Women can have uterine fibroids for years without them causing any symptoms or distress. However when they get too large they can be problematic and cause excessive menstrual bleeding, pelvic pain, and frequent urination.
Uterine fibroids are the most common and benign (non cancerous) tumours of the uterus. They can develop within the uterine wall itself or attach to it and you may get just one, or a cluster of them. Although they have been one of the main reasons for a hysterectomy there are now alternatives available such as bio-identical natural progesterone which can restrict their growth as well as newer, less invasive surgical treatments if necessary.
What Causes Fibroids?
Sadly, we don’t have an exact answer to this but certainly your family history is a factor. Fibroids do tend to run in families, so if your mother, sister or grandmother was affected it is likely that you will be too.
Estrogen dominance is also a major factor as fibroids grow in response to stimulation by this hormone and can be seen in women as young as 20. The good news is that they naturally shrink after menopause when estrogen production is reduced. However, estrogen dominance can occur in women with quite low levels of estrogen if their progesterone levels are also lower than their estrogen.
Fibroids are also more common in women who weigh over 11 stones and this is thought to be due to the higher levels of estrogen that occur in women with a higher proportion of body fat.
Fibroids do grow slowly and are no problem when small, but they can weigh several pounds and result in symptoms such as excessive or irregular bleeding and pain. If you have any of these factors you are more likely to develop fibroids:
- Being overweight
- Never having given birth to a child
- Starting your menstrual cycle before the age of 10
- Having an African-Caribbean heritage (3-9 times greater risk factor)
Most fibroids, even large ones, produce no symptoms and the first you may know about it is if they are found during a regular pelvic examination. When symptoms do occur, these are the most common:
- Irregular vaginal bleeding or an increase in menstrual bleeding, known as menorrhagia, sometimes with blood clots
- A fibroid may press on the bladder so you feel a sense or urgency and need to urinate more frequently
- Pressure on the rectum, resulting in constipation, can occur but is rare
- Pelvic pressure so there is a sense of feeling full in the lower abdomen
- Lower abdominal pain or sometimes back pain
- Increase in waist size and shape of your abdomen so it looks swollen but not associated with any significant weight gain
- Pain or discomfort during sexual intercourse can occur if the fibroid is growing near to the vagina or cervix.
If these symptoms occur and persist then you do need to see your doctor for a checkup and to ensure you do have fibroids and not some other condition. BUT, if you have any of the following signs or symptoms then treat it more seriously and seek more urgent medical attention:
- Menstrual bleeding soaking through more than 3 pads per hour
- Severe or prolonged pelvic or abdominal pain
- Dizziness, lightheadedness, shortness of breath, or chest pain associated with vaginal bleeding
- Vaginal bleeding associated with pregnancy or possible pregnancy
If the fibroids are small, and cause no discomfort, then no treatment is necessary. There is currently no form of medication that can cure fibroids and all treatment is aimed at either shrinking them or relieving the symptoms.
Hysterectomy has been the preferred treatment in the past, but this is a radical option and you may want to consider whether another option might be better. Endometrial ablation
is a procedure that involves removing the lining of the womb and this can be done by different methods including using laser energy, a heated wire loop or by microwave heating.
Magnetic resonance imaging (MRI) and MRI-guided focused ultrasound are newer techniques where laser energy or ultrasound energy is used to destroy the fibroid. However these latter techniques are not suitable for all types of fibroid.
Shrinking the fibroid is a simpler option and Doctors often prescribe medication such as Tranexamic acid 3-4 times a day, for the duration of each period. This works by reducing the breakdown of blood clots in the uterus. You can also be prescribed a gonadotrophin-releasing hormone (GnRH) analogue that causes a very low level of estrogen in the body. Fibroids do indeed shrink if the level of estrogen falls, but can also increase symptoms similar to going through the menopause such as hot flushes and may also increase the risk of osteoporosis.
Simple pain relievers such ibuprofen can work by reducing the high level of prostaglandin in the uterus lining. Prostaglandin is a chemical which seems to contribute to heavy periods. Some women have also found relief through acupuncture or reflexology.
A more natural alternative is to use bio-identical natural progesterone, as it may prevent the fibroid from growing any larger although it will not actually reduce it in size.