Fibroids are benign tumours that originate from the muscular and fibrous tissue of the uterus. Their size can range from very small to 10-15 centimetres.
Symptoms depend both on their location and on their size. They can often cause heavy bleeding during the period, which may be accompanied by pain and, in more severe cases, by anaemia. The main pressure effects they cause are constipation and symptoms from the bladder and ureters. Small fibroids may cause no symptoms or may go unnoticed and be detected by chance on an ultrasound examination.
Symptoms of fibroids
Symptoms depend on the size and location of the fibroids. Small subserosal or intramural fibroids are usually asymptomatic, whereas as their size increases or when they are located in the submucosal region of the uterus, they may cause the following:
• Heavier bleeding during the period
• Pain during the period
• Bleeding between periods
• Constipation
• Frequent urination
• Pain during intercourse
• Infertility
• Recurrent miscarriages
• Preterm birth
Diagnosis of uterine fibroids
Initially, taking a good gynaecological and obstetric history is essential. Bimanual gynaecological examination and then ultrasound of the internal genital organs establish the definitive diagnosis. In uncertain cases, computed tomography and magnetic resonance imaging have a role.
Treatment of fibroids
Treatment always depends on the severity of the symptoms, the size of the fibroids, the woman's wish to have children and, of course, her age. Treatment may be medical, surgical or a combination of both. So-called GnRH analogues are hormones aimed at reducing the size of fibroids by creating an artificial menopause. Painkillers are only for managing pain and have no place in the treatment of fibroids. Definitive treatment is surgical removal, either of the fibroids or, in many cases, of the whole uterus, depending on the woman's age, the size, and the severity of the symptoms. Removal of fibroids can be performed laparoscopically unless there is a contraindication (large size, location of the fibroids), which will be determined by the doctor on assessment.