Many women have fibroids without even knowing it. They are growths in the womb, normally benign, that often don't cause any trouble. However for around 25 - 30% of women they can cause heavy bleeding and discomfort. And they can be the cause of infertility in up to 10% of infertility cases.
Although fibroids are common, what causes them to grow is not so well researched. It seems that oestrogen is the main culprit as fibroids often grow during pregnancy and shrink in post-menopausal women.
Many women don't discover that they have fibroids until they have a pelvic exam or ultrasound. Fibroids are usually fairly small, about the size of a walnut, but they can get to be as big as an orange, or even larger. If there are several small ones or one or two large ones they can interfere with pregnancy. Sometimes fibroids can grow so big that you can look as if you might be pregnant.
The main types of fibroids are:
· intramural -the most common, they grow in the muscle of the womb walls;
· subserosal -grow attached to the outside of the womb and can get very large;
· sub-muscosal - grow in the muscle of the walls and into the womb itself. This type is less common but cause the worst symptoms including very heavy bleeding and sometimes infertility.
Your doctor can diagnose fibroids by giving you a pelvic examination, an ultrasound and/or a vaginal ultrasound. An MRI (Magnetic Resonance Imaging) can even identify the type and exact location of your fibroids. However as MRI equipment are still quite expensive you may need to go private to get one, unless your Primary Care Trust has an agreement with a NHS hospital which has one.
Types Of Treatment
It used to be that women with fibroids were offered either a
· D&C (scrape) - where the doctor would dilate the cervix and scrape (curettage) the inside lining of the womb with a sharp object- a relatively simple procedure, but which can have complications.
· Hysterectomy - which involves the removal of the womb, and often the ovaries and the fallopian tubes as well. Without a womb there are no fibroids to worry about and for women who have completed their families and suffer a lot from very heavy bleeding this can be a solution.
Obviously this is an unsuitable treatment if you want to have children.
Nowadays there is much more choice of treatment
· Myomectomy -which removes the fibroids by using keyhole surgery and has about a 20% pregnancy success rate after the procedure
· Endometrial ablation- is modern type of scrape using laser energy, microwaves, heated wire loop etc
· Uterine artery embolism (UAE) - this procedure uses chemicals to block the blood vessels to the fibroids and helps to shrink them
· MRI treatments -these use MRI technology to guide needles into the fibroids which are then destroyed by laser or ultrasound energy
· Hormone treatment-this is the most common treatment for women who still want to have a family, but isn't effective for everyone
· Medications-there are medications that help reduce bleeding if your fibroids are small, but are not very helpful with large fibroids