What are fibroids?
Fibroids are non-cancerous, benign growths of smooth muscle that grow in the wall of the womb or uterus. They are sensitive to the hormones oestrogen and progesterone. They are common, with one in every 2 or 3 women having at least one fibroid, and are often found incidentally - for example, when under medical investigation for another reason.
Fibroids most commonly develop in women between the ages of 30 and 50 years. The size of a fibroid can vary from pea sized to the size of a tennis ball or even bigger. It is common to have more than one fibroid. After the menopause, fibroids tend to become smaller due to diminishing oestrogen and progesterone supplies in the body. In people using hormone replacement therapy, HRT, the fibroids are less likely to shrink.
Fibroid symptoms
They may cause no symptoms, but they can be associated with heavy and painful periods. Depending upon the location of fibroids, they may also cause pressure symptoms affecting other areas in the abdomen and pelvis, such as urinary symptoms, bloating, back pain, painful sex and constipation. Less commonly, they can interfere with fertility and pregnancy. Because fibroids can cause heavy bleeding, they can lead to anaemia in some people, which in turn can lead to other symptoms such as tiredness.
Fibroids grow in different areas of the womb and are given different names based on the location. This is important to know as the location of a fibroid determines the type of symptoms that it may cause.
Subserous fibroids grow on the outside of the womb and are most likely to cause pressure symptoms such as constipation. If they grow on a stalk in this area, they are known as pedunculated fibroids.
Intramural fibroids grow in the muscle layer of the womb and are the most common type; these are more likely to be associated with painful periods. Submucosal fibroids are found in the inner wall of the womb; they can cause heavy periods and can alter the shape of the uterine cavity. This occasionally causes issues with fertility and pregnancies.
Diagnosis and treatment
Fibroids are usually diagnosed following an examination or pelvic ultrasound scan. They do not necessarily require any treatment unless they cause symptoms or are large.
For people suffering with heavy painful periods due to fibroids, tranexamic acid can be used to reduce the bleeding and anti-inflammatory medication, such as mefenamic acid, can help with period pains. Other options include the contraceptive pills - the combined oral contraceptive pill or progestogen-only pill - which can make periods lighter. The IUS, such as the Mirena coil, is another option that can lighten or stop periods; however, in some women with submucous fibroids it may be difficult or sometimes impossible to insert.
Other treatment options include shrinking or removing the fibroids. This can be achieved using medication or having a procedure. A type of medication known as a GnRH analogue can be given to shrink fibroids. This is usually a monthly injection, although tablets have also now become available, and are given for a maximum of six months.
These medications can trigger menopausal symptoms and side effects related to low oestrogen levels such as thinning of the bones and are sometimes given alongside add-back HRT to reduce the effects of an induced menopause. They can also be used prior to surgery to shrink the fibroids, with the aim of making surgery more straightforward.
Surgical options include removing the womb - hysterectomy - or individual fibroids. Hysterectomy tends to be the preferred surgical option in women who do not want any more children, and myomectomy, surgical fibroid removal, is reserved for those women wishing to conserve their fertility. Other options include uterine artery embolisation, which is a less invasive procedure cutting off the blood supply to the fibroid and resulting in it shrinking, and endometrial ablation - a procedure to remove the womb lining and reduce bleeding.
Although HRT may increase the size of fibroids, it is still an option for most women who would like to take HRT for perimenopausal and menopausal symptoms. Under specialist guidance, it should be possible to find a regime that works well for you and improves your overall health and wellbeing.
Knowing which doctor to consult for menopause can be invaluable in deciding how best to treat your menopause symptoms and whether HRT is right for you. At Menopause Care, we have a team of highly experienced menopause doctors and nurses who can talk you through your options and develop a personalised treatment plan based on your unique circumstances. To get started, book a consultation.
