Fibroids

Myomas (fibroids) are incredibly common with some studies estimating that 70-80% of women will have a fibroid at some stage of their lives. A fibroid is a benign (non-cancerous) growth of muscle that is found in or around the uterus. It may be any size and shape. We do not know why women get fibroids, though it is likely that a combination of factors contribute, such as genetics, hormones such as oestrogen and progesterone and the number of children you have had.

Often fibroids do not cause any symptoms and may only be found when undergoing investigations for other reasons. When fibroids do cause symptoms, they may cause abnormal or heavy vaginal bleeding, pain at the time of periods, problems with fertility, or pressure effects on surrounding organs like bladder and bowel which may cause pain or trouble with toileting. The symptoms they cause are often related to their size and their location, which is described as:
  • Submucosal (partially or completely within the inside of the uterus)
  • Submucosal (partially or completely within the inside of the uterus)
  • Subserosal (on the outside of the uterus)

When a fibroid is very large it may occur across a number of locations. That is, it may be both in the muscle wall and the inside of the uterus. The location fibroids may have more of an effect on your symptoms that the actual size. For example, a small 1cm fibroid completely inside the uterus may cause heavy bleeding while a 5cm fibroid on the outside may cause no symptoms at all. The size, location, and your symptoms will help determine the most appropriate treatment options.

Treatment for fibroids will depend on the number, size and location of the fibroids. Treatment is divided into three groups:

  • Medical (using medications)
  • Radiological (uterine artery embolisation)
  • Surgical (surgical removal of fibroids or the uterus)

Dr Budden has undergone extensive training in the management of fibroids and is particularly adept at laparoscopic and hysteroscopic removal. He can discuss your options with you and create a plan for your care.

Medical treatments are aimed at managing symptoms such as heavy bleeding. They include both hormonal and non-hormonal treatments which are designed to reduce the heaviness of your periods. These treatments do not treat the fibroids themselves, rather they manage the symptoms. Each medical option has pros and cons and may not be appropriate for all women. For example, women who are trying to become pregnant should not use hormonal treatment.

Uterine artery embolization (UAE) is a radiological treatment where a small tube is passed through the main artery in the leg and directed towards the arteries in the pelvis that supply the uterus and fibroid. Small pieces of foam are injected to block the blood supply to the fibroid. This can reduce the volume of the fibroid by up to 50%. The fibroid is not removed but the reduction in size may reduce symptoms such as heavy bleeding or pressure. Currently this procedure is not recommended for women who are planning to fall pregnant in the future.

Surgery or fibroids is the only way to completely remove them, although the advantages should be balanced against the invasive nature of the procedure. It will not prevent new fibroids occurring.

There are three different surgical approaches to removing fibroids:

  • Hysteroscopic removal (surgery performed through the cervix)
  • Laparoscopic removal (keyhole surgery through the abdomen)
  • Removal by laparotomy (large incision in the abdomen)
The most appropriate surgical approach for your fibroids will depend on their size, number and location. Hysteroscopic removal is best for fibroids inside the uterus (submucosal) while fibroids in the muscle wall (intermural) or outside the uterus (subserosal) require abdominal surgery, either laparoscopically or by laparotomy. Dr Budden can remove most intramural and subserosal fibroids laparoscopically and would only recommend open surgery if your fibroids are exceptionally large (greater than 8cm) or there are multiple fibroids to be removed (more than 4).

Fibroids and infertility

Fibroids may contribute to infertility in a number of different ways:

  • Acting like an intra-uterine device (IUD)
  • Changing the blood flow pattern in the uterine cavity
  • Taking space within the uterine cavity
  • Altering the endometrium (lining of the uterus), making it harder for an embryo to implant

Submucosal fibroids are the most likely to be associated with fertility problems. It is recommended to remove them before trying to become pregnant. For intramural and subserosal fibroids routine removal is not recommended. If you have experienced difficulty with a pregnancy, such as premature labour or growth restriction of the baby, then Dr Budden may discuss removing the fibroid before trying for another pregnancy. If you have a pedunculated fibroid (one on a stalk), then removing it may prevent complications of pregnancy such as the fibroid twisting (called torsion) or outgrowing its blood supply and causing pain or possibly premature labour.