Fibroids in Uterus
Symptoms of fibroids may include:
- Heavy Vaginal Bleeding — excessively heavy or prolonged menstrual bleeding is a common symptom. Women describe soaking through sanitary protection in less than an hour, passing blood clots and being unable to leave the house during the heaviest day of flow. As a result, some women develop anemia, also known as a low blood count. Anemia can cause fatigue, headaches and lightheadedness.
- If heavy bleeding interferes with your everyday activities or if you develop anemia, you should see your doctor to discuss fibroid treatment options.
- Pelvic Discomfort — Women with large fibroids may feel heaviness or pressure in their lower abdomen or pelvis. Often this is described as a vague discomfort rather than a sharp pain. Sometimes, the enlarged uterus makes it difficult to lie face down, bend over or exercise without discomfort.
- Pelvic Pain — A less common symptom is acute, severe pain. This occurs when a fibroid goes through a process called degeneration. Usually, the pain is localized to a specific spot and improves on its own within two to four weeks. Using a pain reliever, such as ibuprofen, can decrease the pain significantly. However, chronic pelvic pain can also occur. This type of pain is usually mild but persistent and confined to a specific area.
- Bladder Problems — The most common bladder symptom is needing to urinate frequently. A woman may wake up several times during the night to empty her bladder. Occasionally, women are unable to urinate despite a full bladder.
These symptoms are caused by fibroids pressing against the bladder, reducing its capacity for holding urine or blocking the outflow of urine. Treatment for bladder problems can provide great relief.
- Low Back Pain — Rarely, fibroids press against the muscles and nerves of the lower back and cause back pain. A large fibroid on the back surface of the uterus is more likely to cause back pain than a small fibroid within the uterine wall. Because back pain is so common, it is important to look for other causes of the pain before attributing it to fibroids.
- Rectal Pressure — Fibroids also can press against the rectum and cause a sensation of rectal fullness, difficulty having a bowel movement or pain with bowel movements. Sometimes, fibroids can lead to the development of a hemorrhoid.
- Discomfort or Pain with Sexual Intercourse — Fibroids can make sexual intercourse painful or uncomfortable. The pain may occur only in specific positions or during certain times of the menstrual cycle. Discomfort during intercourse is a significant issue. If your doctor doesn't ask you about this symptom, make sure you mention it.
Most women with fibroids have no symptoms, so the fibroids often go undetected. Sometimes they are found during a routine gynaecological examination. If you have symptoms, such as pain or heavy periods, your doctor may do the following tests:
- An internal examination. This is to check the size of your womb - an enlarged womb indicates that you may have fibroids.
- An ultrasound scan. This uses sound waves to produce an image of part of your womb and can confirm if you have fibroids.
- Other specialised imaging tests. These include:
- Sonohysterography which uses saline to expand the cavity of the womb making it easier to get good ultrasound images
- Hysterosalpingography which uses dye to highlight the cavity of the womb and fallopian tubes on X-ray images
- Hysteroscopy which looks inside the womb with a small telescope.
- An MRI scan. This uses magnets and radio waves to produce images of the inside of your womb.
Your doctor may also order a blood test to see if you've become anaemic from the increased bleeding.
If you don't have any symptoms, or if your symptoms are mild, you won't need treatment.
If you have more severe symptoms, there's a range of treatments available. Discuss with your doctor which treatment is most suitable for you.
There is no medicine that cures fibroids.
Hormone-based treatments such as the oral contraceptive pill can help regulate your periods and relieve your symptoms. While there have been previous reports of fibroids growing in response to use of the pill, this is more likely with older, high-dose formulations.
There are medicines that lower your oestrogen level to try and shrink fibroids. However, they have side effects similar to that of menopause, such as hot flushes and vaginal dryness. And if these medicines are used for more than six months, they increase your risk of osteoporosis (thinning of the bones). These medicines are most likely to be used for the three to four months prior to surgery, to try and reduce the size of the fibroids to make it easier for the surgeon to remove them.
Non-steroidal anti-inflammatory drugs (NSAIDs) may be effective in relieving pain related to fibroids.
Talk to your doctor regarding whether a medicine will be able to help you.
There are a number of surgical options for treating fibroids, including those outlined below.
A myomectomy is an operation to remove fibroids, leaving your womb in place. It may be done through a cut in your tummy, or sometimes it may be possible for your surgeon to use keyhole surgery. Myomectomy is usually only offered to women who would like the option to become pregnant in the future. Because your womb isn't removed there is a chance that more fibroids will grow in the future, so you may need to have further treatment.
Uterine artery embolisation (UAE)
This procedure blocks the blood supply to a fibroid, causing it to shrink. It's performed under local anaesthesia, meaning that feeling in the area will be completely blocked but you will stay awake during the operation. UAE gives relief from symptoms such as bleeding and pain for at least six in every 10 women treated. It's only recommended to be used for treating women with infertility related to fibroids as part of a clinical trial.
Endometrial ablation or resection
Endometrial ablation is a procedure to remove most of the lining of your womb or to destroy or remove an individual fibroid using energy such as microwaves or heat. During an endometrial resection, the lining of your womb or the fibroid is cut away. Endometrial ablation helps stop heavy and prolonged bleeding, but doesn't affect fibroids sitting outside the inside lining of the womb.
A hysterectomy is a major operation to remove your entire womb, usually via a 'bikini-line' cut in your abdomen or, if the fibroids aren't too large, via your vagina. You and your doctor may also choose to remove your fallopian tubes and ovaries. You no longer have periods after a hysterectomy and you can't become pregnant. Discuss with your doctor which of these options is right for you.
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