Fibroids

Fibroids in plain language

Fibroids are non-cancerous growths of the muscle of the womb. They are very common, particularly from the late thirties onwards, and many women have them without knowing. They range from the size of a pea to the size of a melon, and they are named by where they sit in the womb, which affects both the symptoms they cause and the way they can be treated.

Symptoms

Many fibroids cause no symptoms. When they do, the most common are:

• heavy or prolonged periods, sometimes leading to anaemia and tiredness
• a feeling of pressure, swelling or fullness in the lower abdomen
• needing to pass urine often, or constipation, from pressure on the bladder or bowel
• pelvic pain or pain during sex
• difficulty conceiving or miscarriage, particularly with fibroids that bulge into the cavity of the womb

How I assess fibroids

I begin with your history and, with your permission, an examination. At Parkside Hospital and the CRP Clinic I can perform an ultrasound scan during the consultation, so we can usually discuss what it shows at the same visit. The scan shows how many fibroids there are, their size and their position. Before surgery, and particularly for large or numerous fibroids, I usually arrange an MRI scan to map them precisely and to look for features that need further thought.

Treatment options

The right treatment depends on your symptoms, the size, number and position of the fibroids, whether you hope to become pregnant and your own preferences. I will set out each reasonable option, including no treatment, give you my recommendation and leave the decision with you.

• No treatment. If fibroids are not causing problems, regular review may be all that is needed.
• Medical treatment. Non-hormonal medicines that reduce bleeding, hormonal treatments including the hormonal coil, and medicines that temporarily shrink fibroids before surgery can help, depending on the type and position of the fibroids.
• Hysteroscopic removal. Fibroids that bulge into the cavity of the womb can often be removed through the cervix with a hysteroscope, without any incisions on the abdomen. You can read more on the hysteroscopy page.
• Myomectomy. Removing the fibroids while keeping the womb, by keyhole, robotic or, occasionally, open surgery.
• Uterine artery embolisation. A procedure carried out by an interventional radiologist, which blocks the blood supply to the fibroids so that they shrink. I can refer you to discuss it.
• Hysterectomy. For women who do not want a future pregnancy, removing the womb, usually by keyhole surgery. It ends periods and the symptoms that come from fibroids in the womb, although it does not treat pain from other causes. The hysterectomy page explains the choices.

Large and complex fibroids

Many women are told that their fibroids are too large or too numerous for anything other than open surgery, or that a hysterectomy is the only option. Complex cases of this kind are a large part of my practice, and I am often able to offer a keyhole or robotic myomectomy instead.

Robotic surgery is particularly helpful here, and it is my preferred approach for myomectomy. The Royal College of Obstetricians and Gynaecologists notes that robotic surgery is well established for myomectomy, and that surgeons prefer it for complex operations (RCOG, 2022). The magnified three-dimensional view and wristed instruments allow me to remove fibroids deep in the wall of the womb and then repair the muscle carefully in layers, which matters for its strength in any future pregnancy. Whether keyhole surgery is possible depends on the size, number and position of your fibroids, and I will tell you honestly what your scans show.

To remove a large fibroid through small incisions, it is cut into smaller pieces inside a protective bag within the abdomen (contained morcellation). Rarely, something that appears to be a fibroid turns out to be a cancer of the muscle called a sarcoma: according to the RCOG, in between about 1 in 300 and 1 in 1,250 women under 50, and more often with age. Tests before surgery cannot rule this out completely, and the bag reduces, but does not remove, the risk of spreading tissue. UK guidance (RCOG) advises against morcellation for women over 50 or after the menopause, when the risk is higher. Before you decide, I will explain how the risk applies to you, taking into account your age, your scans and any concerning findings, and discuss other ways of removing the tissue if morcellation is not suitable.

Adenomyosis

Adenomyosis, in which tissue similar to the lining of the womb grows into its muscle wall, causes similar symptoms to fibroids, such as heavy, painful periods, and the two often occur together. It is treated differently, and the adenomyosis page explains how it is diagnosed and treated.

What surgery involves and recovery

A keyhole or robotic myomectomy is carried out under general anaesthetic through several small incisions. I remove the fibroids, repair the muscle of the womb and then remove the fibroid tissue through one of the incisions using contained morcellation. Most women stay one night in hospital and return to desk-based work after about three to four weeks, avoiding heavy lifting for around six weeks.

The main risks are bleeding, which occasionally needs a blood transfusion, infection, injury to nearby organs and, rarely, the need to convert to open surgery or, very rarely, to remove the womb to control bleeding. I will explain how these apply to you. If you hope to become pregnant, I will advise you on how long to wait and on whether a planned caesarean birth would be wiser.