Leiomyoma (fibroids)
Facts about Leiomyoma.
What are they?
These are benign (non-cancerous) overgrowths of the muscle layer of the womb. They can be thought of as a knot of muscle caused by muscle or fibrous tissue overgrowth. They vary in size from a few millimetres to tens of centimetres.
What causes them?
The genes you inherit appear to play an important role in the development of fibroids. Leiomyoma (fibroids) grow in response to the hormones produced by your ovaries and usually decrease in size after the menopause.
What symptoms do they cause?
Many fibroids cause no symptoms. When symptoms do occur, they are different depending on the size, location and number of fibroids present. If the fibroids are near the endometrium (womb lining) they can cause heavy, irregular or prolonged menstrual bleeding. If the fibroid(s) are large, they can put pressure on nearby organs like the bladder or bowel, causing the need to pass urine more frequently or difficulty passing bowel motions. Fibroids may be cause pain, particularly during pregnancy.
How are they diagnosed?
Fibroids are often diagnosed on ultrasound scan, when their size, location and number can be assessed. Some people may have an MRI for diagnosis.
How are they treated?
There are a number of treatment options for those with symptomatic fibroids.
Monitoring
This may be appropriate for those trying for a pregnancy or about to become menopausal. No treatment is started, but an ultrasound scan may be repeated to ensure the fibroid is not growing rapidly.
Medical treatments
- Non-hormonal medicines: women who are experiencing heavy bleeding may benefit from iron tablets to improve the symptoms of low iron levels (tiredness, dizziness, shortness of breath). Tranexamic acid and anti-inflammatory medicines are taken during menstruation and can reduce menstrual blood loss and menstrual pains.
- Hormonal tablets like the contraceptive pill may help with heavy bleeding but occasionally can increase the size of a fibroid.
- Hormonal injections/implants/intrauterine systems (https://www.nhs.uk/conditions/contraception/ius-intrauterine-system/) may help with heavy bleeding.
- GnRH analogues are injections that cause a false menopause. They can reduce or even stop menstrual bleeding and may reduce the size of fibroids. However, they may cause menopausal symptoms, such as hot flushes, vaginal dryness and night sweats.
- Ulipristal acetate is a newer medication for treating those with fibroids. These tablets reduce menstrual bleeding and can shrink the size of fibroids. Unlike GnRH analogues, they do not appear to cause menopausal symptoms. They can rarely cause liver problems. It is recommended that those taking ulipristal acetate are regularly monitored with blood tests, ultrasound scans and some women may require an endometrial biopsy.
Surgical treatments
- Uterine artery embolization: this is a procedure to block the blood supply to fibroids. It is usually carried out by interventional radiologists (doctors who specialise in doing keyhole procedures under scan guidance) via a blood vessel in the groin.
Treating fibroids by blocking there blood supply
- Myomectomy: surgical removal of fibroids. This is an appropriate surgery for those who do not wish medical treatment and who wish to keep the womb and/or maintain their fertility.
- Hysterectomy: surgical removal of the womb.
Further information
https://www.nhs.uk/conditions/Fibroids/
Fibroid Network UK (twitter@fibroidsupport)
https://www.nhs.uk/conditions/heavy-periods/treatment/