Uterine Fibroids: Symptoms, Treatment Options and When to See a Specialist

That last point is worth holding on to, because a fibroid diagnosis often arrives with more alarm attached to it than the finding warrants. This article sets out what fibroids are, which symptoms are worth acting on, how they are investigated, and the full range of treatment options, from watchful waiting through to surgery that removes the fibroids and leaves the womb intact.

What uterine fibroids are

A fibroid is a benign growth arising from the muscular wall of the womb. You may also see them called leiomyomas or myomas. They are not cancerous, and the proportion that behave otherwise is very small indeed. Their growth is hormonally driven, which is why they typically appear during the reproductive years and tend to shrink after the menopause.

Where a fibroid sits matters more than how large it is. Three positions are described, and each tends to produce a different pattern of symptoms.

A woman may have a single fibroid or twenty, and they range from a few millimetres across to the size of a grapefruit or larger. It is entirely possible to have several and know nothing about it until an unrelated scan finds them.

The symptoms worth acting on

Most fibroids are silent. When they do cause trouble, the pattern usually falls into one of the following.

Heavy bleeding is the symptom most often normalised, and it is the one we would most encourage women not to normalise. Periods that leave you anaemic, housebound or planning your month around them are not something to be endured. There is a wide range of effective treatment, and it begins with establishing the cause. This is the ground our service covering how heavy and painful periods are investigated and treated sets out in more detail.

Fibroids and fertility

Most fibroids have no bearing on conception. The exception is the submucosal fibroid, which sits inside the cavity and can interfere with implantation by distorting the surface an embryo needs to attach to. Intramural fibroids that indent the cavity may have a similar effect where they are large.

Where a fibroid is judged to be a genuine factor, removing it before trying to conceive, or before a cycle of IVF, is often the right sequence rather than an afterthought. The decision turns on position, size and what else is going on, which is why it belongs within a proper fertility investigation and treatment assessment rather than being settled on the strength of a scan report alone.

How fibroids are diagnosed

Diagnosis is usually straightforward, and most of it can be achieved in a single appointment.

• ●Pelvic examination. An enlarged or irregularly shaped womb is often the first clue, and examination helps rule other causes in or out.
• ●Transvaginal ultrasound. The mainstay of assessment. It maps the number, size and position of fibroids, and distinguishes them from ovarian cysts and from adenomyosis, which can produce very similar symptoms.
• ●Hysteroscopy. A slim camera passed through the cervix gives a direct view of the cavity. It is the definitive way to confirm a submucosal fibroid, and treatment can sometimes be carried out at the same sitting.
• ●MRI. Not needed routinely. It comes into its own for surgical planning where there are multiple fibroids, where the anatomy is complex, or where distinguishing fibroids from adenomyosis will change the plan.
• ●A full blood count, which is easily overlooked. Anaemia is common alongside heavy bleeding, it is correctable, and it is frequently the reason a woman feels as poorly as she does.

Treatment options, from conservative to surgical

It helps to think of treatment as a ladder rather than a menu. Most women start low on it and many never need to climb. The right rung depends on your symptoms, the size and position of the fibroids, your age and whether you may want to conceive in the future.

1. 1Watchful waiting. A fibroid found incidentally and causing no symptoms generally needs monitoring rather than intervention. Doing nothing is a legitimate clinical decision, not a fobbing off.
2. 2Non-hormonal medication. Tranexamic acid taken during the period reduces blood loss, and anti-inflammatories help with both loss and pain. Neither shrinks a fibroid, but for many women that is not the point.
3. 3Hormonal options. A hormonal coil, the combined pill or cyclical progestogens can all lighten bleeding substantially. National guidance notes that medical treatment tends to be less effective once fibroids are appreciably larger than three centimetres, or where they distort the cavity.
4. 4Uterine artery embolisation. A radiological procedure that interrupts the blood supply so the fibroids shrink. It avoids surgery and preserves the womb, though it is not the first choice for everyone, particularly where future fertility is the priority.
5. 5Myomectomy. Removal of the fibroids with the womb left in place, performed hysteroscopically or laparoscopically depending on where they sit. This is the option we are asked about most often and the one covered below.
6. 6Hysterectomy. Definitive, and appropriate for some women who have completed their families and have severe symptoms. It should be a considered choice among several, and it is rarely the only option available.

Hysteroscopic myomectomy

For submucosal fibroids, the fibroid can be removed through the cervix using a hysteroscope, with no abdominal incision at all. It is usually a day case, recovery is measured in days rather than weeks, and because it deals directly with the fibroid causing the bleeding it often produces a marked improvement. Our hysteroscopic myomectomy service also covers correction of a uterine septum and division of intrauterine adhesions, and we use adhesion prevention agents routinely to reduce the risk of scarring inside the cavity.

Laparoscopic myomectomy

For intramural and subserosal fibroids, removal is performed by keyhole surgery through several small incisions. The womb is repaired and preserved, which matters a great deal to women who may want to conceive. Recovery is faster and scarring far less than with open surgery. In our practice, laparoscopic myomectomy is typically a day case or an overnight stay with around four weeks of recuperation, and we use adhesion prevention agents as a matter of course to reduce the risk of pelvic adhesions and help safeguard future fertility.

When to see a specialist

Some situations warrant a specialist opinion rather than continued watchful waiting. We would suggest arranging one if any of the following apply.

None of these is an emergency. Sudden severe pelvic pain, on the other hand, should be assessed the same day.

Fibroid treatment in Manchester and Cheshire

Dr Edmond Edi-Osagie is a Senior Consultant Gynaecologist at Manchester University Hospitals and Senior Lecturer at the University of Manchester, with longstanding clinical and research interests in reproductive medicine and surgery, including benign pelvic masses such as uterine fibroids and ovarian cysts. Clinics are held across the North West, including Manchester city centre and The Alexandra Hospital in Cheadle, Cheshire.

Our approach to fibroids is conservative by instinct and thorough by habit. We assess properly, we set out every option including the option of doing nothing, and where surgery is the right answer we favour the approach that preserves the womb. Consultation and procedure fees are published, so you can see what treatment costs before committing to anything.

Frequently asked questions

This article is for information and does not replace individual clinical advice. If you have symptoms that concern you, arrange an assessment.