy may also have a negative reaction to it. Having uterine fibroids does not increase your risk of cancer.
There is also a higher risk of of developing Incontinence &/or prolapse after Hysterectomy. If it is done Laparascopically or vaginally & the womb is morcellated, without being safely removed or bagged, there is an increased risk of the fibroids fragments regrowing in other parts of the Pelvis. So ask your Dr not to do unconfined Morcellation. In the USA FDA asked Drs to stop doing unconfined Morcellation.
My Own Story
Many women have asked me to tell my story. I was diagnosed with multiple fibroids at 25 years old. I had 4 fibroids, the largest was 10cm across. I had no plans to have children yet, but I wanted to preserve my ferility.There was no Fibroid Support Group in the UK, so I set up the Fibroid Network & researched my options. I had no symptoms from my fibroids for the 1st 8 years. I didn’t want a hysterectomy as I wanted, eventually to have children. In the 9th year, I started to have heavier periods so I was prompted to treat them. I chose an Abdominal Myomectomy (removing the fibroids by Laparotomy, Open Myomectomy , but leaving the womb intact), as this was the most successful procedure for people who wanted to become pregnant compared to other options available. By this stage my largest fibroid was 22cm high & 33cm diameter plus three smaller ones.
The Open myomectomy was successful & the largest fibroid weighed 11 lbs (approximately 5 kilos). I spent 4 days in hospital. The Doctor recommended that I should have at least six weeks off work to recover. My recovery was easier & less painful than I had expected. I lost over 20 lbs in weight. I have not had to take any medical treatment since. My heavy periods, became normal, after the myomectomy. I wasnt ready to settle down & have a family until 6 years later. During this time, I continued to campaign to the UK Government & the National Health Service, on behalf of women with fibroids, for more information on alternatives to hysterectomy. I became a UK Patient Carer Guideline Development Lay Panel member, for the Heavy Menstrual Bleeding NHS NICE( National Institute of Clinical Excellence) Guideline, to help to communicate the patient experience for this condition. This Guideline was published in 2007.
At the age of 40 , I naturally conceived (no ivf needed) , fraternal twins at my 1st attempt at pregnancy, . My fraternal twins girls were born healthy, without the need for intensive care.
I am currently updating the site to reflect , all of the new research into fibroids, including , treatments and diet & lifestyle.
The material provided on this site is for educational purposes only and any recommendations are not intended to replace the advice of your physician. The information is not intended to diagnose, treat, cure, or prevent disease. You are encouraged to seek advice from a competent medical professional regarding the applicability of any recommendations with regard to your symptoms or condition.