Fibroids are the most common growths in a woman's reproductive system. Many women with fibroids have no symptoms at all, while others have symptoms ranging from heavy bleeding and pain to incontinence or infertility. These information pages explain what fibroids are, how they can affect your health and what your options are for treatment. For more information on heavy bleeding or hysterectomy, visit our pages on these topics.

What are fibroids?
Fibroids are tumours that grow in the uterus (womb). They are benign, which means they are not cancerous, and are made up of muscle fibre. Fibroids can be as small as a pea and can grow as large as a melon. It is estimated that 20-50% of women have, or will have, fibroids at some time in their lives. They are rare in women under the age of 20, most common in women in their 30s and 40s, and tend to shrink after the menopause.

Although the exact cause of fibroids is unknown, they seem to be influenced by oestrogen. This would explain why they appear during a woman's middle years (when oestrogen levels are high) and stop growing after the menopause (when oestrogen levels drop).

According to US studies, fibroids occur up to nine times more often in black women than in white women, and tend to appear earlier*. The reason for this is unclear. Also women who weigh over 70kg may be more likely to have fibroids. This is thought to be due to higher levels of oestrogen in heavier women.

In the past, the contraceptive pill was thought to increase the risk of fibroids, but that was when the pill contained higher levels of oestrogen than it does today. Some studies suggest that the newer combined pill (oestrogen and progestogen) and the mini pill (progestogen only) may actually help prevent or slow the growth of fibroids.

Types of fibroids
Fibroids are categorised by where they grow in the uterus

Intramural — these grow in the wall of the womb and are the most common type of fibroid.

Subserous—- these fibroids grow from the outer layer of the womb wall and sometimes grow on stalks (called pedunculated fibroids). Subserous fibroids can grow to be very large.

Submucous — submucous fibroids develop in the muscle underneath the inner lining of the womb. They grow into the womb and can also grow on stalks which, if long enough, can hang through the cervix.

Cervical — cervical fibroids grow in the wall of the cervix (neck of the womb) and are difficult to remove without damaging the surrounding area.

If you have fibroids, you may have one or many. You may also have one type of fibroid or a number of different types.

Fibroids — prevention
As the cause of fibroids is still unknown, there are no clear guidelines for preventing them. However, there are some things you could do that may help reduce your risk:

* Keep your weight in check. This will minimise oestrogen levels in your body.
* Eat green vegetables and fruit, and avoid red meat. An Italian study found that women who eat little meat but a lot of green vegetables and fruit seem to be less likely to develop fibroids than women who eat a lot of red meat and few vegetables.
* Some studies suggest the combined pill may protect against fibroids by keeping hormone levels from peaking and falling. The pill comes with its own set of side effects, however, so talk to your doctor about whether it’s right for you.

Fibroids — Symptoms
It is estimated that 75% of women with fibroids do not have symptoms, therefore many women don't know they have fibroids. Whether or not you have symptoms depends on the size of the fibroids and where they are in your womb. This also affects the types of symptoms you are likely to have. For example, a small fibroid in the wall of your womb probably won't cause any problems, whereas a large fibroid growing outward from your womb might press against your bladder, causing bladder problems.

The most common symptom of fibroids is heavy menstrual bleeding. Other symptoms include abdominal pain or pressure, changes in bladder and bowel patterns and, in some cases, infertility.

Heavy menstrual bleeding (menorrhagia)

Heavy bleeding may involve flooding (a sudden gush of blood), long periods or passing large clots of blood. Heavy bleeding is not always due to fibroids, but when it is, it is usually associated with fibroids that grow into the womb (submucous). Although it is unclear exactly why fibroids cause bleeding, it may be that they stretch the lining of the womb, creating more lining to be shed during a period.

Heavy bleeding can be distressing and can make every day activities difficult. You will need to use extra sanitary protection and will probably need to change towels or tampons frequently. Some women with heavy bleeding feel they need to stay near a toilet during their periods. This can greatly restrict activity and may be frustrating or tiring.

Anaemia (iron deficiency)

Some women with fibroids and heavy bleeding develop anaemia as a result of blood loss. Anaemia can make you feel weak, dizzy and tired. If blood tests show that you have anaemia, ask your doctor about supplements or changes in your diet that might help. Foods such as liver, leafy green vegetables, dried fruit and even red wine can help boost your iron levels.

Pain and pressure

Some women with fibroids experience painful periods, dull aches in their thighs, back pain or constant pressure in the abdominal area that feels like bloating or fullness.

Pain during your period may be due to large clots of blood pushing through your cervix. Cramps could also be caused by the womb trying to force out a submucous fibroid that is growing on a stalk in the cavity of the womb.

Large fibroids can make the womb big and bulky, which can lead to lower back pain or pelvic discomfort. Some women with fibroids feel a dull ache in their thighs or develop varicose veins in their legs. This happens when fibroids become so large they press on nerves and blood vessels that extend to the legs.

Occasionally, fibroids can cause sudden severe pain in the pelvic area or lower back. This may be due to a fibroid on a stalk (pedunculated) that has become twisted. This kinks the blood vessels in the stalk and cuts off the blood supply to the fibroid. If you feel sudden severe pain and also have a fever or feel sick, you should see your doctor. The fibroid may need to be removed or your doctor may recommend bed rest and painkillers until the pain stops on its own.

Pain during sex

Fibroids that press on the cervix or hang through the cervix into the vagina can make penetrative sex painful and can also cause bleeding during sex.

Bladder and bowel symptoms

Large subserous fibroids (on the outer part of the womb) can press on your bladder or bowel, leading to one or more of the following symptoms:

* Bladder
o frequent need to urinate
o leaking or dribbling urine
o urgent need to urinate, often passing only a small amount
o difficulty or inability to pass urine – this is very serious and you should tell your doctor as you may need urgent care. A tube, called a catheter, will be put into your bladder to empty it
o cystitis caused by trapped urine that becomes infected
* Bowel
o constipation
o haemorrhoids (piles)

Fibroids and pregnancy
Most fibroids do not get in the way of a pregnancy. They may cause discomfort, but they generally do not cause any other problems. Some fibroids in certain areas, however, can make conception difficult or lead to miscarriage. Fibroids may press against, or block the entrance to, the fallopian tubes, thus preventing the egg from reaching the uterus. Submucous fibroids that grow inwards into the womb are thought to cause recurrent miscarriage.

A fibroid can also interfere with labour and birth if it blocks the passage to the birth canal. If this is the case, your doctor may recommend a Caesarean section. Fibroids may increase your risk of bleeding heavily after birth, and can increase the time it takes for your womb to return to its normal size.

Just as fibroids can affect pregnancy, pregnancy can affect fibroids. It is thought that fibroids grow during pregnancy because of higher levels of oestrogen, but there is little evidence to support this. Another effect of pregnancy on fibroids is something called 'red degeneration.' This is when a fibroid’s blood supply is cut off, causing it to turn red and die. It can also happen outside of pregnancy but it usually occurs in the middle weeks of a pregnancy. Red degeneration can cause intense abdominal pains and contractions of the womb, which could lead to early labour or miscarriage. If you feel these symptoms, tell your doctor. The pain and contractions usually stop on their own but your doctor may give you drugs to ease the pain and stop the contractions more quickly.

Fibroids are never removed during a pregnancy because of the risk of haemorrhage (bleeding).









 

  Fibroids grow in the wall of
the womb

  Fibroids grow in the womb of a woman

  Large fibroid uterus. The ovaries and tubes are seen on both sides

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