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My doctor told me I have fibroids, what now?

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Today we’re diving into fibroma and uterine fibroids, a very common condition that affects 1 in 3 women at some point in life. This post will cover it all so that if you’re worried about or have recently been diagnosed with fibroids you can learn it all here.

Let’s start by covering some medical terms (so we are all on the same page):

  • Uterine fibroids = leiomyofibroma = uterine myoma
  • Uterus = womb

What are uterine fibroids and fibroma?

Uterine fibroids are growths of muscle tissue within the uterus (womb). These growths are non-cancerous but can still cause troubling symptoms for some women. They usually appear during a woman’s “reproductive years” (between puberty and menopause). Fibroma can range in size from very small to quite large and women may have a single fibroid or may have many. Some women do not know they have fibroids as they do not cause them any symptoms. Your doctor may notice you have a fibroid during a pelvic examination or on an ultrasound scan. Fibroids are very common, with approximately 1 in 3 women developing them at some stage in their life.

 

First, let’s look at the structure of the uterus.

The uterus is made up of three layers of tissue:

  • The endometrium is the lining of the uterus and is the part that sheds when you bleed during your period
  • The next layer behind that is called the myometrium and is a layer of muscle
    • This is how the uterus contracts during labour or if you have period cramps
  • The outer covering of the uterus (a bit like the “skin” of the uterus) is called the serosa

Fibroids are always growths of muscle tissue, but they can be found in any of these three layers.

The diagram below shows the different locations that fibroids can be found. The symptoms that they cause will depend on where they are, as well as how big they are.

Submucosal fibroids

(sub = underneath, mucosa = the layer lining the inside of the uterus) are the closest to the uterine cavity (the space in the middle).

    • They often make the lining a bit lumpy and irregular which can increase the surface area of the endometrium. Increasing the surface area increases the area from which you bleed which means they can cause heavy periods
    • Pedunculated submucosal fibroids are similar, but they have a thin bit of tissue that attaches them to the wall of the uterus
      • “Pedunculated” is just a medical term that describes something on a stalk
    • Submucosal fibroids can also affect pregnancy depending on exactly where they are and how big they are because they are taking up space in the uterine cavity which is where the baby grows
      • We will talk about this a bit more later on

Intramural fibroids

(intra = within, mural = the wall) are located within the muscle layer of the uterus

      • These are less likely to cause problems with periods as they are not disrupting the endometrial layer
      • These are the most common type of fibroid

Subserosal fibroids

(sub = underneath, serosa = the outer layer of the uterus) are on the outside of the uterus

      • Subserosal fibroids are more likely to cause problems like pain or bowel/bladder symptoms because they can get quite big and start to push on other structures in the pelvis
        • A fundal subserosal fibroid is shown in the diagram – the fundus is the top of the uterus so a fundal subserosal fibroid is one on the outside of the uterus at the top
Source: Mayo Clinic

 

What causes uterine fibroids?

It is not clear exactly what causes fibroma but there are several theories. It is likely that there are lots of different factors that contribute to the development of fibroids.

Hormones are thought to play a key role in fibroid development, especially oestrogen and progesterone. They both seem to promote the growth of fibroids which can explain why they tend to grow during pregnancy when levels of these hormones are high. They may then get smaller after pregnancy as the uterus returns to its usual size. Fibroids also tend to shrink or disappear after menopause which is when these hormone levels drop.

The growth of fibroids varies significantly with some growing very slowly, some growing quickly and some not really changing in size once they have appeared. They often also disappear on their own.

 

Fibroid and fibroma Risk factors

Any woman between puberty and menopause can develop fibroma. However, there are a few factors that might mean you are more likely to develop fibroids than other women:

  • Ethnicity
    • Women with an African or Caribbean ethnic background are more likely to develop fibroids than women of other ethnic groups. These women are also more likely to develop fibroids younger, have larger fibroids and have more symptoms associated with them
  • Family history
    • If the other women in your family (especially your mother or your sisters) had/have fibroids then you are more likely to develop them
  • Earlier onset of periods
  • Obesity
    • Fat tissue produces oestrogen, so it is thought that higher levels of oestrogen in overweight women increases the chance of fibroids developing
  • Vitamin D deficiency
  • Diet
    • There appears to be some evidence that the chance of developing fibroids is increased with a diet high in red meat and low in green vegetables, dairy or fruit. There is also some evidence that alcohol can increase the risk of fibroids.

Women who have had babies seem to be at lower risk of developing fibroids. It is also thought that this risk reduces the more babies you have.

 

What might I notice if I have fibroids?

The symptoms caused by fibroids can be very variable. Some women have no symptoms at all while others can get quite severe symptoms. The symptoms that a woman experiences often depend on the location, size and number of fibroids. Approximately 1 in 3 women with fibroids will experience symptoms.

Common symptoms include:

  • Heavy periods (menorrhagia)
  • Long periods (more than 7 days of bleeding in a row)
  • Painful periods (dysmenorrhoea)
  • Pelvic pain
  • A feeling of pressure in the pelvis
  • Problems with passing urine (peeing) or feeling like your bladder doesn’t fully empty when you pee or feeling like you need to pee more frequently than usual
  • Constipation
  • Pain in the back or legs
  • Discomfort or pain during sex (dyspareunia)

 

Are fibroids dangerous?

No.

Fibroids are not dangerous, however, they can cause the symptoms we mentioned earlier. There are also some reasons you might want to see a doctor relating to your fibroma which are discussed below.

Can fibroids make you tired?

Possibly.

At times, if women experience particularly heavy or long periods because of their fibroids they might become anaemic (“low blood count”/low haemoglobin count). This can cause tiredness and fatigue as well as mood changes. Rarely, this may mean women require a blood transfusion to replace the blood lost through their periods.

Can fibroids be cancerous?

Not usually.

VERY rarely, what appears to be a fibroid can actually be a cancer (less than 1 in 1,000 fibroids). This is called a leiomyosarcoma and these are not thought to develop from existing fibroids. This is a different condition from fibroma that your doctor will investigate if they are concerned.

 

When should I see a doctor about fibroma?

Although fibroids and fibroma are not dangerous, sometimes it is important to see a doctor in order to access treatment that can help your symptoms. It is also sometimes a good idea to make sure your symptoms are not being caused by something else that should be treated.

If you have pelvic pain that is lasting a long time and not getting better, it is a good idea to see a doctor. It is also a good idea if you have very heavy, long or painful periods as you may need help to reduce your blood loss and prevent or treat anaemia (low blood count/low haemoglobin count). If you have a blood test that shows anaemia then your doctor may want to discuss your periods with you.

If you are having trouble peeing or feeling like your bladder is not empty after you go to the toilet it is a good idea to see your doctor.

NOTE: Always see a doctor if you bleed between periods or after sex.

If you see your doctor and they think you might have fibroids or fibroma they may refer you for an ultrasound scan to confirm the diagnosis. The NHS website has more information about the process of diagnosing fibroids.

 

REASONS TO SEE A DOCTOR URGENTLY:

  • Any vaginal bleeding which means you are filling a pad more than once an hour for 2 consecutive hours
  • Sudden, sharp pelvic pain

The NHS website has more information about when you might want to see a doctor.

 

Can fibroids affect my chances of having a baby?

Usually, fibroids do not affect a woman’s ability to get pregnant or carry a normal pregnancy, However, depending on the size and location of fibroids they might affect a pregnancy. Submucosal fibroids MAY contribute to infertility or miscarriage, however, this does not mean that every woman with submucosal fibroids will have trouble getting pregnant. Submucosal fibroids might also mean there is a higher chance of the baby being breech (bum down instead of head down) at the end of the pregnancy or be restricted in its growth because the fibroid is taking up some of its space. They may also increase the chance of preterm labour (going into labour too early) because the baby starts to run out of space. Again, this is not to say that this will happen to all women with submucosal fibroids, but you may want to discuss this with your GP or midwife.

Sometimes during pregnancy, a fibroid can start to grow very quickly because of the hormones involved in pregnancy. This may cause it to outgrow its blood supply. If this happens, the fibroid starts to degenerate which can cause sudden pain. This is called fibroid degeneration or sometimes “red” degeneration because of what a degenerating fibroid looks like under a microscope. This is not dangerous but can be very painful.

The location and size of the fibroids might also affect the safest way to deliver your baby – if a large fibroid is blocking the way out of your uterus you may need to have a caesarean section. Your obstetrician, GP or midwife will be able to advise you about whether this applies to you or not.

 

Fibroids and menopause

Fibroids respond to the hormones oestrogen and progesterone. After menopause, the levels of these hormones in the body reduce and so fibroids usually shrink or disappear. After menopause, most women find that the symptoms from their fibroids either disappear completely or significantly improve.

 

How to treat fibroids or fibroma

If your fibroids are not causing you any symptoms or your symptoms are not bothering you they do not need to be treated. Often they will shrink or disappear by themselves over time, especially after menopause.

 

The treatment of fibroids and fibroma often depends on whether or not you are wanting to get pregnant, and whether or not you have had all the children you want to have. If you do have symptoms that bother you then the first treatment to try is usually medication. Some of these options might include:

  • Hormonal contraception
    • The combined oral contraceptive pill (“the pill”)
      • This often makes periods lighter and can help with period pain
    • Hormonal intrauterine system (IUS)
      • g. Mirena, Kyleena, Jaydess
      • This can make periods lighter and improve pain
  • Non-hormonal medications if you do not want to be using contraception
      • Tranexamic acid
        • Reduces blood loss by about 50% during periods
        • These tablets should be taken 3-4 times per day for up to the first four days of your period
      • Anti-inflammatory medications
        • g. ibuprofen, naproxen, mefenamic acid
        • These act to reduce bleeding and improve period pain

There are also medications that can be given to shrink the fibroids, but these are usually only used in the short term, if surgery is planned in the near future.

If your symptoms are not helped by medication your GP my refer you to see a specialist gynaecologist for further investigations and treatment. If medications have not helped your symptoms then surgery might be the most appropriate option. Surgery for fibroids may involve removing only the fibroid or removing the whole uterus. These options are complex and need to be discussed with a gynaecologist. The NHS website has a good explanation of the different procedures if you are interested in further information.

 

Posted By  : Katherine Maslowski

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