Fibroids

Many women experience no issues from small fibroids, but common symptoms include:

Occasionally, fibroids can lead to anaemia because of heavy blood loss during menstruation and also fertility and pregnancy complications because of distortion of the womb.

Though the cause is unclear, fibroid development seems tied to oestrogen levels. Risk factors include:

Fibroids typically remain benign in nature and almost never become cancerous. Leiomyosarcoma is an extremely rare fibroid cancer, affecting around 500 women in the UK each year (which makes it much rarer than lung cancer or ovarian cancer).

Fibroids that aren’t causing any symptoms don’t require treatment, and symptomatic women who enter menopause tend to find that their symptoms significantly improve as a drop in oestrogen levels shrinks their fibroids.

Painkillers and anti-inflammatory medications, such as ibuprofen, can ease period pain and cramping associated with fibroids. Still, many women will require hormonal treatments and even surgery to gain sufficient relief from their symptoms.

Contraceptive pill

The combined pill can help reduce blood loss during menstruation and can also help with period pain.

Progesterone medications

Oral progesterone and injectable progesterone (e.g. Depo Provera) reduce the thickness of the womb’s lining and blood loss during menstruation.

Gonadotrophin-releasing hormone analogues are medications which can help shrink fibroids. They act on the pituitary gland, limiting its production of follicle-stimulating hormone and luteinising hormone, which control the menstrual cycle. They induce a kind of temporary menopause and, with it, menopausal symptoms of hot flushes and vaginal dryness, etc.

Ryeqo is a new oral medication for the treatment of severe fibroid symptoms. It comprises three components- Relugolix, which is a GnRH analogue, and estradiol and norethisterone, which are HRT (hormone replacement therapy) ‘add backs’, to reduce the impact of the menopausal symptoms induced by the Relugolix.

Ryego has been shown to reduce menstrual blood loss and fibroid-associated pain and can significantly shrink fibroids. Oestradiol and norethisterone also help lessen the impact of bone density loss. It can also be used to shrink fibroids before fibroid surgery.

This minimally invasive procedure restricts blood flow to the fibroids, causing them to wither and shrink. It’s an outpatient procedure carried out under light sedation by an interventional radiologist. A tube is passed into the femoral area in the groin, and using real-time X-ray imaging, the radiologist guides the catheter up into the uterine arteries that supply blood directly to the fibroids. Tiny synthetic particles are then injected to block these vessels, cutting off oxygen and nutrients to the fibroids so they decrease in size. After the procedure, you may experience some pain and cramping for a day or so, and you will likely have a watery discharge for a few weeks. Most women benefit from the treatment after three months, and it’s very successful. The majority of women report an excellent improvement in their symptoms.

It can also be used to shrink fibroids before surgery.

Uterine artery embolisation is only recommended if you don’t intend on becoming pregnant, and some people will have a re-growth of their fibroids in the years following their treatment.

Myomectomy means the surgical removal of fibroids, and it can be a good option for women who wish to get pregnant in the future as it conserves the womb. Sometimes, it is possible to remove small fibroids growing into the womb cavity (submucosal fibroids) via hysteroscopy. This is known as a transcervical resection of the fibroids, and it’s carried out under a general anaesthetic. Fibroids growing on the surface of the womb can often be removed via keyhole surgery (laparoscopy).

Large fibroids need to be removed via an abdominal incision, called a laparotomy, and as with all surgeries, there is the potential for complications, including:

For some women who have not yet reached menopause and who have tried various medical treatments for their fibroids but are still suffering from severe bleeding or pressure problems, hysterectomy offers a permanent solution. Hysterectomy link involves removing the womb along with the fibroids, so it’s only suitable for women who do not wish to have any more children. I perform this kind of hysterectomy via a small incision in the bikini line area, and for many women, the surgery can be life-changing.

If you suspect you may have fibroids, I’m here to help.