There are four types of fibroids, according to NHS Direct, which are named after their position in the womb:-
- Intramural fibroids are the most common, lying within the wall of the womb.
- Subserosal fibroids lie outside of the womb and can also be attached to the womb on stalks. They can be quite large.
- Submucosal fibroids are found in the muscle beneath the lining of the wall of the womb.
- Cervical fibroids are found on the neck of the cervix.
Fibroids can vary in size from pea-sized to up to 20cm width. They can also be a mixture of sizes. They grow slowly and don’t spread to other parts of the body because they are enclosed in a fibrous pod.
Causes of Fibroids
The exact cause of fibroids isn't known but certain factors are linked to them. They occur during reproductive age as a result of high hormone levels in the body. Oestrogen can cause them to increase in size, particularly during pregnancy when levels are five times higher than normal. They shrink during the menopause when oestrogen levels are low. Ethnicity is also a link - they are common amongst Afro-Caribbean women.
Common Symptoms of Fibroids
Many women don’t notice any symptoms and can live with them comfortably knowing that they shrink during the menopause. However, if they are particularly large or located in an uncomfortable position (on the bladder or cervix) they can cause the following problems and will need to be treated: -
- Heavy, painful periods
- Anaemia
- Bloating and swelling in the abdomen
- Lower back ache and/or leg pains
- Needing to urinate regularly or being constipated
- Finding penetrative sex painful
- Recurrent problems with miscarriage, conception and pregnancy
They are often picked up during routine gynaecological examinations and can be confirmed using ultrasound scanning.
Treatment Options for Fibroids
There are several treatment options for fibroids depending on their size, number and location: -
- Gonadotropin Releasing Hormone Agonist (GnRHa) is a short-term hormonal medicine, which reduces oestrogen levels in the body. This can bring on menopausal symptoms so is only used in the short-term.
- Hysterectomy is a surgical procedure to remove the womb. It will remove fibroids permanently but should only be considered if a woman does not want to have children or has completed her family. It is recommended for painful, heavy periods and large fibroids.
- Myomectomy is an alternative to hysterectomy if a woman wishes to have children. It removes the fibroids leaving the uterus in place. Suitability depends on their size and location.
- Endometrial Ablation is non-surgical and uses laser energy. It eradicates the lining of the womb via a thermal balloon or heated rollerball. The fibroids need to be close to the lining of the womb.
- Uterine Artery Embolisation (UAE) is a new, non-surgical treatment that shrinks fibroids by halting their supply of blood. It involves a chemical injection into the uterine artery to block it. This isn't suitable for women who want to have children.
- MRI (Magnetic Resonance Imaging) guided laser ablation and ultrasound are new techniques that use tiny needles through the skin to the middle of the fibroid. Laser/ultrasound energy is then transmitted through the needles to shrink the tumour.
Treatment options depend on the type, size and location of the fibroids and other factors. Your gynaecologist will be able to recommend the right type of treatment for your circumstances.
Resources
Uterine Fibroids Specialist Website - current information and treatment options.
NHS Choices, Fibroids information, accessed 20 March 2009.
This article is for general information purposes only. Consult your health practitioner for specific guidance on a health issue.
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