Fibroids.

Fibroids are very common non-cancerous growths of the uterus. They vary in size, number, and location and can be completely asymptomatic or significantly impact quality of life. While the exact cause is not fully understood, fibroids are influenced by hormones (oestrogen and progesterone) and often run in families.

Symptoms

Many women have no symptoms, but fibroids can cause:

• Heavy or prolonged menstrual bleeding

• Flooding or passage of large clots

• Pelvic pressure or bloating

• Painful periods

• Back or leg pain

• Frequent urination or constipation (from pressure on the bladder or bowel)

• Pain with intercourse

• Fertility or pregnancy-related issues (depending on location)

Fibroid Classification

Fibroids are described based on where they sit in the uterus. They are almost always benign - but very rarely, a cancer called leiomyosarcoma can occur; this is extremely uncommon.

Submucosal

• Grow just under the endometrium and protrude into the uterine cavity

• Most associated with heavy bleeding, infertility, and miscarriage

• Best treated with hysteroscopic myomectomy when appropriate

Intramural

• Grow within the muscular wall of the uterus

• Can cause heavy bleeding, pressure symptoms, or pain

• Treatment depends on size, symptoms, and fertility goals

Subserosal

• Grow on the outer surface of the uterus

• Typically cause bulk-related symptoms (pressure, bloating, urinary issues)

• Less commonly associated with heavy bleeding

Investigations

Diagnosis usually involves:

• Pelvic ultrasound - first-line imaging to assess size, number, and location

• MRI scan - used in selected cases to clarify anatomy or plan surgery

• Blood tests - including full blood count and ferritin to check for anaemia

• Hysteroscopy - to directly view the cavity for suspected submucosal fibroids

Management Options

Treatment depends on fibroid size, symptoms, future fertility plans, and overall health. Some fibroids may not require any treatment.

Non-Hormonal Treatments

• Tranexamic acid to reduce heavy bleeding

• NSAIDs to reduce bleeding and control pain

Hormonal Treatments

• Combined oral contraceptive pill

• Progesterone-only methods

• Mirena® (levonorgestrel IUS)

• GnRH agonists/antagonists (short-term use to shrink fibroids or manage symptoms)

Uterine Artery Embolisation (UAE)

A minimally invasive radiology procedure that blocks the blood supply to fibroids, causing them to shrink. Best suited to women who wish to avoid surgery and are not planning future pregnancy.

Surgical Management

Myomectomy

Surgical removal of fibroids while preserving the uterus.
Suitable for women wishing to retain fertility or avoid hysterectomy.

• Hysteroscopic myomectomy – for submucosal fibroids inside the uterine cavity

• Laparoscopic (keyhole) myomectomy – for appropriately sized and located fibroids

• Open myomectomy – for very large or numerous fibroids

Hysterectomy

Complete removal of the uterus and the definitive treatment for fibroids.

• Laparoscopic hysterectomy – associated with faster recovery

• Open hysterectomy – for very large uteri or complex anatomy

Morcellation

For large fibroids removed laparoscopically, tissue may need to be broken down to extract it through small incisions.
This is performed within a contained bag to improve safety and prevent tissue spread.