Your uterus might seem like it has a mind of its own sometimes – aching, tender, swollen, bleeding… You likely just put it down to the time of the month or file it under “women’s problems”, but there might be more to it than that – fibroids could be responsible.

Two-thirds of us are likely to have one or more fibroids in our lifetime*, and most of us have no idea that these benign tumours or swellings made of muscle and fibrous tissue are tucked away inside us. 

For some women, though, they can cause potentially debilitating symptoms, including heavy periods, pressure on the uterus and urinary incontinence. And many struggle in silence.

“They often endure it,” says Dr Paula Briggs, consultant in sexual and reproductive health at Liverpool Women’s NHS Foundation Trust.

“Maybe they don’t know what’s going on and are too scared to find out, or they don’t have time to think about it. It’s vital you seek support. Don’t soldier on.”

Here’s what you need to know… 

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The Risk Factors

Fibroids tend to afflict women aged 30-50, but particular risk factors include being of African-Caribbean origin and being overweight.

“As women age, they’re more likely to get fibroids, but younger women can get them too,” says Dr Briggs.

Having children can reduce the risk, and after menopause, fibroids will often shrink without treatment, because there’s a drastic drop in oestrogen, which feeds their growth.

The three main types of fibroid are:

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• Intramural: These develop inside the muscle wall of the uterus. If you have lots, they can stretch the lining and increase the surface area to bleed from.
• Submucosal: Found just under the surface of the womb lining, these can distort the womb cavity and cause heavy menstrual bleeding.
• Subserosal: Found on the outside of the uterus, these can result in increased pressure on the uterus.

Recognise the signs 

“Some women may not be aware they have fibroids,” says Dr Briggs, who is also chair of the British Menopause Society. 

But others will experience crippling physical symptoms, including heavy periods, flooding, anaemia, pressure in the womb area, which can cause a sudden, intense need to urinate, and difficulty conceiving. 

Heavy bleeding – which can also be caused by other conditions, such as polycystic ovary syndrome, endometriosis and pelvic inflammatory disease – can have a knock-on effect on mental wellbeing.

“Having a low blood count can be associated with low mood, but sometimes people don’t put those two things together,” says Dr Briggs.

“They just think they’re feeling down. But if bleeding is affecting your ability to have a normal quality of life, that would also make you feel low.”

Seek Help

Whether you know you have fibroids or not, ask yourself: “How are my symptoms affecting my life?”

This is especially important when it comes to heavy bleeding.

“There’s nothing good about bleeding, full stop, but there’s certainly nothing good about heavy bleeding that can lead to anaemia and depression.

So as soon as somebody thinks their periods are heavier than average, or heavier than is acceptable to them, they should seek help,” says Dr Briggs. 

“If it’s a fertility issue, it doesn’t become an obvious problem until somebody has been trying to conceive for up to two years, while pressure symptoms will depend on the impact they have on the individual.

"If somebody experiences urinary incontinence, you wouldn’t want them to soldier on – that’s particularly unpleasant. And if it’s caused by a fibroid, then it might be a reasonably straightforward thing to manage.”

Don’t Minimise your Symptoms

If you have chronically heavy periods and get used to it, this can be dangerous. 

Dr Briggs explains: “You get a cumulative reduction in haemoglobin (a substance found in red blood cells that carries oxygen around the body), so it’s a gradual fall.

"Sometimes women will present to A&E with breathlessness, which can even tip into heart failure, because their blood count drops to such an extent it could potentially be fatal. It’s not something that should be ignored at all.” 

This is more common than you may think.

“A GP might see one woman a month who has been running along with a low blood count and just got used to it and then has a big bleed and gets admitted for a blood transfusion.” So if your quality of life is being impacted, see your GP. 

Research Treatments

If you’ve booked to see your doctor, research potential treatments so you can ask questions.

“There are many treatments for heavy menstrual bleeding, whether it’s caused by fibroids or not,” says Dr Briggs.

“An intrauterine system like the Mirena coil is one. Or there’s other hormonal contraception – whether a combined pill or progesterone-only, or a contraceptive injection.”

There are also non-hormonal treatments like tranexamic acid and non-steroidal anti-inflammatory drugs.

“If fibroids are diagnosed, they’re usually treatable with medication or minimally invasive procedures,” she adds. Options can include: 

• Morcellation: Fibroid tissue is removed from inside the uterus.
• Medications: These include Esmya and Ryeqo, the latter being a relatively new treatment for fibroids. It contains Relugolix, a drug that stops the menstrual cycle from happening and replaces lost hormones.
• The Sonata System: This ultrasound tech targets fibroids with radiofrequency energy to reduce their volume.
• Isolated myomectomy: Fibroids can be removed surgically, to avoid interfering with fertility. 

“If none of these are appropriate, there’s the option of a hysterectomy – and for pressure on the uterus, that may be the best option,” says Dr Briggs. 

How to be heard

“It’s common for women to present to primary care and be told there’s nothing that can be done to help them. That’s wrong.

"Women shouldn’t put up with extremely heavy bleeding, especially as the sooner a woman presents for treatment, the more options she’s potentially eligible for,” says Dr Briggs. 

“If you go to your GP and don’t get the right answer, book with another GP, or a practice nurse, or ask if there’s a GP with an interest in gynaecology – and if not, ask to be referred to a secondary care specialist at your local hospital,” she says. 

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“Heavy menstrual bleeding could be a sign of endometrial cancer or pre-cancer – so don’t ignore it. With fibroids, the chance of malignant changes is about 1%. So although they can cause distressing symptoms, they are unlikely to become cancerous, but it’s not impossible.” 

Find out more about treatment options and access fibroid support groups at British Fibroid Trust (Britishfibroidtrust.org.uk).  

• Source: *NHS 

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