Fibroids
What is a fibroid?
Fibroids, also known as leiomyomas, are benign (non-cancerous) growths that develop from the muscle of the uterus.
They are one of the most common gynaecological conditions and can vary considerably in size, number and location. Fibroids may develop:
- on the outer surface of the uterus (subserosal fibroids)
- within the muscular wall of the uterus (intramural fibroids)
- within the uterine cavity (submucosal fibroids).
Although many fibroids cause no symptoms, some can contribute to heavy menstrual bleeding, pelvic pain and fertility problems.
The exact cause is not fully understood, but fibroid development is thought to be influenced by a combination of genetic, hormonal and environmental factors. Oestrogen plays an important role in stimulating fibroid growth, which is why fibroids usually shrink after menopause.
How common are fibroids?
Fibroids are very common, affecting up to two in five women over the age of 40.
They are seen more frequently in women with infertility and those who have not had children. Because fibroids are hormone-responsive, they often reduce in size after menopause as oestrogen levels decline.
What do fibroids do?
Many fibroids remain small and never cause symptoms.
However, depending on their size and location, fibroids may:
- distort the shape of the uterus
- contribute to heavy or prolonged menstrual bleeding
- cause pelvic pain or pressure
- affect bladder or bowel function
- interfere with fertility or pregnancy.
Submucosal fibroids, which project into the uterine cavity, are the most likely to affect fertility because they can interfere with embryo implantation.
What are the symptoms?
Many women have fibroids without ever knowing they are there.
When symptoms occur, they may include:
- heavy or prolonged menstrual bleeding
- bleeding between periods
- painful periods
- pelvic pain or pressure
- lower back pain
- pain during sexual intercourse
- pain when passing urine or opening the bowels
- difficulty becoming pregnant (infertility).
Very rarely, a fibroid may represent a cancerous tumour. This is uncommon, occurring in fewer than one in 1,000 cases, and is seen more frequently after menopause.
How are fibroids diagnosed?
Fibroids may first be suspected during a pelvic examination.
Imaging is usually used to confirm the diagnosis and assess their size and location.
Investigations may include:
- pelvic ultrasound
- magnetic resonance imaging (MRI)
- computed tomography (CT) in selected circumstances.
Depending on the findings, your specialist may also recommend:
- hysteroscopy, to examine the uterine cavity
- laparoscopy, if further assessment of the pelvis is required.
What are the treatment options?
Treatment depends on:
- whether you have symptoms
- the size and number of fibroids
- where the fibroids are located
- whether fertility is a consideration
- your age and stage of life.
Many women require no treatment at all.
Observation
If fibroids are small and not causing symptoms, regular monitoring may be all that is required.
Your specialist may recommend periodic review or repeat imaging to ensure the fibroids remain stable.
Medical treatment
Medication may be used to reduce symptoms or temporarily shrink fibroids.
Some treatments work by creating a temporary low-oestrogen (medical menopause) state, allowing fibroids to decrease in size before surgery or other treatment.
These medications are generally used for a limited period because fibroids usually regrow once treatment stops.
Newer medications are continuing to emerge, and your specialist can discuss whether these are appropriate for your individual circumstances.
Uterine artery embolisation
Uterine artery embolisation is performed by an interventional radiologist.
The procedure blocks the blood supply to the fibroid, causing it to shrink over time.
It is usually performed as a day procedure or short hospital admission and does not require an abdominal incision.
Surgery
Surgery may be recommended when fibroids cause significant symptoms or affect fertility.
Myomectomy
A myomectomy removes the fibroid while preserving the uterus.
Depending on the size and location of the fibroids, this may be performed:
hysteroscopically
laparoscopically (keyhole surgery)
through an abdominal incision.
Myomectomy is often the preferred surgical option for women wishing to preserve fertility.
Although successful, fibroids can recur, with recurrence reported in approximately one in three women.
For women who have completed their family or have severe symptoms that cannot be managed conservatively, hysterectomy provides definitive treatment by removing the uterus and all associated fibroids.
The procedure may be performed vaginally, laparoscopically or through an abdominal incision, depending on the individual circumstances.
What can I expect?
The outlook for women with fibroids is generally very good.
Many fibroids remain stable or cause few symptoms throughout life. When treatment is required, a range of effective medical, radiological and surgical options are available.
Management is individualised, with consideration given to symptom severity, future pregnancy plans and overall health.
What to remember
Fibroids are one of the most common benign conditions affecting the uterus.
Although many require no treatment, larger or symptomatic fibroids can affect menstrual bleeding, pelvic comfort and fertility. Early assessment allows the most appropriate treatment to be selected while preserving reproductive options whenever possible.
Further information
For additional evidence-based information, visit Jean Hailes for Women’s Health.
https://www.jeanhailes.org.au/health-a-z/ovaries-uterus/fibroids
