Fibroids

What are fibroids?

Also known as myomas or leiomyomas, fibroids are firm, round lumps that develop in women of all ages and races. As many as 40 per cent of women over the age of 35 have them. In fact, some research suggests that if you looked hard enough for tiny fibroids, you'd find them in every woman.

In most cases, fibroids are no trouble at all. Although a type of tumour - thought to form from muscle cells in the walls of the womb's blood vessels - they are benign (they don't spread around the body or become cancerous). Many women aren't even aware they have them.

Symtoms

For a number of women, however, fibroids cause significant problems. Possible complications include:

• Heavy periods (menorrhagia) and anaemia
• Abdominal pain
• Bloating - large fibroids can cause a visible tummy bulge
• Urinary problems - pressure from large fibroids on the bladder can make you feel like you need to go to the toilet more often
• Painful bowel movements - pressure on the bowel can cause problems such as constipation
• Miscarriage and premature birth - fibroids are stimulated by high levels of oestrogen and can increase to as much as five times their normal size during pregnancy, getting in the way of a growing baby
• Infertility - more common among women with large fibroids, possibly because the fibroids interfere with the way the fertilised egg implants into the lining of the womb

Very rarely - in about one in 1,000 cases - a cancer called a leiomyosarcoma may form in the fibroid. Some research suggests these tumours are actually very different from fibroids.

Treatment and recovery

There are a number of treatment options:

• Hormone treatments - drugs, such as progesterone, can decrease bleeding or shrink the fibroids, but the effects may be temporary. Another group of drugs known as LHRH analogues, which suppress oestrogen production and induce an artificial menopause, may be more effective. There may be risks such as osteoporosis and they obviously aren't suitable for women who are trying to conceive

A number of different surgical operations to treat fibroids may be offered. These include:

• Myomectomy - this is an operation to 'shell' the fibroids out of the wall of the womb. As the womb itself is preserved, this is an option for women still wanting children. It's often recommended to women with infertility that may be due to fibroids, although there may be scarring that can aggravate infertility problems. Other complications include serious haemorrhage that can only be stopped by a hysterectomy, and recurrence of the fibroids.

• Hysterectomy - for many women, hysterectomy is the best option because it removes all chance of the fibroids recurring. But it's a final step that carries significant risks and may cause an early menopause. Some women find it liberating, while others have problems with depression or lost libido.

• Endometrial ablation or endometrial resection - this operation destroys the lining of the womb. There are various ways of doing it, including thermal balloon endometrial ablation (which uses a hot balloon to destroy the lining of the womb), rollerball endometrial ablation (using a heated rollerball to destroy the womb) and resection (in which tiny pieces of the lining are removed. The pros and cons of this treatment are not yet proven.
• Medications such as tranexamic acid or non-steoidal anti-inflammatory drugs eg mefanamic acid, ibuprofen, can help with symptoms of painful,heavy periods but are not treatments for fibroids as such.
• Uterine artery embolisation (sometimes referred to as UAE or UFE) - this involves blocking the blood supply to the fibroids by injecting tiny particles through a small tube guided by x-ray scans. Research suggests symptoms improve in 60-90 per cent of women, but not enough is known about long-term benefits.
• Newer treatments including MRI guided percutaneous laser guided ablation or MRI guided transcutaneous focussed ultrasound but these are not yet proven and may not be suitable for all fibroid sufferers.

Which treatment best suits you depends on the size of the fibroids, the problems they're causing and your individual needs. For example, older women with large fibroids who've completed their family may choose a hysterectomy. In younger women still trying to have children, other treatments may be more suitable.

• If fibroids are diagnosed, don't fret unnecessarily - they may cause you no problems at all
• Think carefully before surgery and make sure you choose the right option for you
• Always report abnormal vaginal bleeding to your doctor