Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime. But what are fibroids, how do we look out for symptoms and what are the treatments if we’re diagnosed? Read on to find out. 

Quick facts:

• Fibroids are non-cancerous growths in and around the uterus.
• They can cause symptoms like heavy or painful periods and bloating.
• You’ll need a pelvic ultrasound scan to diagnose fibroids definitively. 
• There are a number of surgical and non-surgical treatment options available.

What are fibroids?

Uterine fibroids are benign or non-cancerous growths in and around the uterus, or womb. They are made up of fibrous muscle tissue and are extremely common. Around 2 in 3 people assigned female-at-birth will develop a fibroid at some point in their lifetime (1).

Your risk of developing a fibroid increases with age and if you:

• Hit puberty younger than usual 
• Have a higher BMI
• Have never had children
• Have a family history of fibroids
• Are of Black ethnicity, particularly of Afro-Caribbean ancestry (2). 

Where do fibroids grow?

Fibroids can vary in size and you may have one or multiple fibroids. They can develop as singular fibroids or as clusters. There are three different types of fibroid, depending on where in the body they grow:

• Submucosal fibroids: these grow just under and into the inner lining of the womb.
• Intramural fibroids: these grow within the muscle layer (myometrium) of the womb.
• Subserosal fibroids: these develop on the outside of the womb and grow into the peritoneal cavity. This is the space in your abdomen which contains your stomach, liver, intestines and reproductive organs.

Signs and symptoms of fibroids

Not all people who develop fibroids experience symptoms. Most are actually asymptomatic and have no symptoms at all. Only approximately 1 in 3 people with fibroids will experience symptoms.

The symptoms of fibroids can include:

• Heavy and/or painful periods
• Abdominal pain
• Lower back pain
• Frequent need to urinate
• Constipation
• Deep pain or discomfort during sex
• Bloating
• Trouble conceiving

What causes fibroids? 

Unfortunately, like many reproductive health conditions, the exact cause of fibroids is unknown. What we do know though, is they’re affected by oestrogen and progesterone—two hormones important for regulating the menstrual cycle. After menopause, when oestrogen and progesterone levels drop, fibroids tend to shrink (3).

How are fibroids diagnosed?

To diagnose fibroids you’ll need a pelvic ultrasound scan. Usually, your doctor will discuss any symptoms you’ve been experiencing with you first. Then they’ll carry out an abdominal examination to look for any areas of tenderness or masses in your abdomen, before referring you for a scan. 

The ultrasound will look at your reproductive organs including your uterus, Fallopian tubes, ovaries and general pelvic area. This can be done either transvaginally (through the vagina) or transabdominally (looking at your uterus through your abdomen).

A scan is the only way to definitively diagnose fibroids and to determine their size and location. You may also be offered a blood test to screen for iron deficiency anaemia, which is a condition that can occur as a result of heavy bleeding. 

Because lots of people with fibroids don’t experience symptoms, often fibroids are found coincidentally. This could be during an ultrasound for a pregnancy or another suspected condition.

Black women have an increased risk of developing fibroids

Black women are three times more likely to develop fibroids than white women. They’re also more likely to be diagnosed with fibroids at a younger age, have a longer duration of symptoms and have larger, more rapidly growing fibroids.

Although the increased risk of fibroids in Black women is known, there’s been little research conducted to understand why this is. Some research suggests genetics, such as Vitamin D deficiency in Black women (4) could be a link.

Other research has suggested certain environmental factors could be linked. These include exposure to chemical relaxers, used for afro-textured hair, which have been linked to a higher risk of developing fibroids (5).

Will fibroids affect my fertility?

Some fibroids can cause problems with fertility (6). This largely depends on their size and where they are located. 

Fibroids can affect the structure of the uterus and its surrounding organs. Meaning they can prevent sperm from fertilising an egg or prevent an embryo from implanting.

However, lots of people with fibroids do not have any difficulties getting pregnant.

How are fibroids treated? 

Treatment for fibroids depends on: 

• whether they’re causing symptoms
• their position and size alongside factors such as your age 
• whether you are looking to have a family 

If you have fibroids that are not causing symptoms and aren’t likely to affect your fertility, then generally no treatment is required. But if you begin to experience any new symptoms, it is really important to go back to the doctor to have a check-up. 

The treatment methods for fibroids can be broken down into non-surgical and surgical methods.

Non-surgical methods

If you commonly experience heavy periods as a result of your fibroids, you may be given medications such as tranexamic acid. This is a medication which breaks down blood clots in the womb. You may also be given anti-inflammatory medications, like ibuprofen or an oral medication called Ryeqo.

The combined oral contraceptive pill and hormonal IUD can also be prescribed to help you have lighter, less painful periods. 

As well as treating heavy periods directly, you may also be given a gonadotrophin-releasing hormone (GnRH) analogue. This is to try and shrink your fibroids and is also commonly prescribed before any surgical treatment. 

GnRH analogues work by reducing your levels of oestrogen. Low levels of oestrogen can lead to several other long-term complications, so this method can only be used for a short period.
If you have larger fibroids, you may be offered a procedure called Uterine Artery Embolisation. This is used to block the arteries which supply blood to the fibroids. If you have smaller fibroids, you may also be offered a procedure which removes the lining of the womb called Endometrial Ablation.

Surgical methods

There are various surgical techniques which can be used to treat fibroids. Surgery can be explored if medical treatments don’t work for you or aren’t suitable in the long term. 

You may be offered one of the following surgical treatments for fibroids: 

• Myomectomy: This is usually conducted via keyhole or open surgery. It’s used to remove fibroids whilst preserving your womb.
• Morcellation of fibroids: This is where fibroids are cut up into smaller pieces so they can be removed through the vagina or small cuts in your abdomen.
• Hysterectomy: This is the complete removal of your womb to treat fibroids. This is a major surgery and is only considered if you don’t want to have future children. 

What type of procedure is most suitable for you depends on the location, size and number of your fibroids. Each varies in terms of invasiveness, risks and its potential effect on fertility. Some people’s fibroids may grow back after surgery, known as ‘recurrence’. 

Suspect you may have fibroids?

As the symptoms mentioned above are commonly experienced in various types of pelvic issues, they may be linked to other causes apart from fibroids. 

If you’re suffering from painful periods or any of the above symptoms, it’s important to get your hormones tested, to rule out a hormonal cause. This, alongside a pelvic ultrasound scan, can help you get to the bottom of symptoms and get a recommended care plan based on your biology. 

If you’ve been diagnosed with fibroids, you can also talk to our team of specialists about possible treatment options.

There are also a variety of support networks with lots of resources for women with fibroids, such as the British Fibroid Trust, TheWhiteDressProject or Fibroid Forum UK.

References:

1. (Fibroids, 2017). 
2. (National Institute for Health and Care Excellence, no date). 
3. (National Institute for Health and Care Excellence, 2022b).
4. (Baird et al., 2013) 
5. Chang et al., 2022; Iizuka et al., 2022).
6. (Somigliana et al., 2021)