Uterine fibroid

A uterine fibroid is a tumor that is not cancer. It is a benign tumor. This kind of tumor grows in the muscle of the uterus, or womb. Fibroids often do not grow very large and do not always need to be treated. This kind of tumor often gets smaller after menopause. But sometimes fibroids cause heavy bleeding or pain. In this case, a physician may treat it.

Fibroids are almost always benign (not cancerous). Rarely (less than one in 1,000) a cancerous fibroid will occur. This is called leiomyosarcoma. Doctors think that these cancers do not arise from an already-existing fibroid. Having fibroids does not increase the risk of developing a cancerous fibroid. Having fibroids also does not increase a woman's chances of getting other forms of cancer in the uterus. 

 Treatment 
Treatment may not be necessary if there are no or minor symptoms. Fibroids often shrink after the menopause and symptoms will usually either ease or disappear completely.
For fibroids that need treatment, medicine may help to relieve the symptoms.  

 Medicine for symptoms 
Medicines are available that can be used to reduce heavy periods, but they can be less effective the larger the fibroids are.

 Levonorgestrel intrauterine system (LNG-IUS) 
The levonorgestrel intrauterine system (LNG-IUS) is a small, plastic T-shaped device placed in the womb that slowly releases the progestogen hormone levonorgestrel.
It stops the womb lining growing quickly, so it's thinner and bleeding becomes lighter.
Side effects include:
 irregular bleeding that may last for 3 to 6 months
 acne
 headaches
 breast tenderness
 in some cases, no periods at all (absent periods)
LNG-IUS also acts as a contraceptive, but does not affect chances of getting pregnant after the usage stop. 
 Tranexamic acid 
If LNG-IUS is unsuitable (for example, if contraception is not desired) tranexamic acid tablets may be considered.
They work by helping the blood to clot, reducing blood loss.
Tranexamic acid tablets are taken 3 or 4 times a day during period for up to 4 days.
Tranexamic acid tablets are not a form of contraception and will not affect chances of becoming pregnant.
Feeling sick, being sick or diarrhoea are possible side effects of tranexamic acid tablets. 
 Anti-inflammatory medicines 
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and mefenamic acid, can be taken 3 times a day from the first day of period until bleeding stops or reduces to manageable levels.
NSAIDs work by reducing the body's production of a hormone-like substance called prostaglandin, which is linked to heavy periods.
Anti-inflammatory medicines are also painkillers, but they are not a form of contraception.
Indigestion and diarrhoea are common side effects of NSAIDs.
 The contraceptive pill 
The contraceptive pill is a popular method of contraception that stops an egg being released from the ovaries to prevent pregnancy.
As well as making bleeding lighter, some contraceptive pills can help reduce period pain.
 Oral progestogen 
Oral progestogen is synthetic (man-made) progesterone (one of the female sex hormones) that can help reduce heavy periods.
It's usually taken as a daily tablet from days 5 to 26 of the menstrual cycle, counting the first day of period as day 1.
Oral progestogen works by preventing the womb lining growing quickly. It's not a form of contraception, but can reduce chances of conceiving while it is being taken.
The side effects of oral progestogen can be unpleasant and include weight gain, breast tenderness and short-term acne.
 Injected progestogen 
Progestogen is also available as an injection to treat heavy periods. It works by preventing the lining of womb growing quickly.
This form of progestogen can be injected once every 13 weeks for as long as treatment is required.
Common side effects of injected progestogen include:
 weight gain
 irregular bleeding
 absent periods
Injected progestogen also acts as a contraceptive. It does not prevent pregnancy after usage is stopped, although there may be a significant delay (up to 12 months) after one stop taking it before one is able to get pregnant.

 Medicine to shrink fibroids 
 Gonadotropin releasing hormone analogues (GnRHas) 
If symptoms related to fibroids remain despite treatment with the above medicines, a GP can refer the individual to a gynaecologist.
They may prescribe medicine called gonadotropin releasing hormone analogues (GnRHas) to help shrink the fibroids.
GnRHas, such as goserelin acetate, are hormones given by injection. They work by affecting the pituitary gland, which stops the ovaries producing oestrogen.
The pituitary gland is a small, pea-sized gland located at the bottom of the brain. It controls a number of important hormone glands within the body.
GnRHas stop the menstrual cycle (period), but are not a form of contraception. They do not affect chances of becoming pregnant after usage is stopped.
If GnRHas is prescribed, they can help ease heavy periods and any pressure felt on the stomach. They also help improve symptoms of frequent urination and constipation.
GnRHas are sometimes also used to shrink fibroids prior to surgery to remove them.
GnRHas can cause a number of menopause-like side effects, including:
 hot flushes
 increased sweating
 muscle stiffness
 vaginal dryness
Sometimes a combination of GnRHas and low doses of hormone replacement therapy (HRT) may be recommended to prevent these side effects.
Osteoporosis (thinning of the bones) is an occasional side effect of taking GnRHas.
Additional medicine may be prescribed to minimise thinning of your bones.
GnRHas is only prescribed on a short-term basis (a maximum of 6 months at a time). Fibroids may grow back to their original size after treatment is stopped.
A type of GnRHas that also contains oestrogen and progestogen may also be offered. It's taken as a tablet and can be taken for as long as needed.

 Ulipristal acetate 
Ulipristal acetate (Esmya) is a medicine that can be used to treat fibroids. However, it should only be prescribed for occasional use if:
 there are moderate to severe symptoms
 the person is an adult and have not reached the menopause
 surgery and non-surgical procedures are not suitable, have not worked or the person decides not to have them
This is because there is a risk of serious liver damage and liver failure.
The risks and benefits should be discussed and considered before.
If a person decide to try ulipristal acetate, the liver function will be closely monitored using liver function tests before, during and after treatment.
It’s an emergency condition if symptoms of liver damage develop, such as:
 tummy pain
 yellowing of the skin or eyes (jaundice)
 dark pee
 tiredness
 loss of appetite
 nausea and vomiting
There may be symptoms even after one stops taking ulipristal acetate.
There are currently no concerns with the emergency contraceptive pill ellaOne, which also contains ulipristal acetate.

 Non-surgical procedures 
As well as traditional surgical techniques to treat fibroids, non-surgical treatments are also available.

 Uterine artery embolisation (UAE) 
Uterine artery embolisation (UAE) is an alternative procedure to a hysterectomy or myomectomy for treating fibroids. It may be recommended for women with large fibroids.
UAE is carried out by a radiologist, a specialist doctor who interprets X-rays and scans. It involves blocking the blood vessels that supply the fibroids, causing them to shrink.
During the procedure, a special solution is injected through a small tube (catheter), which is guided by X-ray through a blood vessel in your leg.
It's carried out under local anaesthetic, so you'll be awake but the area being treated will be numbed.
You'll usually need to stay in hospital a day or two after having UAE. When you leave hospital, you'll be advised to rest for 1 to 2 weeks.
Although it's possible to have a successful pregnancy after having UAE, the overall effects of the procedure on fertility and pregnancy are uncertain.
It should therefore only be carried out after you have discussed the potential risks, benefits and uncertainties with your doctor.

 Endometrial ablation 
Endometrial ablation is a relatively minor procedure that involves removing the lining of the womb.
It's mainly used to reduce heavy bleeding in women without fibroids, but it can also be used to treat small fibroids in the womb lining.
The affected womb lining can be removed in a number of ways – for example, by using laser energy, a heated wire loop, or hot fluid in a balloon.
The procedure can be carried out either under local anaesthetic or general anaesthetic.
It's fairly quick to perform, taking around 20 minutes, and you can usually go home the same day.
You may experience some vaginal bleeding and tummy cramps for a few days afterwards, although some women have bloody discharge for 3 or 4 weeks.
Some women have reported experiencing more severe or prolonged pain after having endometrial ablation.
In this case, you should speak to a GP or a member of your hospital care team, who may be able to prescribe a stronger painkiller.
It may still be possible to get pregnant after having endometrial ablation, but the procedure is not recommended for women who want to have more children because the risk of serious problems, such as miscarriage, is high.
The Royal College of Obstetricians and Gynaecologists (RCOG) website has more information about endometrial ablation

 MRI-guided procedures 
There are also 2 relatively new techniques for treating fibroids that use MRI.
They are:
 MRI-guided percutaneous laser ablation
 MRI-guided transcutaneous focused ultrasound
These techniques use MRI to guide laser energy or ultrasound energy to destroy the fibroid.
These treatment methods cannot be used to treat all types of fibroids, and the long-term benefits and risks are unknown.
Research is still being carried out, but there's some evidence to suggest that these non-invasive procedures have short- to medium-term benefits when performed by an experienced clinician.
But the effects on pregnancy and women who want to have a baby in the future are not fully known, so this should be taken into consideration.

 Ultrasound-guided procedures 
Transcervical ultrasound-guided radiofrequency ablation is a new procedure that uses heat to shrink fibroids.
Before the procedure you’ll be given a general or local anaesthetic, so you will not feel any pain.
A long, thin device that has an ultrasound probe at the end is passed into your vagina, through your cervix and into your womb.
The ultrasound probe sends images to a screen which helps your doctor see the fibroid. Heat is then applied to the fibroid to shrink it.
Because transcervical ultrasound-guided radiofrequency ablation is a new treatment, evidence about its safety and long-term effectiveness is limited.
Your doctor should explain the possible risks and benefits before you agree to have the procedure.

 Surgery 
Surgery to remove fibroids may be considered if symptoms are particularly severe and medicine has been ineffective.
Several different procedures can be used to treat fibroids and they have different benefits and associated risks.
The main surgical procedures include:

 Hysterectomy 
A hysterectomy is a surgical procedure to remove the womb.
A hysterectomy may be recommended if you have large fibroids or severe bleeding and do not wish to have any more children.
There are a number of different ways a hysterectomy can be carried out, including through the vagina or through a number of small cuts (incisions) in your tummy (abdomen).
Depending on the technique used, a hysterectomy can be carried out using a spinal or epidural anaesthetic, where the lower parts of the body are numbed.
Sometimes a general anaesthetic may be used, where you'll be asleep during the procedure.
You'll usually need to stay in hospital for a few days after having a hysterectomy. It takes about 6 to 8 weeks to fully recover, during which time you should rest as much as possible.
Side effects of a hysterectomy can include early menopause and a low sex drive (loss of libido). This usually only occurs if the ovaries have been removed.

Studies suggested that hysterectomy with and without removal of ovary might be associated with cardiovascular disease and stroke risk. 

 Myomectomy 
A myomectomy is surgery to remove the fibroids from the wall of your womb. It may be considered as an alternative to a hysterectomy if you'd still like to have children.
But a myomectomy is not suitable for all types of fibroid. Your gynaecologist can tell you whether the procedure is suitable for you based on factors such as the size, number and position of your fibroids.
Depending on the size and position of your fibroids, a myomectomy may involve making either a number of small incisions in your tummy (keyhole surgery) or a single larger incision (open surgery).
Myomectomies are carried out under general anaesthetic and you'll usually need to stay in hospital for a few days afterwards. You'll be advised to rest for several weeks while you recover.
Myomectomies are usually an effective treatment for fibroids, although there's a chance the fibroids will grow back and further surgery will be needed.

 Hysteroscopic resection of fibroids 
A hysteroscopic resection of fibroids is a procedure where a thin telescope (hysteroscope) and small surgical instruments are used to remove fibroids.
The procedure can be used to remove fibroids from inside the womb (submucosal fibroids) and is suitable for women who want to have children in the future.
No incisions are needed because the hysteroscope is inserted through the vagina and into the womb through the entrance to the womb (cervix). 
A number of insertions are needed to ensure as much fibroid tissue as possible is removed.
The procedure is often carried out under general anaesthetic, although local anaesthetic may be used instead. You can usually go home on the same day as the procedure.
After the procedure you may experience stomach cramps. There may also be a small amount of vaginal bleeding, which should stop within a few weeks.

 Hysteroscopic morcellation of fibroids 
Hysteroscopic morcellation of fibroids is a procedure where a clinician who's received specialist training uses a hysteroscope and small surgical instruments to remove fibroids.
The hysteroscope is inserted into the womb through the cervix and a specially designed instrument called a morcellator is used to cut away and remove the fibroid tissue.
The procedure is carried out under a general or local anaesthetic. You'll usually be able to go home on the same day.
The main benefit of hysteroscopic morcellation compared with hysteroscopic resection is that the hysteroscope is only inserted once, rather than a number of times, reducing the risk of injury to the womb.
The procedure may be an option in cases where there are serious complications.
Read the National Institute for Health and Care Excellence (NICE) guidance about hysteroscopic morcellation for uterine fibroids

Page last reviewed: 09 September 2022
Next review due: 09 September 2025

References

Attribution:

 Other websites 
 Fibroids are serious. Surgery isn’t the only way to stop them. - The Washington Post, 2022

Category:Diseases and disorders of the female reproductive system
Category:Female reproductive system