Uterine fibroids: what they are and when they need treatment
Fibroids are non-cancerous growths of the muscle wall of the uterus. They are extremely common, and a large number of women who have them never know it — the fibroid causes no symptoms and is found only incidentally, on a scan done for another reason.
Open 24 hours for pregnancy and gynaecology emergencies. Complex gynaecological surgeries are done in our own operation theatre.
Symptoms
Where fibroids do cause symptoms, the usual ones are periods that are heavier, longer, or more painful than before; a feeling of pressure or fullness in the pelvis; needing to pass urine more often, if a fibroid is pressing on the bladder; and, depending on exactly where a fibroid sits, sometimes difficulty conceiving. Size is not the whole story — a small fibroid in the wrong place can cause more trouble than a large one elsewhere.
Diagnosis
An ultrasound scan is usually enough to find and map fibroids. Where a fibroid is bulging into the uterine cavity itself, a hysteroscopy — a thin telescope passed through the cervix, with no cut anywhere — gives a direct look inside the cavity, and a small submucous fibroid can sometimes be removed in the same short visit.
The treatment ladder
- Watch and wait. A small fibroid with no symptoms, found incidentally, usually needs nothing more than a repeat scan in due course to confirm it is stable.
- Medication. For manageable symptoms, particularly heavy bleeding, medication is often tried before any operation is considered.
- Myomectomy. Removes the fibroids and keeps the uterus in place — the usual choice when symptoms need treating and the uterus is being preserved. See myomectomy.
- Hysterectomy. Kept for fibroids that are extensive, causing bleeding that has not responded to the above, or where the uterus is not being preserved. See the hysterectomy overview.
When surgery is not the answer
A fibroid with no symptoms does not need an operation just because it exists. The great majority of fibroids found on a routine scan fall into this category, and the right response is monitoring, not surgery.
Fibroids and fertility
Not every fibroid affects fertility — it depends mainly on where it sits in relation to the uterine cavity. This is often assessed as part of a wider fertility work-up, since a submucous fibroid distorting the cavity is treated differently from one sitting harmlessly on the outer wall.
Who operates
Our consultant gynaecologist, a laparoscopic surgeon of 15 years, assesses and, where an operation is needed, performs it himself.
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This page is for general education and is not personal medical advice. Treatment depends on your own examination and reports, so please speak to a doctor about your situation. We do not carry out or offer sex determination of any kind.