Fibroids 101: Signs, symptoms and treatments
Around 2 in 3 women will develop a fibroid at some point in their lifetime, but what are fibroids, and how do they affect our lives? Don’t worry; we are taking it back to basics and giving you the lowdown on fibroids.
What are fibroids?
Uterine fibroids are benign or non-cancerous growths of fibrous and muscle tissue in or around the uterus (womb). They are sometimes known as myomas or leiomyomas.
Fibroids are extremely common. In fact, around 2 in 3 women will develop a fibroid at some point during their life (Fibroids, 2017).
Your risk of developing fibroids increases with age, if you hit puberty earlier, if you have a higher BMI, if you have never had children, if you have a family history of fibroids or are of Black ethnicity (particularly Afro-Caribbean ancestry) (National Institute for Health and Care Excellence, no date).
Fibroids can vary in size and location. You may have one or multiple fibroids, and they can also develop as singular or as clusters. They are typically seen in three distinct locations;
- Submucosal – these grow just under the inner lining of the womb and grow into it.
- Intramural – these grow within the muscle layer (myometrium) of your womb.
- Subserosal – these develop on the outside of your womb and grow into your peritoneal cavity (the space in your abdomen which contains your stomach, liver, intestines and other organs, as well as your womb, Fallopian tubes and ovaries).
Signs & Symptoms of Fibroids
It’s worth noting that not all women who have fibroids experience symptoms. Most are actually asymptomatic (i.e. have no symptoms at all), with only approximately 1 in 3 women experiencing symptoms.
- Heavy and/or painful periods
- Tummy (abdominal) pain
- Lower back pain
- Frequent need to urinate
- Deep pain or discomfort during sex
- Trouble conceiving
Being diagnosed with fibroids doesn’t just impact physical health, iIt can affect mental health too. In fact, research has shown that women with fibroids are more likely to experience anxiety and depression than women without fibroids, and the risk is also higher in women with symptomatic fibroids (Chiuve et al., 2022).
There are a variety of support networks with lots of resources for women with fibroids, such as the British Fibroid Trust, TheWhiteDressProject or Fibroid Forum UK.
What causes fibroids?
Unfortunately, like many reproductive health conditions, the exact cause of fibroids is unknown. However, what we do know is that they are affected by oestrogen and progesterone, two hormones which are important during your reproductive life. After menopause, when oestrogen and progesterone levels drop, fibroids tend to shrink (National Institute for Health and Care Excellence, 2022b).
How are fibroids diagnosed?
As many women with fibroids do not experience symptoms, many cases are discovered coincidentally. This could be during a pregnancy or pelvic examination for another reason.
To diagnose fibroids, your doctor will take a detailed medical and gynaecological history, ask about your symptoms and how they affect your life, if there is a family history of fibroids or any history of fertility issues. In addition to this, they will do an abdominal examination, where they will be looking for any areas of tenderness or masses in your abdomen.
A routine ultrasound scan will be done to look at the location, number and size of your fibroids. This can be done either transvaginally (through the vagina) or transabdominally (looking at your uterus through your abdomen).
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.
Did you know Black women are three times more likely to develop fibroids than white women? They are 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.
What is the link between an increased risk of fibroids in Black women?
Although the link between an increased risk of fibroids in Black women is known, there has been relatively little research conducted to understand why this may be the case, although there are suggestions that genetics and environmental factors likely play a cause. Research has shown that Vitamin D deficiency in Black women (Baird et al., 2013) and the use of chemical relaxers, which are frequently used for afro-textured hair, have been linked to a higher risk of developing fibroids (Chang et al., 2022; Iizuka et al., 2022).
Additionally, despite this increased prevalence of fibroids in Black women, there is still a lack of data out there exploring the experiences of Black women in the UK when it comes to their experiences of care (Ptacek et al., 2021). What we do know, from data in the US and Canada, is that not only are Black women are more likely to develop fibroids almost five years earlier, but they are also up to three times more likely to have a hysterectomy (Eltoukhi et al., 2014; Murji et al., 2020).
Will fibroids affect my fertility? Will having fibroids stop me from getting pregnant?
Many women with fibroids do not have difficulties getting pregnant. However, some fibroids (depending on their size and where they are located) can cause problems with fertility (Somigliana et al., 2021).
As fibroids can affect the structure of the uterus and its surrounding organs, they can prevent the sperm from fertilising an egg or prevent an embryo from implanting.
How are fibroids treated?
The combined oral contraceptive pill may be prescribed to help you have lighter, less painful periods, or you may also be offered the hormonal intrauterine The treatment of fibroids depends on whether they are causing symptoms, their position and size alongside factors such as your age and whether you are looking to have a family.
If you have fibroids that are not causing symptoms or are likely to affect fertility, then no treatment is required. However, 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.
If you commonly experience heavy periods as a result of your fibroids, you may be given medications such as tranexamic acid (a medication which breaks down blood clots in the womb) or anti-inflammatory medications such as ibuprofen.
system (this is dependent on the size and the location of your fibroids).
As well as treating heavy periods directly, you may also be given a gonadotrophin-releasing hormone analogue (GnRH analogue) to try and shrink your fibroids prior to any surgical treatment. These medicines work by reducing your levels of oestrogen by interacting with your pituitary gland. However, low levels of oestrogen can lead to a number of other long-term complications, so this method can only be used for a short period of time.
If you have larger fibroids, you may be offered a procedure called Uterine Artery Embolisation. This is a procedure which 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 removings the lining of the womb called Endometrial Ablation.
In 2022, a new oral medication, Ryeqo, is now to be offered for women with moderate to severe symptoms (National Institute for Health and Care Excellence, 2022a). This new hormonal treatment is a positive step towards improving the quality of life of women suffering from fibroids by giving them a new option for long-term, improved, less invasive and sustained symptom management.
There are various different types of surgical techniques which can be used to treat fibroids. If medical treatments do not work, are not effective for long-term use, or are not suitable for you, you may be offered one of the following surgical treatments;
- Myomectomy – usually conducted via keyhole or open surgery and is used to remove fibroids whilst preserving your womb.
- Morcellation of fibroids – where fibroids are cut up into smaller pieces so they can be removed through the vagina or small cuts in your abdomen.
- Hysterectomy – the complete removal of your womb to treat fibroids.
Each surgical procedure varies in terms of invasiveness and its potential effect on fertility and associated risks. Additionally, some people’s fibroids may grow back after surgery – this is known as ‘recurrence’. What type of procedure is most suitable for you depends on the location, size and number of your fibroids.
How can Hertility help you?
This article is designed for informational purposes and should not be taken as medical advice. 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, our at-home clinical services can help you get to the root of your period problems. At Hertility, we don’t believe in giving you results without the rest. Our team of experts include specialists who can help give you the actionable advice you need.
Written by Ruby Relton & reviewed by Dr Tharni Vasavan
Baird, D.D. et al. (2013) ‘Vitamin D and the Risk of Uterine Fibroids’, Epidemiology, 24(3). Available at: https://journals.lww.com/epidem/Fulltext/2013/05000/Vitamin_D_and_the_Risk_of_Uterine_Fibroids.18.aspx.
Chang, C.-J. et al. (2022) ‘Use of Straighteners and Other Hair Products and Incident Uterine Cancer’, JNCI: Journal of the National Cancer Institute, 114(12), pp. 1636–1645. Available at: https://doi.org/10.1093/jnci/djac165.
Chiuve, S.E. et al. (2022) ‘Uterine fibroids and incidence of depression, anxiety and self-directed violence: a cohort study’, Journal of Epidemiology and Community Health, 76(1), p. 92. Available at: https://doi.org/10.1136/jech-2020-214565.
Eltoukhi, H.M. et al. (2014) ‘The health disparities of uterine fibroid tumors for African American women: a public health issue’, American Journal of Obstetrics & Gynecology, 210(3), pp. 194–199. Available at: https://doi.org/10.1016/j.ajog.2013.08.008.
Fibroids (2017) nhs.uk. Available at: https://www.nhs.uk/conditions/fibroids/ (Accessed: 31 March 2023).
Iizuka, T. et al. (2022) ‘Mono-(2-ethyl-5-hydroxyhexyl) phthalate promotes uterine leiomyoma cell survival through tryptophan-kynurenine-AHR pathway activation’, Proceedings of the National Academy of Sciences, 119(47), p. e2208886119. Available at: https://doi.org/10.1073/pnas.2208886119.
Murji, A. et al. (2020) ‘Influence of Ethnicity on Clinical Presentation and Quality of Life in Women With Uterine Fibroids: Results From a Prospective Observational Registry’, Journal of Obstetrics and Gynaecology Canada, 42(6), pp. 726-733.e1. Available at: https://doi.org/10.1016/j.jogc.2019.10.031.
National Institute for Health and Care Excellence (2022a) Overview | Relugolix–estradiol–norethisterone acetate for treating moderate to severe symptoms of uterine fibroids | Guidance | NICE. NICE. Available at: https://www.nice.org.uk/guidance/ta832 (Accessed: 31 March 2023).
National Institute for Health and Care Excellence (2022b) Prognosis | Background information | Fibroids | CKS | NICE. Available at: https://cks.nice.org.uk/topics/fibroids/background-information/prognosis/ (Accessed: 31 March 2023).
National Institute for Health and Care Excellence (no date) Risk factors | Background information | Fibroids | CKS | NICE. Available at: https://cks.nice.org.uk/topics/fibroids/background-information/risk-factors/ (Accessed: 31 March 2023).
Ptacek, I. et al. (2021) ‘Each Uterus Counts: A narrative review of health disparities in benign gynaecology and minimal access surgery’, European Journal of Obstetrics and Gynecology and Reproductive Biology, 265, pp. 130–136. Available at: https://doi.org/10.1016/j.ejogrb.2021.08.024.
Somigliana, E. et al. (2021) ‘Fibroids and natural fertility: a systematic review and meta-analysis’, Reproductive BioMedicine Online, 43(1), pp. 100–110. Available at: https://doi.org/10.1016/j.rbmo.2021.03.013.