Fibroids

A fibroid found on a scan doesn’t always need treatment. Fibroids are growths in or around the womb that are not cancer, and some cause no symptoms. When they cause heavy bleeding, pain or pressure, there are medicines and procedures to talk about.

Who gets fibroids

The US Office on Women’s Health estimates that about 20 percent to 80 percent of women get fibroids by age 50. That wide range is an estimate across a large group. It can’t tell you what will happen to you. The same source says African-American women are more likely to get fibroids than white women. NHS guidance also says they are more likely in people from a Black background.

Fibroids can grow in the muscle wall of the womb, into the space inside the womb, or on its outer surface. Their size, number and position help guide treatment. Ask your clinician to explain what these details on your scan report mean for your treatment.

Bleeding, pain and pressure symptoms

Symptoms can include heavy or painful periods, pain in your lower back or tummy, pressure in your pelvis, and pain during sex. Fibroids can also make you need to pee more often, or make it harder to empty your bowels. Heavy bleeding can cause anaemia from low iron. Mention both the bleeding and how it affects your day.

At an appointment, the clinician will usually start with questions and an examination. An ultrasound scan can show how many fibroids there are, how big they are and where they are. Sometimes fibroids are found during another scan, including a pregnancy scan. If your bleeding or pain has changed since that scan, tell the clinician what has changed.

Medicines and monitoring

If fibroids aren’t causing symptoms, keeping an eye on them may be enough. If you need treatment, painkillers can help with cramps, and tranexamic acid or hormone treatments can help reduce bleeding. A hormonal coil is another option. Your pharmacist, GP or doctor can tell you whether these suit you. Follow the leaflet and your prescription.

Specialist hormone treatments can shrink fibroids or control heavy bleeding. Some are used before surgery. Talk to your clinician about their side effects and whether they suit you. Ask whether a medicine is meant to reduce bleeding, shrink the fibroids, or both, and when the plan will be reviewed.

Procedures and future pregnancy

A myomectomy removes fibroids but keeps the womb. It may be an option if you want a pregnancy in future, but new fibroids can grow afterwards. Uterine artery embolisation blocks the blood supply to the fibroids so they shrink. A hysterectomy removes the womb. Each of these affects your chance of a future pregnancy in a different way.

Before choosing a procedure, talk about whether you want a pregnancy in future, even if you’re not sure. Ask which treatments keep that possibility open and what is known about pregnancy afterwards. Ask too whether a fertility specialist’s view would help. The NHS warns that some fibroid treatments prevent pregnancy or raise the risks in pregnancy.

Pregnancy and menopause

Having fibroids doesn’t mean you’ll definitely have problems in pregnancy. Some pregnancies are affected by problems such as an early birth or needing a caesarean. If you get pregnant, tell your pregnancy care team about any fibroids you know of, so they can talk about your care.

Fibroids often shrink after menopause, which may affect your decision about treatment. Your symptoms and what you want from treatment still matter. Ask how a “watch and wait” plan would work, including which changes should prompt another appointment.

Book a GP appointment (UK), or see your doctor (US or elsewhere), for any vaginal bleeding after menopause, even a small amount or bleeding that happens once. Don’t assume fibroids are the cause.

When to ask for help

Call 999 now (UK) or 911 (US), or your local emergency number, if pain in your pelvis is severe or getting worse, or comes with feeling faint, difficulty breathing or heavy vaginal bleeding. Also call for heavy vaginal bleeding with feeling faint, collapse or difficulty breathing, even without pelvic pain.

Get help today from NHS 111 or an urgent GP service (UK), or your doctor or urgent care service (US or elsewhere), for pain in your pelvis if you are or could be pregnant, or if the pain comes with a very high temperature or feeling hot, cold or shivery. For severe symptoms, use the emergency advice above.

Book a GP appointment (UK), or see your doctor (US or elsewhere), for heavy bleeding, bleeding between periods, or symptoms that affect everyday life. Bring any past scan information and a note of what you want treatment to change.