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What are fibroids?


Fibroids are non-cancerous growths that form in the womb. They are made up of muscle and fibrous tissue and vary in size; there might be one or many. They are the most common tumour of the female reproductive system and are also known as myomas or leiomyomas. They are more common with increasing age. It is estimated that up to 70% of all women may develop fibroids by the age of 50, but not all of them will cause symptoms.


Depending on their position within the womb, they are classified to three main types:


Submucosal: when they develop under the lining of the womb

Intramural: when they are present within the muscle of the womb.

Subserosal: when they develop under the outer layer of the womb,, stretching out towards the tummy.


What is their progression?


Fibroids tend to grow slowly until the menopause, and then they start to shrink. How big they will become depends on their blood supply as well as other factors such as increasing age, obesity, ethnicity, family history and pregnancies. They may degenerate (become soft) or calcify (become very hard). Extremely rarely they may develop into cancer, which is called leiomyosarcomas. 


What symptoms can they cause?


Many women are unaware of their fibroids as they do not have any symptoms. Evidence shows that they are rarely symptomatic in women younger than 30. Approximately 1 in 3 women experience symptoms which may be:


  • heavy and/or painful periods

  • pelvic pain including pain during sex

  • lower back pain

  • passing urine often / urinary urgency / urinary retention

  • pressure 

  • constipation

  • difficulty in getting pregnant


How are fibroids diagnosed?


Despite the fact that up to 50% of the women of reproductive age may have fibroids, not all are diagnosed. Often fibroids are big enough to be picked up during a routine gynaecological examination or investigations for other problems. A firm, round, enlarged, sometimes tender mass, is usually felt during an internal or an abdominal examination. 


The most commonly used investigations for the diagnosis of fibroids are:


  • Ultrasound Scan (transabdominal and/or transvaginal): A probe is placed on the tummy or a slim probe is inserted into the vagina to provide images of the womb and the ovaries.

  • Magnetic Resonance Imaging (MRI): MRI scans use a magnetic field to create detailed images of the inside of the body. With specific techniques, the arteries supplying the fibroids can be identified and blocked (embolised) as a mode of treatment.

If the fibroids have been causing heavy periods, then a blood test to check for anaemia should be organised.


I have fibroids. Now what?


Choosing the right treatment for the fibroids is not always straight-forward and depends on several factors:


  • Your overall health

  • Previous surgeries

  • Size and position of the fibroids

  • Fertility wishes

  • Tolerance of medications

  • Most importantly your own treatment preference!


If the fibroids are not causing any problems, then sometimes they may be left untreated. In this case, you will be closely monitored. The size of the fibroids will be assessed in regular intervals, to ensure that there is no growth. 


If however the fibroids are causing symptoms, affecting your quality of life, then treatment may be necessary. At Hampshire Women's Health we offer all the available treatment options:


  • Medical treatment:

    • Mirena coil® 

    • Mefenamic and Tranexamic acid

    • Combined Oral Contraceptive pill

    • Progestogen injection (Depo-Provera®)

    • Gonadotrophin-releasing hormone (GnRH) agonists: short term treatment to shrink the fibroids before surgical treatment

    • Esmya®: A medication licensed for three months prior to a myomectomy or a hysterectomy. It is used to shrink the fibroids.


  • Surgical treatment:

    • Hysteroscopic resection of fibroids: A small operation during which an instrument is inserted in the womb through the neck of the womb, to remove the fibroid growing in the lining of the womb.

    • Laparoscopic myomectomy: During this keyhole procedure, the uterus is preserved and only the fibroid which is growing within the womb or under its external layer is removed. 

    • Hysterectomy:  This is the complete removal of the womb. Fibroids remain the most common cause for hysterectomies in the world.

    • Endometrial ablation:  A procedure where with the use of a special instrument, through the neck of the womb, the lining of the womb is cauterised leading to improvement/cessation of the periods.

    • Uterine Artery Embolisation: A relatively new treatment option by which the arteries that feed the fibroid are blocked, making it shrink. This procedure is performed by our interventional radiology colleagues.





What are polyps?


Uterine polyps are growths from the lining of the womb. They are usually benign, although some can be cancerous or can eventually develop into cancer. They vary in size from a few millimeters to the size of a golf ball. 



What are their symptoms?


Endometrial polyps may cause:


  • Irregular periods

  • Bleeding in between the periods

  • Heavy periods

  • Post-menopausal bleeding

  • Subfertility



How are the polyps diagnosed?


If your symptoms raise the suspicion of endometrial polyps, then the following investigations are helpful in diagnosing the polyps. 


Ultrasound Scan (transabdominal and transvaginal): A probe is placed on the tummy or a slim probe is inserted into the vagina to provide images of the womb and the ovaries.

Hysteroscopy. A thin, flexible, lighted telescope (hysteroscope) is inserted through the vagina and cervix into the womb. Hysteroscopy allows for direct visualisation of the lining of the womb.



How are the polyps treated?


Most uterine polyps are benign. However, some precancerous changes of the womb (endometrial hyperplasia) or womb cancers (endometrial carcinomas) first appear as uterine polyps. We will likely recommend removal of the polyp and will send a tissue sample for lab analysis to be certain you don't have cancer of the womb.


Surgical removal. During the hysteroscopy, instruments are inserted through the hysteroscope, the device  used to see inside your womb. These instruments make it possible to remove polyps. The removed polyp will then be sent to the lab for examination, to exclude cancer.


Rarely, polyps recur. If that happens you might need more treatment.

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