Fibroid treatment & surgery

What are fibroids?

Fibroids are non-cancerous growths that develop within the muscular wall of the uterus. They are very common—affecting a large proportion of women at some point—and vary in size, location, and the symptoms they cause. Understanding their causes, symptoms, diagnosis, and treatment options is essential for managing their impact on health.

Causes and risk factors

The exact cause of fibroids is unknown. Factors that may increase the risk include: hormonal factors (oestrogen and progesterone, which affect the uterine lining, can encourage fibroid growth); genetic factors (fibroids often run in families); and other risk factors such as age (women in their thirties and forties are more likely to have fibroids), ethnicity (some groups have a higher risk and more severe symptoms), low physical activity, a diet heavy in red meat, obesity, not having had children, and early menarche. Growth factors and the way cells are held together in the uterus may also play a role.

Types of fibroids

Based on where they sit in the uterus, fibroids are often classified as:

• Intramural fibroids: the most common type; they develop inside the muscular wall of the uterus and may make the uterus appear enlarged.
• Subserosal fibroids: grow on the outer surface of the uterus into the pelvic cavity; they can become large and press on nearby organs.
• Submucosal fibroids: grow just under the inner lining of the uterus (endometrium) and can bulge into the uterine cavity; they are less common but can cause heavy menstrual bleeding and fertility problems.
• Pedunculated fibroids: attached to the uterine wall by a narrow stalk; they can be subserosal or submucosal and may twist and cause severe pain.

Symptoms of fibroids

Symptoms depend on the size, number, and location of fibroids. Many women have no symptoms; others have: heavy or prolonged menstrual bleeding (which can lead to anaemia); pelvic pain or pressure and a feeling of fullness in the pelvis; frequent urination (from pressure on the bladder); constipation or difficulty passing stool (from pressure on the rectum); backache or leg pain (from pressure on nerves or muscles); and reproductive problems such as infertility or repeated miscarriages when submucosal fibroids affect implantation. We assess your symptoms and scans to recommend the best treatment.

Diagnosis of fibroids

Fibroids are often first seen during a pelvic exam or pregnancy ultrasound. To confirm the diagnosis and assess size, number, and position, the doctor may use: ultrasound (sound waves to image the uterus); MRI (detailed images of the uterus); hysterosonography (saline infused into the uterus during ultrasound to show submucosal fibroids); hysterosalpingography (X-ray with contrast in the uterus and fallopian tubes to check for blockages and fibroids); and hysteroscopy (a thin telescope passed through the cervix to view and sometimes remove submucosal fibroids). We can refer you to a gynaecologist for these tests and for treatment.

Treatment options for fibroids

Treatment depends on the severity of symptoms, the size and location of the fibroids, your age, and whether you wish to preserve fertility. Options include: watchful waiting (especially if you are near menopause and have few or no symptoms); medication (hormonal treatments, IUDs, or drugs such as tranexamic acid to reduce bleeding—drugs can control symptoms but do not remove fibroids); minimally invasive procedures (uterine artery embolisation to cut off blood supply to fibroids, or focused ultrasound to heat and shrink them; myomectomy—surgical removal of fibroids while keeping the uterus—can be done by open surgery, laparoscopy, or hysteroscopy); and hysterectomy (removal of the uterus) when other treatments have failed or fibroids are very large. We can refer you to a gynaecologist to explore the best option for you.

Fibroids and fertility

Fibroids can affect fertility and pregnancy. Submucosal fibroids can change the shape of the uterine cavity and make it harder for an embryo to implant and for sperm to reach the egg. During pregnancy, fibroids can increase the risk of restricted fetal growth, preterm birth, and placental abruption. Large fibroids can block the birth canal and raise the chance of caesarean delivery. If you want to become pregnant and have fibroids, discuss your options with a gynaecologist so you can choose a treatment that preserves fertility where possible.

Lifestyle and home remedies

Lifestyle changes cannot remove fibroids but may help control symptoms and improve general health: maintain a healthy weight (excess body fat can raise oestrogen and encourage fibroid growth); eat a balanced diet with plenty of whole grains, fruits, vegetables, and lean protein; take regular exercise; manage stress (e.g. with yoga, mindfulness, or meditation); and if you have heavy periods, include iron-rich foods to help prevent anaemia. We can advise on what might help in your case.