Treatment of uterine fibroids
Read our guide below about what causes uterine fibroids and how we treat them.
You can also download a PDF version of this patient information by following the link on the right.
What are uterine fibroids?
Uterine fibroids or myomas are benign swellings of the uterus (womb). They’re made up of smooth muscle and are usually harmless.
Uterine fibroids are very common in women between 25 to 45 years old. About 20 to 30% of women in that age group get fibroids. They’re also more common in women of Afro-Caribbean origin who may have larger fibroids and more of them.
You may have fibroids on the inside of the uterus, in the muscle wall or outside of the womb, known as subserous fibroids. This type of fibroid may only attach to the uterus by a long stalk.
Fibroids vary in size from very being small (pea sized) to quite large.
What causes uterine fibroids?
They grow under stimulation from oestrogen and progesterone hormones produced by the ovaries. The first half of the menstrual cycle produces mainly oestrogen. The second half of the cycle produces both oestrogen and progesterone.
After the menopause, your body no longer produces these hormones. Fibroids usually shrink but don’t disappear.
What symptoms can fibroids cause?
Up to 75 in 100 women with fibroids may not have symptoms so a lot of women don’t know they have fibroids. Whether or not you have symptoms depends on the size and location of the fibroids in your uterus.
Fibroids can cause heavy menstrual flow by increasing the overall size of the womb. This might involve flooding, passing large clots or bleeding for an increased number of days. As a result, some women may develop anaemia (low blood iron), making you feel weak and tired.
Fibroids can also cause painful crampy periods and lower abdominal (pelvic) pain.
They may also cause symptoms related to a large pelvic mass which might include:
- lower back pain
- pelvic discomfort
- passing urine frequently and/or constipation
- uncomfortable sex.
Can fibroids affect fertility?
About 5 to 10 in 100 of women who have difficulty in getting pregnant may have fibroids. They may be may be the main factor in 1 to 2 in 100 of infertile women.
Evidence suggests that fibroids affect the uterine lining making it more difficult for pregnancies to implant. They may also block the opening of the uterine fallopian tubes on the inside of the uterus. Generally fibroids do not need treating for women with infertility.
Your uterus may be larger than normal.
An internal (vaginal) or abdominal (tummy) pelvic ultrasound may show fibroids in your womb. A more detailed MRI scan can show a fibroid uterus more clearly.
A consultant can diagnose a fibroid on the inside of the womb through a hysteroscopy procedure. This involves passing a small telescope (hysteroscope) through the cervix (the neck of the womb) and into the uterus. Hysteroscopy happens in an outpatient clinic or with a general anaesthetic in theatre.
A laparoscopy may help to identify fibroids on the outside of the womb. This involves inserting a thin telescope (laparoscope) through a tiny cut into your belly button. You’ll have a general anaesthetic for this. Your tummy will be filled with gas to see all the pelvic organs including the uterus.
At the end of the procedure, the gas is released. The laparoscopy takes around 30 minutes and you’ll come to hospital as an outpatient meaning you can go home on the same day.
What are the treatment options for fibroids?
If you don’t have any symptoms, you don’t need to treat fibroids. Your gynaecologist will discuss whether or not you need treatment, and the best options for you.
A group of drugs called GnRH analogues temporarily reduce oestrogen levels in your body and cause fibroids to shrink. They may also reduce or stop menstrual flow and reduce the pain of fibroids.
Usually you’ll have a monthly injection for about 6 to 9 months which may cause side effects like hot flushes and sweats. If doctor prescribes this drug and you experience side effects, they may give you another type of hormone to relieve your symptoms.
GnRH analogues only shrink fibroids for a short period of time. Once you stop taking the drugs your fibroids will grow again though slowly. GnRH analogues generally reduce fibroid size before surgery to make removing fibroids.
GnRH drug (Ryeqo)
This new approved drug can be taken by mouth for long periods of time. It contains an ‘add back’ hormone which reduces hot flush side effects.
The MHRA and NICE re-approved the use of ESMYA in uterine fibroid treatment in 2001. The approval is limited to intermittent use in treatment of severe symptoms or for patients who have failed surgical treatments (including fibroid embolisation see below).
Your gynaecologist will strictly monitor you due to the risk of liver failure.
Uterine/fibroid artery embolisation
It blocks the uterine arteries or the blood vessels supplying the fibroid(s) causing them to shrink.
You’ll have this procedure in the X-ray department and will need to stay overnight in hospital.
A radiologist will pass a catheter into an artery in your groin and into the arteries in the womb or fibroid. You’ll have a local anesthetic. The radiologist will inject a chemical foam or fluid containing particles into the catheter which blocks the fibroid blood vessels and causing it to shrink.
Complications are rare but may include fever, pain and infection in about 1 in 100 procedures.
Hysteroscopic fibroid resection
This involves removing small fibroids on the inside of the womb.
You’ll have a general anaesthetic and can go home the same day or the day after the procedure.
You’ll have a small telescope (hysteroscope) passed through your vagina and cervix into the womb. An electrical current will pass through a wire loop, fed into the hysteroscope and used to cut away the fibroid.
There’s a small risk of perforation which can lead to a very small risk of bowel injury. There’s a similar small risk from the absorption of too much fluid used for the procedure. If this happens, your gynaecologist will treat it.
Myosure hysteroscopic fibroid resection
Another device to remove fibroids on the inside of the womb. You’ll have the myosure passed through a small hysteroscope through your vagina, the neck of the womb (cervix) and into the uterus.
Under direct vision, a healthcare professional will cut the fibroid gently and remove it.
You’ll have local pain relief or a general anaesthetic.
As with all procedures inside the womb, there’s a small chance of a perforation and a very small risk of bowel injury. However, it’s a very safe procedure.
This involves cutting out the fibroids from the womb. It’s most suited to women who want more children.
A myomectomy usually involves major surgery under a general anaesthetic and an incision In the tummy. You’ll need to stay in hospital for 1 to 3 nights and be off work for about 4 to 6 weeks. One or two women in every 100 who have a myomectomy operation will need a hysterectomy due to heavy bleeding during the procedure.
Myomectomies can be done by laparoscopic (keyhole) surgery. Your doctor will discuss whether the fibroids you have are suitable for keyhole surgery.
About 15 to 30 in 100 women who have a myomectomy will have fibroids grow back.
Women who don’t want any more children can have their fibroids treated by a hysterectomy.
A hysterectomy is major surgery and involves the same stay in hospital and recovery as a myomectomy.
Complications may include:
- damage to your bladder or bowel
- infection or bleeding during or after the operation
The surgery is often more straight forward than a myomectomy.
Your consultant will discuss the best treatment option for you and you can ask any questions you may have.
This page explains some of the most common side effects that some people may experience. It’s not a complete list so if you get other side effects or want to talk to us about your treatment, call us on 01494 426108/418111.
How can I help reduce healthcare associated infections?
Infection prevention and control is important to the wellbeing of our patients so we have procedures in place. Keeping your hands clean is an effective way of preventing the spread of infections.
You, and anyone visiting you, must use the hand sanitiser available at the entrance to every ward before coming in and after you leave. You may need to wash your hands at the sink using soap and water. Hand sanitisers are not suitable for dealing with patients who have symptoms of diarrhoea.
More help or advice
Contact our patient advice and liaison service (PALS) on 01296 316042 or firstname.lastname@example.org
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