What Are Fibroids?
Fibroids are the most common growths in a woman's reproductive system. Many
women with fibroids have no symptoms at all, while others have symptoms
ranging from heavy bleeding and pain to incontinence or infertility.
These information pages explain what fibroids are, how they can affect your
health and what your options are for treatment. For more information on heavy bleeding
or hysterectomy, visit our pages on these topics.
What are Fibroids?
Fibroids are tumours that grow in the uterus (womb). They are benign, which
means they are not cancerous, and are made up of muscle fibre. Fibroids can
be as small as a pea and can grow as large as a melon. It is estimated that
20-50% of women have, or will have, fibroids at some time in their lives.
They are rare in women under the age of 20, most common in women in their
30s and 40s, and tend to shrink after the menopause.
Although the exact cause of fibroids is unknown, they seem to be influenced
by estrogen. This would explain why they appear during a woman's middle
years (when estrogen levels are high) and stop growing after the menopause
(when estrogen levels drop).
According to US studies, fibroids occur up to nine times more often in black
women than in white women, and tend to appear earlier*. The reason for this
is unclear. Also women who weigh over 70kg may be more likely to have
fibroids. This is thought to be due to higher levels of estrogen in heavier
In the past, the contraceptive pill was thought to increase the risk of
fibroids, but that was when the pill contained higher levels of estrogen
than it does today. Some studies suggest that the newer combined pill
(estrogen and progestogen) and the mini pill (progestogen only) may actually
help prevent or slow the growth of fibroids.* This information is based on
studies involving black and African American women. The papers do not
identify more specific ethnic backgrounds. We found no similar UK studies.
Types of Fibroids
Fibroids are categorised by where they grow in the uterus:
- These grow in the wall of the womb and are the most common type of
- These fibroids grow from the outer layer of the womb wall and sometimes
grow on stalks (called pedunculated fibroids). Subserous fibroids can grow
to be very large.
- Submucous fibroids develop in the muscle underneath the inner lining of
the womb. They grow into the womb and can also grow on stalks which, if long
enough, can hang through the cervix.
- Cervical fibroids grow in the wall of the cervix (neck of the womb) and
are difficult to remove without damaging the surrounding area. If you have
fibroids, you may have one or many. You may also have one type of fibroid or
a number of different types.
It is estimated that 75% of women with fibroids do not have symptoms,
therefore many women don't know they have fibroids. Whether or not you have
symptoms depends on the size of the fibroids and where they are in your
womb. This also affects the types of symptoms you are likely to have. For
example, a small fibroid in the wall of your womb probably won't cause any
problems, whereas a large fibroid growing outward from your womb might press
against your bladder, causing bladder problems.
The most common symptom of fibroids is heavy menstrual bleeding. Other
symptoms include abdominal pain or pressure, changes in bladder and bowel
patterns and, in some cases, infertility.Heavy menstrual bleeding (menorrhagia)Heavy
bleeding may involve flooding (a sudden gush of blood), long periods or
passing large clots of blood. Heavy bleeding is not always due to fibroids,
but when it is, it is usually associated with fibroids that grow into the
womb (submucous). Although it is unclear exactly why fibroids cause
bleeding, it may be that they stretch the lining of the womb, creating more
lining to be shed during a period.
Heavy bleeding can be distressing and can make every day activities
difficult. You will need to use extra sanitary protection and will probably
need to change towels or tampons frequently. Some women with heavy bleeding
feel they need to stay near a toilet during their periods. This can greatly
restrict activity and may be frustrating or tiring.Anaemia (iron
deficiency)Some women with fibroids and heavy bleeding develop anaemia as a
result of blood loss. Anemia can make you feel weak, dizzy and tired. If
blood tests show that you have anemia, ask your doctor about supplements or
changes in your diet that might help. Foods such as liver, leafy green
vegetables, dried fruit and even red wine can help boost your iron
levels.Pain and pressureSome women with fibroids experience painful periods,
dull aches in their thighs, back pain or constant pressure in the abdominal
area that feels like bloating or fullness.Pain during your period may be due
to large clots of blood pushing through your cervix. Cramps could also be
caused by the womb trying to force out a submucous fibroid that is growing
on a stalk in the cavity of the womb.
Large fibroids can make the womb big and bulky, which can lead to lower back
pain or pelvic discomfort. Some women with fibroids feel a dull ache in
their thighs or develop varicose veins in their legs. This happens when
fibroids become so large they press on nerves and blood vessels that extend
to the legs.Occasionally, fibroids can cause sudden severe pain in the
pelvic area or lower back. This may be due to a fibroid on a stalk (pedunculated)
that has become twisted. This kinks the blood vessels in the stalk and cuts
off the blood supply to the fibroid. If you feel sudden severe pain and also
have a fever or feel sick, you should see your doctor.
The fibroid may need to be removed or your doctor may recommend bed rest and
painkillers until the pain stops on its own. Pain during sexFibroids that
press on the cervix or hang through the cervix into the vagina can make
penetrative sex painful and can also cause bleeding during sex. Bladder and
bowel symptomsLarge subserous fibroids (on the outer part of the womb) can
press on your bladder or bowel, leading to one or more of the following
·frequent need to urinate
·leaking or dribbling urine
·urgent need to urinate, often passing only a small amount
·difficulty or inability to pass urine - this is very serious and you should
tell your doctor as you may need urgent care. A tube, called a catheter,
will be put into your bladder to empty it.
·cystitis caused by trapped urine that becomes infected bowel
Fibroids and Pregnancy
Most fibroids do not get in the way of a pregnancy. They may cause
discomfort, but they generally do not cause any other problems. Some
fibroids in certain areas, however, can make conception difficult or lead to
miscarriage. Fibroids may press against, or block the entrance to, the
fallopian tubes, thus preventing the egg from reaching the uterus. Submucous
fibroids that grow inwards into the womb are thought to cause recurrent
miscarriage. A fibroid can also interfere with labour and birth if it blocks
the passage to the birth canal. If this is the case, your doctor may
recommend a Caesarean section. Fibroids may increase your risk of bleeding
heavily after birth, and can increase the time it takes for your womb to
return to its normal size. Just as fibroids can affect pregnancy, pregnancy
can affect fibroids. It is thought that fibroids grow during pregnancy
because of higher levels of oestrogen, but there is little evidence to
Another effect of pregnancy on fibroids is something called 'red
degeneration.' This is when a fibroid's blood supply is cut off, causing it
to turn red and die. It can also happen outside of pregnancy but it usually
occurs in the middle weeks of a pregnancy. Red degeneration can cause
intense abdominal pains and contractions of the womb, which could lead to
early labour or miscarriage. If you feel these symptoms, tell your doctor.
The pain and contractions usually stop on their own but your doctor may give
you drugs to ease the pain and stop the contractions more quickly.Fibroids
are never removed during a pregnancy because of the risk of haemorrhage
Prevention of Fibroids
As the cause of fibroids is still unknown, there are no clear guidelines for
preventing them. However, there are some things you could do that may help
reduce your risk:
·Keep your weight in check. This will minimise oestrogen levels in your body
·Eat green vegetables and fruit, and avoid red meat. An Italian study found
that women who eat little meat but a lot of green vegetables and fruit seem
to be less likely to develop fibroids than women who eat a lot of red meat
and few vegetables
·Some studies suggest the combined pill may protect against fibroids by
keeping hormone levels from peaking and falling. The pill comes with its own
set of side effects, however, so talk to your doctor about whether it's
right for you.
Testing For Fibroids
Because there are often no symptoms, you may only find out you have fibroids
when you go for an internal examination. If you have symptoms and think you
might have fibroids, see your doctor. You may be referred to a gynaecologist
who should be able to diagnose whether you have fibroids or another
condition. The doctor will give you a vaginal examination to feel your
uterus for lumps or bulges.If your doctor says you do have fibroids, ask if
there is more than one, where they are and how large they are. This will
help you better understand your symptoms and decide what action to take, if
any. Your doctor may want to confirm a fibroid diagnosis with additional
An ultrasound uses sound waves to get an image of your internal organs. This
can help determine if the lumps are fibroids or another type of tumour. It
can also provide more detailed information about the size and location of
fibroids. You may be given an abdominal ultrasound, a vaginal ultrasound or
both. An abdominal ultrasound is best at finding large fibroids. Before your
appointment you will be asked to drink up to a litre of liquid so that you
have a full bladder for the test. The scan itself is not painful (the doctor
simply moves the probe over your belly), but waiting for your appointment
with a full bladder may be uncomfortable. A vaginal ultrasound is used to
find small fibroids. The scanner (probe) will be put into your vagina and
may be a little uncomfortable. You do not need to have a full bladder for
this scan and it should not be painful.If the ultrasound results are
unclear, your doctor may suggest a hysteroscopy or laparoscopy.
A hysteroscopy examines the inside of your womb by using a small telescope (hysteroscope)
which is inserted into your womb through your vagina. Hysteroscopy can also
be used to take a biopsy (tissue sample) of the lining of the womb. You may
be given a local anaesthetic, general anaesthetic or in some cases, neither.
If you do not have an anaesthetic, the procedure may be slightly painful.
Hysteroscopy is done in hospital and you can usually go home the same day.
Whereas a hysteroscopy (see above) looks at the inside of the womb, a
laparoscopy looks at the size and shape of the outside of the womb. It can
also be used to take tissue samples. The procedure involves making a small
cut (about 1cm wide) in the lower abdomen, just below the belly button, and
inserting a thin telescope (the laparoscope). You may also have a probe
inserted into your vagina to help move your womb so the laparoscope can see
it from different angles.The operation usually takes about 30 minutes and is
done in hospital. You will be given a general anaesthetic before the
procedure and will have a few stitches afterwards. Sometimes air is pumped
into the abdomen as part of the procedure and this may leave you feeling
Living With Fibroids
The most common approach to fibroids that are causing heavy bleeding is to
monitor rather than treat them. You will probably be asked to have regular
check-ups, but you may still want help with your symptoms.Self-helpAlthough
a healthy diet may not reduce your fibroids, it may help reduce some of the
symptoms:·Avoid alcohol, sugar and saturated fats. They make it difficult
for your body to regulate hormones. This can increase cramps and bloating.
·Eat fruits and vegetables, particularly broccoli and spinach - they also
may help your body regulate its oestrogen levels. ·Get plenty of B vitamins,
calcium, magnesium and potassium - thought to help reduce cramps and
Treatments For Fibroids
If you have fibroids that are not causing you any problems, you don't need
treatment. Your doctor may suggest you keep an eye out for any changes, or
s/he may ask you to have regular ultrasounds to check if the fibroids are
growing. If your doctor does suggest treatment, it will depend on several
factors, including the severity of your symptoms, the size and position of
your fibroid(s), your age and whether or not you want to have children in
the future. If you are nearing the menopause, for example, when fibroids
tend to shrink on their own, you may want to wait and see if your symptoms
improve without treatment.
Treating fibroids has traditionally meant undergoing major surgery, but now
there are other options to consider (see table below). Talk to your doctor
about treatment options. Ask for a full explanation of each approach,
including the risks, benefits and success rates. You may also want to talk
with women who have had the treatment you are considering.
A group of drugs, called GnRH analogues, reduce oestrogen levels in your
body and, as a result, cause fibroids to shrink. Studies have shown that
when taken for six months, GnRH analogues can reduce the size of fibroids by
up to 50%. They also stop menstrual bleeding and pelvic pain. But GnRH
analogues should not be taken for more than six months in total and there
are a number of side effects. These include menopause-like symptoms such as
hot flushes, vaginal dryness and bone loss (osteoporosis). Once you stop
taking the drugs, fibroids begin to grow again.Your periods should also
return within a few weeks, although some women may no longer ovulate after
treatment.GnRH analogues are most commonly used to reduce the size of
fibroids before surgery.
In some cases, doctors may recommend them as a temporary treatment for women
who are nearing the menopause, when fibroids should begin to shrink
naturally.Surgical and non-surgical procedures.
The main treatments for fibroids are:
·Myomectomy (removing fibroids individually, leaving the womb intact)
·Hysterectomy (removing the womb entirely)
·Uterine artery embolisation (blocking the blood supply to the fibroids)
These are discussed in detail below.
There is also a new procedure that is not included in the treatment chart
because it is still undergoing trials. The procedure involves inserting four
specially designed needles through the abdomen. Magnetic resonance imaging
(MRI) is then used to guide the needles directly to the fibroid. The MRI is
also used to monitor the effects on normal tissue around the fibroid in
order to prevent any damage during the procedure. Once in place, the needles
release laser energy into the centre of the fibroid, burning its tissue and
halting its growth. Results so far suggest this procedure is effective in
reducing symptoms and fibroid size, is minimally invasive and is without
complications. These are, however, only the first set of results. More
research and longer follow-up is needed to fully understand the benefits,
risks and long-term effects.
Treatment Options for Fibroids
What is an abdominal myomectomy?
Open surgery to remove fibroids (also called laparotomy)
What types of fibroids does it treat?Can remove fibroids in the wall of the
womb (intramural) and in the outer layer of the womb (subserous)
How is abdominal myomectomy surgery performed?
A cut is made in the abdomen for the doctor to shell out the fibroids. This
is done with a looped wire, knife or laser. Once the fibroids have been
removed, the uterus and abdomen are stitched up. The operation requires
general anaesthetic and you will be in hospital for a few days.
What is the recovery period following abdominal myomectomy
It will take about a month or more to recover at home. You will probably
feel tired and weak and will need to regain your strength by walking and
doing specific exercises. Do not lift heavy objects while recovering.
Will the fibroids come back after an abdominal myomectomy?
Some studies show a 10-15% chance of fibroid regrowth, while others estimate
30%. In black women, regrowth may be as high as 50%.
Will I still be able to get pregnant after an abdominal
Most women can still become pregnant after a myomectomy, but in some cases
scarring in the womb can cause fertility problems.
What are the advantages of the abdominal myomectomy procedure?
Your womb is left intact and you may still be able to have children.
What are the possible complications and other disadvantages to
Bleeding that can lead to an emergency hysterectomy. Infection. Damage to
surrounding organs. Disadvantages: 20 - 25% of women undergo additional
surgery, usually hysterectomy, to stop symptoms. Possible weakening of the
womb wall and scarring may cause complications during pregnancy such as
rupturing of the womb wall.
What is it?
Keyhole surgery (through the abdomen) to remove fibroids.
What types of fibroids does a laparoscopic myomectomy address?
Recommended for fewer than four fibroids and fibroids that are less than
How is a laparoscopic myomectomy performed?
A laparoscope (telescope) is inserted into the womb through a tiny cut in
the abdomen. Other small cuts are made in the same area to insert
instruments that slice up and remove the fibroids. This is done under
general anaesthetic and you will be in hospital for a day or two. It is a
difficult, often long, procedure and requires a highly skilled surgeon.
What is the recovery period following a laparoscopic myomectomy?
The surgery may take longer but recovery is much quicker than abdominal
myomectomy. Recovery at home takes 7 - 14 days.
Will the fibroids come back after a laparoscopic myomectomy
This procedure may not remove all fibroids. Any missed fibroids are likely
to continue to grow. New fibroids may also develop.
Will I still be able to get pregnant?
Laparoscopic myomectomy does not usually interfere with fertility.
What are the advantages of having a laparoscopic myomectomy?
Less invasive than other surgical options. Small abdominal scars and little
scarring inside the womb.
What are the possible complications and other disadvantages of
Unexpected complications may require an abdominal myomectomy or emergency
hysterectomy. There may also be an increased risk of your womb rupturing
What is a hysteroscopic myomectomy?
Removal of small fibroids through the vagina.
What types of fibroids does a hysteroscopic myomectomy address?
Can remove only small submucous fibroids.
How is a hysteroscopic myomectomy performed?
A small hysteroscope (telescope) is inserted into the womb through the
vagina and cervix. A laser or wire loop is then inserted through the
hysteroscope to remove the fibroids. You will be given a general or local
anaesthetic and will probably be able to go home the same day.
What is the recovery period following a hysteroscopic myomectomy
It should take 2 - 7 days to recover at home.
Will the fibroids come back after a hysteroscopic myomectomy?
There is a 20-30% chance of fibroids growing back.
Will I still be able to get pregnant following a hysteroscopic
Hysteroscopic myomectomy does not usually interfere with fertility.
What are the advantages of a hysteroscopic myomectomy?
No incisions. Recovery is less than a week. Little scarring. You will still
have your womb and may be able to have children.
What are the possible complications and other disadvantages?
Possible damage to the womb wall. Symptoms may continue: one study showed
that after three years, heavy bleeding had returned in 30% of women who had
a hysteroscopic myomectomy.
Uterine Artery Embolisation
What is uterine artery embolisation?
A new procedure that blocks the blood supply to the fibroids. This reduces
rather than removes fibroids.
What types of fibroids does a uterine artery embolisation
There has not been enough research to determine which types of fibroids
respond best to embolisation.
How is a uterine artery embolisation performed?
The radiologist (doctor) threads a fine tube into the right and left uterine
arteries and injects a dye to locate the arteries that are feeding the
fibroids. A special substance is then injected to block (embolise) the blood
supply. This is done under a local anaesthetic and you will be in hospital
for a couple of days.
What is the recovery period following a uterine artery
Recovery at home should take 1 - 2 weeks.
Will the fibroids come back after a uterine artery embolisation?
There is little information about fibroid regrowth after embolisation.
Will I still be able to get pregnant if I have a uterine artery
Some women have become pregnant after embolisation, but it can also lead to
ovarian failure. More research is needed.
What are the advantages of the uterine artery embolisation
Minimally invasive. No incisions or scars. Quick recovery period. You will
still have your womb and may be able to have children.
What are the possible complications and other disadvantages of
Risk of infection that requires a hysterectomy. Risk of ovarian failure.
Radiation exposure. May cause ovarian failure. This is a very new procedure
and long-term effects are still unknown.
What is a hysterectomy?
Removal of the uterus (womb). In some cases, the fallopian tubes, cervix
and/or ovaries are also removed.
What types of fibroids does a hysterectomy address?
Removes all fibroids. Should only be done if fibroids are very large or
cause problems that cannot be treated in other ways.
How is a hysterectomy done?
The uterus is removed either through a cut in the abdomen (if fibroids are
large) or through the vagina (if fibroids are small). Both are major
operations. Abdominal hysterectomy can take one hour or several depending on
the size of fibroids. You will be in hospital for 5-7 days. Vaginal
hysterectomy takes about an hour and you will be in hospital for 2-3 days.
What is the recovery period following a hysterectomy?
Abdominal hysterectomy - Recovery will take 6 - 8 weeks at home. Vaginal
hysterectomy - Recovery should take about 5 weeks at home. You will feel
tired but try to walk as much as possible.
Will the fibroids come back after a hysterectomy?
Fibroids will not grow back.
Will I still be able to get pregnant if I have a hysterectomy?
If you have a hysterectomy you will not be able to have children.
What are the advantages of the hysterectomy procedure?
All of your fibroids will be gone and will never grow back.
What are the possible complications and other disadvantages?
Possible damage to your bladder or bowel. Infection. Risk of bleeding
heavily during or after the operation, which may require a blood
transfusion. You will no longer have your womb or be able to have children.
Can lead to an early menopause.