Uterine fibroids: symptoms, diagnosis and treatment options

Uterine fibroids are non-cancerous growths of the muscle wall of the uterus, common in women of reproductive age. They can cause heavy or prolonged periods, pelvic pressure, and bladder or bowel symptoms, and occasionally affect fertility. Many fibroids cause no symptoms and need no treatment; others respond well to medical or surgical management. 

Fibroids are one of the most common gynaecological findings, yet many women first hear the word during an ultrasound for something else entirely. Understanding what they are, and what they are not, helps take the uncertainty out of a diagnosis. 

What are uterine fibroids? 

Fibroids (also called leiomyomas) are benign growths of the smooth muscle of the uterus. They vary widely in size, number and location — some sit within the uterine wall, some bulge into the uterine cavity, and some grow on the outer surface. Very small fibroids are extremely common and often found incidentally; larger or cavity-distorting fibroids are more likely to cause symptoms. 

What are the symptoms? 

• Heavy or prolonged periods, sometimes with clotting 

• Pelvic pressure, bloating or a feeling of fullness 

• Pain or pressure during sex 

• Frequent urination or difficulty emptying the bladder 

• Constipation or bowel pressure 

• Lower back pain 

• Difficulty conceiving or pregnancy complications, in some cases 

Many fibroids cause no symptoms at all and are simply monitored. 

What causes fibroids? 

The exact cause isn't fully understood, but growth is influenced by oestrogen and progesterone, which is why fibroids tend to grow during the reproductive years and shrink after menopause. Family history, age and ethnicity all influence risk, and fibroids are more common, and can be more symptomatic, in women of African descent. 

How are fibroids diagnosed? 

A pelvic examination may raise suspicion, but ultrasound is the main diagnostic tool, mapping the number, size and position of fibroids. MRI is sometimes used for complex cases or before surgery, to plan the best approach. 

What treatment options are available? 

Management depends on symptoms, fibroid size and location, and whether you are planning a pregnancy: 

• Watchful waiting — appropriate when fibroids are small and symptoms are minimal 

• Medical management — hormonal treatments to reduce bleeding, or medicines that temporarily shrink fibroids before surgery 

• Minimally invasive procedures — such as uterine artery embolisation, for suitable candidates 

• Surgery — myomectomy to remove fibroids while preserving the uterus, or hysterectomy where appropriate 

Do fibroids affect fertility or pregnancy? 

Most people with fibroids conceive and carry a pregnancy without difficulty. Fibroids that distort the uterine cavity are more likely to affect fertility or increase miscarriage risk, and may be considered for removal beforehand. During pregnancy, fibroids can occasionally cause pain as they grow, but serious complications are uncommon. 

When should you see a doctor? 

See a doctor if your periods are heavy enough to need frequent pad or tampon changes, if you're passing large clots, if pelvic pressure or bloating is persistent, or if bladder or bowel symptoms are new. Investigation is also worthwhile if you're planning a pregnancy and know or suspect you have fibroids. 

Frequently asked questions

• What are the symptoms of uterine fibroids? 

  The most common symptoms are heavy or prolonged periods, pelvic pressure or bloating, and bladder or bowel pressure. Many fibroids, however, cause no symptoms at all and are found incidentally on ultrasound. 

• Do fibroids need to be removed? 

  Not always. Small, symptom-free fibroids are often simply monitored. Treatment is considered when fibroids cause heavy bleeding, pain, pressure symptoms, or affect fertility, and options range from medical management to minimally invasive procedures or surgery. 

• Can fibroids affect fertility? 

  Some fibroids, particularly those distorting the uterine cavity, can affect fertility or increase miscarriage risk. Most fibroids, however, do not prevent a healthy pregnancy. Book an assessment at elysianwomenshealth.com.au. 

Book an appointment now 

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