Gynae Geek x Stylist is our new regular column, bringing you myth-busting information about women’s health every single week. Here, gynaecologist Dr Anita Mitra breaks down everything we need to know about fibroids.
Almost 75% of women will be affected by fibroids in their lifetime, but that doesn’t mean it’s a condition taken seriously.
A report by MPs previously found that thousands of women suffering from endometriosis or fibroids feel dismissed, ignored and unable to access information and specialised treatment. So what should you do if you suspect you have fibroids? And how can they be treated?
Read on to find out…
What are fibroids? What types of fibroids are there?
Fibroids, also known as myomas or leiomyomas, are benign (non-cancerous) overgrowths of the muscle layer that makes up the wall of the womb/uterus. There are three main types; intramural – these grow almost entirely within the wall, submucosal – these grow inwards and push into the uterine cavity, and subserosal – these grow outwards and can poke out of the uterine wall looking almost like Mickey Mouse ears. Some people may have one single fibroid, other women may have multiples fibroids in various locations and of various types.
They’re super common and in fact, it’s estimated that about 75% of women will have a fibroid at some point during their lifetime. Many women don’t even know that they have them, as I’ve often noticed them when I’m scanning women in the very early stages of pregnancy who, upon asking, have never had any symptoms, and would otherwise have gone through life never knowing that they had one. For some women however, they can cause quite significant symptoms…
What are the symptoms of fibroids?
They can cause very heavy periods, because they can increase the surface area inside the womb, which means you’ll have more space for the endometrium (lining) to grow, so there’s more to fall away when you have your period. They also tend to have a pretty impressive blood supply, which is another reason you can get pretty torrential periods. Periods which are heavy also tend to be more painful.
Other symptoms of fibroids include a feeling of fullness if they’re very large, and if they’re pressing on your bladder or bowel can cause a need to go to the toilet more frequently or even constipation. They can also cause pain during sex if they’re in the right (or actually wrong!) location.
Fibroids can also cause problems with fertility in a small number of women. This tends to be if they’re close to where the tubes enter the cavity of the uterus, or if they’re significantly distorting the shape of the cavity making it difficult for a pregnancy to implant. If you’re having problems with fertility, or have had miscarriages, your doctor will be able to talk to you about whether your fibroids need removing, as not all of them do, it very much depends on their size and location.
Most people with fibroids, however, will get pregnant with no problems, and in most cases they shouldn’t complicate the pregnancy. During the pregnancy you may require extra scans if your fibroid(s) is/are large. If you have a fibroid very close to the cervix it could get in the way if having a vaginal delivery and may mean you would need a Caesarean section, but it’s unusual. There is also a slightly higher risk of heavy bleeding during delivery, regardless of whether it’s normal or by C-section, so you would usually be advised to deliver in hospital on the labour ward so that we can promptly give you medications to reduce the bleeding.
Where do we get fibroid pain?
It tends to be in your lower abdomen, or in your back. Some women also say they feel the pain goes into their buttocks or thighs. This is due to the cross-connection of the nerves which supply the uterus and the skin on those areas. Fibroids can also cause pain when you’re not having your period.
Occasionally the fibroids can degenerate. This causes the most excruciating pain and the pain is basically like a heart attack in your uterus because the blood supply from the fibroids is being shut down and the fibroid starts to die from the inside. A very unsual case of fibroid degeneration sticks in my mind from when I very first qualified as a doctor. I was the gynaecology doctor on call and a lady in her late 40s with known fibroids was admitted with unbearable, labour-like pain. She wasn’t pregnant (we’d done a test to check) but when I performed an internal examination I noticed that her cervix was slightly open and something white was coming through. I gave it a gentle tug with an instrument and a white, palm-shaped object came out. Like magic her pain disappeared, and a few hours later she went home. I sent the object to the lab, and it turned out to be a degenerated fibroid that had fallen off from the inside of her womb and come out on its own!
Is there a natural treatment for fibroids?
Unfortunately, there aren’t any really good proven ways of treating fibroids naturally. Except the menopause! Which isn’t quite what you were hoping for when you asked for a natural solution, hey? Fibroids grow in response to oestrogen, and levels of this will naturally drop after the menopause, which is why they shrink away so they don’t tend to cause the same pressure symptoms that you might have had. And of course, your periods will have stopped so you won’t get any of the bleeding trouble that you had before. Any bleeding after the menopause (that’s any bleeding over a year after your periods stopped) needs reporting to your doctor, whether you had fibroids or not.
Eating plenty of green veggies, and fibre is also important because they help your liver to break down oestrogen, and get rid of it via your bowels. Helping to rid your body of excess oestrogen might stop the fibroids from growing too large. But with even the healthiest diet in the world, some women will just get fibroids, probably through a genetic predisposition. There aren’t any vitamins or supplements however that have been shown to be effective in sorting out fibroids.
How are fibroids removed?
Not all fibroids need removing. It depends on the symptoms that you’re having, as well as their size and location, which also dictate how they’re removed. Ultrasound scans are used to diagnose the presence of fibroids, and also determine their location which can be helpful for planning treatment. In some cases an MRI scan (the type where you go in the tunnel) might also be helpful for your surgeon to determine what’s going to be the best way of tackling them. If the fibroids are mainly within the cavity, it may be possible to remove them hysteroscopically, which means using a telescope through the vagina into the cavity. If they’re mainly in the wall, or poking outwards, they could be removed individually during an operation called a myomectomy, which can sometimes we done by keyhole surgery, or by making a larger cut to your tummy called a laparotomy or ‘open surgery’. If you’re not planning on having any more children, it is sometimes possible to use a technique called ‘uterine artery embolisation’ to block off their blood supply so that they shrink away, or also to do a hysterectomy to remove the entire uterus.
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