More than half of us will develop fibroids before we're 50. Many of us will never know about it, while others will experience painful, heavy periods, and some will have pregnancy complications. By Joanna Egan.
Fibroids are very common in women of reproductive age. They are benign growths that form in and around your uterus, either singularly or in groups. They can vary significantly in size – from being smaller than a seedling and invisible to the naked eye, to being as large as 20cm in diameter, or about the size of a rockmelon.
What causes fibroids?
It's not known exactly why fibroids occur. "They probably have partly a genetic and partly an environmental cause," says Brisbane-based obstetrician and gynaecologist Dr Graham Tronc, who helped found the Brisbane Fibroid Clinic in 2001.
He explains that they generally don't appear until after women ovulate for the first time and they tend to decrease in size after women undergo menopause. As a result, researchers believe the sex hormones oestrogen and progesterone affect their development and growth.
Who is at risk of developing them?
Fibroids are very common in women aged 20 and older. They grow at varying rates until the onset of menopause, when they tend to decrease in size. By the age of 40, about 40 per cent of Australian women have one or more fibroids and by the age of 50, up to 70 per cent have had fibroids.
Factors that increase your risk of developing them include a family history of fibroids; the early onset of menstruation; obesity; diabetes; age (your risk of developing fibroids increases in your late reproductive years); having never been pregnant; polycystic ovarian syndrome (PCOS); and hypertension (high blood pressure).
How do you know if you have fibroids?
Many women with fibroids experience no symptoms and can go through life without even knowing they have them. Often, fibroids are detected incidentally during a routine gynaecological exam or while a pelvic ultrasound or surgical procedure is being performed for another condition.
If symptoms do occur, you may experience heavy, long and painful periods, spotting between periods, pelvic pressure or discomfort during sex. The size and bulk of your fibroids may cause swelling in your lower abdomen and place pressure on your lower back, bladder or bowel.
What are the health complications?
One of the most common conditions is anaemia (a reduction in your red blood cells). This occurs if your fibroids cause an excessive loss of menstrual blood. Anaemia can lead to breathlessness, paleness, and feelings of fatigue.
Other complications include bladder and bowel problems. These occur when large fibroids cause your uterus to bulge and press against your pelvic organs, causing feelings of fullness or discomfort, constipation or an increased need to urinate.
In very rare instances, fibroids can also become cancerous.
Fibroids can compromise your fertility if they interfere with the implantation of a fertilised egg – the egg may try to implant on top of a fibroid or have difficulty implanting because the fibroids have changed the shape of your uterus.
During pregnancy, fibroids that place pressure on the placenta can reduce placental blood flow, causing a higher risk of miscarriage and premature delivery. Fibroids situated in the lower part of your uterus can affect delivery if they obstruct the baby as it moves down your birth canal. This can increase your risk of needing a caesarean section.
How can fibroids be treated?
Generally, if fibroids aren't causing any problems they don't require treatment; they simply need to be monitored. If they are large or cause unwanted symptoms, there are a number of treatment options you can discuss with your GP or gynaecologist.
"The treatment of fibroids should depend on where the fibroid is, whether it is growing and if so, how rapidly, what the patient's symptoms are (if any), and whether she desires to conserve her fertility," says Graham.
The contraceptive pill may be prescribed to treat symptoms such as heavy menstrual bleeding.
Pressure symptoms caused by large fibroids may be relieved using a procedure known as uterine fibroid embolisation, which is performed under local anaesthetic. It involves an interventional radiologist threading a tube into the artery that supplies the fibroid with blood, and blocking it, which causes the fibroid to shrink.
If surgery is required, your gynaecologist may be able to remove the fibroids but leave uterus in place. This procedure is called a myomectomy and it can be performed vaginally – using an operating telescope that is inserted into the uterus through the cervix – or via abdominal surgery, where the fibroid is removed through a keyhole or open incision in the lower abdomen.
Another surgical option is a hysterectomy, which involves the removal of your uterus.
Last updated: December 2012
© Women’s Health Queensland Wide Inc. This article was written by Joanna Egan and reviewed by the Women’s Health Queensland Wide editorial committee. It was published in Health Journey Issue 4 2012.