Fibroids
A fibroid is a firm lump of muscle and fibrous tissue that grows in the wall of the womb. It is not a tumour in the usual sense: it does not turn into cancer…
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Medicines commonly prescribed for Fibroids
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 75 microgramsActive substance: desogestrelManufacturer: Kern Pharma S.L.Prescription requiredDosage form: TABLET, 75 microgramsActive substance: desogestrelManufacturer: Laboratorios Cinfa S.A.Prescription requiredDosage form: TABLET, 75 microgramsActive substance: desogestrelManufacturer: Laboratorio Stada S.L.Prescription required
A fibroid is a firm lump of muscle and fibrous tissue that grows in the wall of the womb. It is not a tumour in the usual sense: it does not turn into cancer and does not spread through the body. Fibroids are very common — most women develop one at some point — and they mostly keep quiet, turning up by chance on a scan. Treatment only comes into the conversation when a fibroid causes trouble: flooding periods, pressure on neighbouring organs, or difficulty carrying a pregnancy. What follows covers how to tell whether a fibroid is behind your symptoms, what can be done about it, and when speed really matters.
Where they grow and what sort they are
There may be a single fibroid or twenty; sizes run from a pea to a mass that lifts the abdomen. Position matters more than size, because it decides whether a fibroid is noticed at all.
- Within the muscle wall, the commonest sort; a large one stretches the womb and makes periods heavier.
- Under the outer covering, growing towards the abdomen. It rarely bleeds, but it presses on the bladder and bowel and reaches a considerable size unnoticed.
- Under the inner lining, growing into the cavity. The noisiest sort: even a small one causes heavy, drawn-out bleeding and gets in the way of conception.
- On a stalk: the fibroid hangs from a narrow strand of tissue that can twist, and that is an acute situation.
What a woman notices
In about two women out of three fibroids give no sign at all. In the rest the complaints run like this:
- heavy periods: a pad needs changing more often than every two hours, clots come away, blood leaks at night and bleeding lasts more than a week;
- painful periods, with a dragging ache low in the abdomen and in the lower back in between;
- a feeling of heaviness and pressure in the pelvis, and a fuller abdomen without any change in weight;
- needing to pass urine often, or a sense that the bladder never empties;
- constipation and bloating;
- pain or discomfort during sex, often in particular positions;
- difficulty conceiving and repeated pregnancy loss.
What hides behind the word “heavy” deserves a paragraph of its own. Month after month iron drains away and anaemia follows: tiredness, breathlessness on ordinary exertion, palpitations, pallor, brittle hair and nails, sometimes an odd urge to chew ice. Women put it down to being run-down for years. If your periods are heavy, ask for ferritin as well as haemoglobin: iron stores empty first, and at that stage everything is easier to put right.
Where they come from
The exact cause is unknown: a fibroid starts from a single muscle cell that begins dividing for unclear reasons, and its growth is then sustained by oestrogen and progesterone. That explains the whole shape of the condition: fibroids appear during the reproductive years, often grow in pregnancy and usually shrink after the menopause.
Heredity counts: if a mother or sister had fibroids, the risk is higher. In women of African origin they are more common, appear earlier and grow larger. Excess weight plays a part too, because fat tissue makes oestrogen of its own. Women who have had children average fewer fibroids.
What not to listen to: fibroids do not come from stress, from sunbathing, from saunas or from a woman having “had a shock”. These explanations have circulated online for decades and are worth nothing.
How they are found
Often a fibroid turns up at a routine examination, with the womb enlarged or uneven to the touch. An ultrasound scan follows, usually through the vagina, because the picture is far clearer than through the abdomen. That is generally enough to establish how many fibroids there are, where they sit and how big they are.
Sometimes further tests are needed:
- hysteroscopy: a thin telescope is passed into the cavity of the womb to see fibroids growing inwards and to take a sample of the lining. It feels like strong period cramps, so agree on pain relief beforehand — putting up with pain in silence is not part of the procedure;
- a scan with fluid instilled into the cavity, a simpler way of seeing the fibroids inside;
- an MRI scan before surgery or embolisation, when the exact position of every fibroid matters;
- blood tests for haemoglobin and ferritin where periods are heavy.
The same symptoms can come from adenomyosis, polyps, a clotting disorder, thyroid disease or, in older women, changes in the lining of the womb. So a fibroid that has been found does not always explain everything, and the doctor checks the rest.
Treatment is not always needed
A fibroid causing nothing is not treated; it is watched, usually with a scan once a year. It may grow, or it may sit unchanged for years, and after the menopause fibroids generally shrink along with the symptoms. Operating “just in case” on a symptomless fibroid serves no purpose.
Where there are symptoms, medicines come first. They cannot remove a fibroid, but they can give life its ordinary shape back.
- An intrauterine system releasing levonorgestrel thins the lining and cuts blood loss substantially, and works as contraception into the bargain. It is unsuitable if a fibroid distorts the cavity.
- Tranexamic acid is taken only on the days of bleeding; it reduces blood loss without touching hormones or the chance of conceiving.
- Non-steroidal anti-inflammatory drugs ease the pain and reduce blood loss as well; they are taken during the period.
- Combined hormonal contraceptives make periods more regular, shorter and less painful.
- Iron is essential where there is anaemia, and it has to be continued for several months after the haemoglobin comes back up.
- Drugs that temporarily switch off the ovaries' hormone production do shrink fibroids, but they bring on a menopause-like state and drain calcium from bone. They are given in short courses, usually before surgery, and often alongside a low dose of hormones that offsets the side effects.
And to be straight about the limits: once any of these is stopped, the fibroids return to their previous size and the periods to their previous volume. Medicines relieve symptoms and buy time; they do not close the matter.
Surgery and procedures
If medicines are not enough, an intervention is discussed. The choice depends on where the fibroids are, how many there are and how large, and above all on whether you are planning a pregnancy.
- Removing the fibroids while keeping the womb: through the cavity where a fibroid grows inwards, and through keyhole punctures or an abdominal incision otherwise. This is the option for anyone hoping to conceive; fibroids can grow back and some women are operated on again.
- Uterine artery embolisation: through a puncture in a blood vessel, guided by X-ray, the arteries feeding the fibroid are blocked and it shrinks. The womb is preserved and recovery is quicker than after surgery; the effect on a later pregnancy is not fully established, so discuss it if children are in your plans.
- Destroying the fibroid with heat or with focused ultrasound under image guidance. It does not suit every position, and long-term results are still accumulating.
- Destroying the lining of the womb reduces bleeding, but it applies only to small fibroids inside the cavity, and pregnancy is not planned afterwards.
- Removing the womb is the only way to be rid of fibroids for good; it is discussed for large multiple fibroids with heavy bleeding when no children are planned. The ovaries are usually left in place so that an early menopause does not follow.
One detail worth knowing in advance: fibroids are sometimes broken up inside the abdomen so that they can be drawn out through a small incision. If what looks like a fibroid turns out to be a rare malignant tumour, breaking it up scatters its cells. The risk is small and the tissue is now removed inside a protective bag, but asking the surgeon how exactly they intend to do it is entirely reasonable.
Pregnancy and fertility
For most women fibroids get in the way of neither conceiving nor carrying a baby. The ones that matter are mainly those growing into the cavity: they stop an embryo implanting, and removing them raises the odds noticeably. A large fibroid may also block the entrance to a fallopian tube.
During pregnancy a fibroid sometimes grows fast and outstrips its blood supply. That causes sharp pain at one particular spot in the abdomen, occasionally with a slight temperature; it is not dangerous and settles with rest and pain relief, but it needs a doctor rather than guesswork. Large fibroids raise the chance of the baby lying awkwardly, of premature labour, of caesarean birth and of heavier bleeding afterwards, so the maternity unit should know about them in advance.
If you have had surgery for fibroids, make a point of telling the obstetrician: whether the cavity of the womb was opened during that operation shapes how you will give birth.
When waiting is not an option
Call an ambulance (across Europe the single number is 112) or go to emergency care if you develop:
- bleeding that soaks a pad within an hour for several hours running, particularly together with dizziness, breathlessness, palpitations, pallor and cold sweat;
- sudden severe pain low in the abdomen with nausea and vomiting, which is how a fibroid on a stalk twisting presents;
- inability to pass urine with a full bladder;
- a high temperature with pain low in the abdomen.
And separately, something that does not look urgent but needs a doctor without delay: a fibroid that has clearly grown after the menopause, and any bleeding once periods stopped a year or more ago. A fibroid should not grow after the menopause; occasionally such growth turns out to be a malignant tumour of the womb muscle, and catching that in time matters more than anything else in this text. Do not wait for a routine scan in six months.
Online consultation
A remote appointment is a good place to sort out what usually stays unclear after a short visit. The doctor will go through your scan report and explain what the size and position of the fibroids mean in your case, judge how heavy your periods actually are, and say which blood tests to have and whether anaemia already needs treating. Online is also the place to weigh up the options you have been offered, work out the questions to put to a surgeon, and plan a pregnancy with fibroids. Examination, scanning and any procedure all need you in the room, and the signs in the section above mean going straight to emergency care.
This material is for information only and does not replace medical advice.
Consult with a doctor about Fibroids
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Fibroids
Discuss your symptoms and possible next steps for Fibroids with a doctor online.
