Fibroid Treatment
Management of non-cancerous growths in the uterus, based on symptoms, size, location and reproductive plans
What is fibroid treatment?
Fibroids are firm growths of muscle and fibrous tissue that arise from the wall of the uterus. They are benign, they are extremely common by the forties, and they grow slowly under the influence of oestrogen, so they tend to enlarge through the reproductive years and shrink after the menopause.
Where a fibroid sits matters more than how big it is. One that bulges inwards distorts the cavity and interferes with how the lining sheds each month and with how an embryo settles into it. One that grows outwards from the wall can reach a considerable size quietly, and announces itself only when it starts pressing on the bladder or the bowel.
Most women who have fibroids need nothing done about them. Treatment is considered when they are interfering with daily life, when they are pressing on a neighbouring organ, or when they are thought to be the reason a pregnancy is not being conceived or carried.
What you might notice
- Periods that are heavy or long
- Pelvic pain
- Periods painful enough to stop the day
- Irregular or painful periods
How it is diagnosed
A pelvic ultrasound is the main test. A transvaginal scan counts the fibroids, measures each one and shows where in the wall it sits, and that map is what every later decision is built on.
A doctor will also ask for a blood count, because months of steady loss show up there before you feel it, and a thyroid test where the cycle itself has changed. Where the scan leaves a question about the cavity, saline is run into the uterus during the scan to outline it, or an MRI is added; MRI earns its place when the uterus is large and holds many fibroids and the surgeon needs to know exactly which is where.
Growth after the menopause is the one finding that changes the pace of the workup. It is uncommon, and it needs explaining before anything is assumed.
Recovery
Recovery is decided by the route taken to the fibroid and not by the fibroid itself. Anything done through the cervix leaves no cut on the abdomen, and asks for a day or two of rest with some cramping and light spotting over the following week.
Work done through small cuts in the abdominal wall means two to four weeks before ordinary activity feels normal, and about six weeks before heavy lifting or vigorous exercise. Where the abdomen has been opened, expect a few nights in hospital and six to eight weeks before strenuous work.
If the wall of the uterus has been cut and repaired, you will be asked to wait three to six months before trying to conceive so the scar has time to gain its strength, and a pregnancy after that is watched a little more closely and the delivery planned in advance.
If it is left untreated
Fibroids are benign and there is no rule that they must be removed. A small one found on a scan done for something else is usually just watched, and after the menopause many shrink without any help at all.
The ones already causing trouble tend to keep going. Steady monthly loss drains iron faster than food replaces it, and anaemia builds quietly over a year. A uterus that keeps enlarging presses harder on the bladder and the bowel. A fibroid distorting the cavity lowers the chance of an embryo implanting and raises the chance of an early miscarriage, so a woman planning a pregnancy is usually advised to deal with it before she starts trying instead of after.
Two situations need seeing promptly instead of watching: sudden severe pain in a known fibroid, and any growth after the menopause.
Questions about fibroid treatment
Can I still have children after fibroid surgery?
In most cases yes, and preserving that possibility is one of the main reasons a myomectomy is chosen over removing the uterus. A fibroid that was distorting the cavity is often the reason conception was not happening or a pregnancy was not being carried, so taking it out can improve matters. Where the wall of the uterus was cut and repaired, you will be asked to wait three to six months before trying so the scar can gain strength, and a later pregnancy is monitored more closely with the mode of delivery planned in advance. Uterine artery embolisation is the one option usually kept for women who have completed their family, because its effect on a future pregnancy is not well established.
Do fibroids grow back after they are removed?
They can. A myomectomy removes the fibroids that are present and does not change the tendency to form new ones, and the chance of another appearing over the following five years is meaningful, higher in a woman who had several to begin with and lower in one who had a single fibroid. Not every new fibroid causes trouble, and many are simply seen on a later scan and left alone. Removing the uterus is the only approach that ends the possibility completely, and that trade is the substance of the conversation with your surgeon.
Can a fibroid turn into cancer?
It is very rare. The malignant tumour that can arise in the muscle of the uterus is uncommon, and current evidence suggests it generally arises on its own instead of developing out of an existing benign fibroid. The situation that gets attention is a fibroid that grows quickly after the menopause, when oestrogen has fallen and growth is not expected, and that finding is investigated with imaging before anything is assumed. A fibroid that has been stable for years, or one that shrinks after the menopause, is behaving exactly as a benign fibroid should.
Other obstetrics & gynaecology treatments
Delivery of a baby through surgery when vaginal delivery is not advisable or safe
InpatientTreatment for tissue similar to the uterine lining growing outside the uterus, which can cause pain and fertility problems
Day CareTalk to a care coordinator about fibroid treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one