When having an ultrasound scan, you may be found to have something called “Fibroids”. These are little benign growths within the muscle wall of the womb.
Surprisingly, as many as 70% of women get fibroids. They can be singular, or multiple and can be very small or grow to a larger size.
What causes fibroids?
You are more likely to have fibroids if you are aged 30 to 50, they are hormone dependent, take time to grow, and shrink after the menopause. Interestingly, excessive consumption of soya milk increases the chance of fibroids, presumably due to the natural plant oestrogen content of soya. Being afro-carribean in race or having a family history makes fibroids more likely. Obesity, high blood pressure alcohol and smoking all promote fibroids.
It is very common for us to be low in vitamin D in the UK, and this is another factor that increases the chance of acquiring fibroids. One of the many reasons to take a vitamin D supplement in this country, especially from October to March when sunlight is low. Having been pregnant is a protective factor reducing the chance of developing fibroids, as is being on the combined contraceptive pill or the depo contraceptive injection.
Where are fibroids?
Fibroids are described depending on their exact location. If they are just under the womb lining they are called “submucosal”. If they are completely within the womb wall and not near the internal or external womb lining they are known as “intramural”. Finally, if a fibroid is on the outside surface of the womb they are called “subserosal”.
Fibroids have a characteristic appearance on ultrasound scan of a whorled pattern. They cast acoustic shadows on the structures further away from the ultrasound probe, meaning that it can be difficult to completely see them, or surrounding structures clearly. Sometimes an MRI scan will be done as another way to look more closely at fibroids.
What problems do they cause?
Most people who have fibroids will not notice any affects at all from them. If fibroids get very big, they can sometimes cause pressure effects on organs around them, for example if they press onto the bladder you might notice increased urinary frequency. Occasionally fibroids pressing into the womb lining (submucosal) can cause heavy menstrual flow, and may be spotted on a scan requested to investigate heavy periods.
Fibroids can affect the implantation of a pregnancy if they are submucosal, pressing into the womb lining (endometrial) and if you are experiencing fertility issues there may be a benefit from removing a submucosal fibroid. There is no benefit to fertility from removal a subserosal fibroid. For intramural fibroids the evidence is less clear and it may depend on the exact site and nature as well as your fertility specialist’s opinion, as to whether removal would be recommended.
During pregnancy fibroids do not normally cause problems. Only rarely do they cause issues and this is usually if they are very large.
Can fibroids be treated?
Treatment options for fibroids would only be recommended if they are causing problems. The option recommended would depend on their size, site and your fertility goals.
In terms of surgery, smaller submucosal fibroids can be removed hysteroscopically by a small telescope procedure into the womb. A keyhole procedure through the tummy is sometimes performed for larger fibroids or ones located subserosally or intramurally. For very large fibroids a keyhole procedure may not be possible and the options would be hysterectomy or a small traditional operation.
Non invasive treatment with something called fibroid “embolisation” is a radiologically guided procedure with differing pros and cons to surgery. There are also medical treatment options such as hormone blocking medication.
How can I check if I have fibroids?
If you have some pressure symptoms, heavy periods or problems getting pregnant, it is advisable to book a gynaecology pelvic ultrasound scan to look for fibroids. To read more about this scan and to book an appointment please click here