Uterine Fibroids – What Are They, Causes, Symptoms & Treatment of Uterine Fibroids

Has a routine gynaecological examination revealed a uterine fibroid, or do you suspect you might have one? Uterine fibroids are the most common benign tumours in gynaecology and can occur at any age.

Don't worry – in most cases they don't lead to any serious complications. Small fibroids that cause no symptoms don't even need treating. It is important, however, to keep an eye on them through regular visits to your gynaecologist, so that treatment can be started promptly if needed. Read on to find out what causes fibroids, which symptoms they produce and what treatment options are available.

What is a uterine fibroid? 

A uterine fibroid is a benign growth that develops in the womb. It is a non-cancerous tumour made up of connective tissue and muscle, which grows inside or around the uterus – usually during a woman's reproductive years. It is not cancer and hardly ever turns malignant.

Also known as a myoma or leiomyoma, it causes a thickening of the uterine wall – either throughout or in one particular spot. Fibroids can be so small that they're invisible to the naked eye, or larger than a grapefruit.

Most women have no idea they have a uterine fibroid and only find out during a routine gynaecological check-up, because no symptoms occur. According to statistics, only one in three women develops symptoms.

How common are uterine fibroids? 

Uterine fibroids are the most common benign gynaecological tumour. Around 40% of women aged between 35 and 50 are affected, and up to 80% of all women develop at least one fibroid during their lifetime.

As a rule, fibroids don't appear during puberty or before the first period, so girls who haven't yet started menstruating are not usually affected. Fibroids are also less common in women after the menopause.

Types of uterine fibroid and where they occur  

Uterine fibroids can grow singly or in clusters. They range in size from 1 mm to over 20 cm in diameter. These growths can sit within the uterine wall, inside the uterine cavity or on the outer surface. Depending on these factors, several types of uterine fibroid are distinguished:

Submucosal uterine fibroid  

This type of fibroid grows beneath the inner lining of the womb and develops into the uterine cavity. Because of its position, a submucosal fibroid can cause heavy menstrual bleeding, lower abdominal pain and complications in pregnancy, including miscarriage or infertility.

Subserosal uterine fibroid  

The subserosal fibroid develops beneath the outer covering of the uterus. It grows outwards into the pelvic cavity and can reach a considerable size.

Intramural uterine fibroid  

Intramural fibroids are the most common type of uterine fibroid. They grow within the muscular wall of the uterus and can cause heavy menstrual bleeding, lower abdominal and back pain, bladder and bowel problems as well as fertility difficulties.

Intraligamentous uterine fibroid  

The intraligamentous or cervical uterine fibroid is very rare. It grows in the area of the cervix and the supporting ligaments of the uterus.

Uterine fibroids – causes and risk factors  

The exact causes of uterine fibroids are unknown, but experts believe that oestrogen and progesterone play a role. This may explain why fibroids typically occur in women of childbearing age rather than in adolescents.

According to research, high hormone levels (such as during pregnancy) are associated with fibroid growth, while low hormone levels are linked to them shrinking.

In addition, several risk factors have been identified, which we explain below.

Hormonal factors 

As oestrogen and progesterone influence the development of fibroids, women in their fertile years are more often affected. Susceptibility may also depend on:

• Hormone treatments
• Number of pregnancies
• The menopause
• Hormonal imbalances

Genetic factors 

Women with a family history of uterine fibroids on their mother's side have a higher risk of being affected themselves.

The risk of fibroids is also higher in Black women. By way of comparison: around 50% of Black women have symptomless fibroids, compared with only 25% of white women.

Body weight  

Being overweight is another factor that can increase the risk of developing uterine fibroids.

Uterine fibroids – common symptoms 

In most cases, uterine fibroids cause no symptoms at all. Women without symptoms have no idea these growths are there until they're discovered during a routine gynaecological examination.

Even so, roughly one in three women with uterine fibroids does experience symptoms. The most common complaints include:

• Heavy menstrual bleeding, requiring frequent changes of pads and tampons, or unusual bleeding between periods.
• An increase in abdominal size that can give the impression of pregnancy
• Lower abdominal pain or a feeling of pressure in the abdomen
• Pain during sexual intercourse

• Bladder or bowel problems

  

Uterine fibroids – how is the diagnosis made? 

As a rule, your gynaecologist discovers these growths during a pelvic examination, as part of a routine check-up or because symptoms such as heavy menstrual bleeding have raised suspicions.

Once identified, several investigations can be carried out to confirm the diagnosis of a uterine fibroid and to determine its size more precisely:

• Gynaecological examination and palpation of the abdomen: to establish the position and size of any growths.
• Saline infusion sonohysterography: a small amount of saline solution is introduced into the uterus to outline its contours and produce clearer images than a conventional ultrasound scan.
• Transvaginal ultrasound: allows a detailed assessment of the number and size of the fibroids.
• MRI or hysteroscopy: MRI uses radio waves and magnetic fields to produce detailed images of the internal organs. In a hysteroscopy, a flexible tube with a camera at its tip is passed through the vagina and cervix into the uterus, allowing the doctor to view the fibroids directly.
• Further investigations: depending on the case, additional tests may be carried out before a diagnosis is made, including sonography, computed tomography, hysterosalpingography or laparoscopy.

Treatment of uterine fibroids 

If uterine fibroids are very small and cause no symptoms whatsoever, treatment may not be necessary. In such cases all that's recommended is monitoring the patient through regular gynaecological check-ups, along with a watch-and-wait approach based on the knowledge that uterine fibroids shrink after the menopause.

If the fibroids are not small or they cause various symptoms, treatment depends on how many growths there are and how large they are, where they're located, how severe the symptoms are, the patient's age and whether or not she wishes to become pregnant.

Medical treatment of uterine fibroids 

Depending on the symptoms, your doctor may recommend hormonal or non-hormonal drug therapy.

Painkillers are recommended for pain and abdominal discomfort caused by fibroids. If anaemia develops as a result of heavy menstrual bleeding, iron supplements are indicated.

Where fibroids cause more severe symptoms, such as heavy bleeding during and between periods or marked period pain, hormonal treatments such as the pill may be recommended. These act on the hormones that control the menstrual cycle – oestrogen and progesterone.

Gonadotropin-releasing hormone (GnRH) antagonists may also be prescribed to shrink fibroids before surgery and make them easier to remove. This is a time-limited rather than a permanent treatment, because once it's stopped the fibroids start growing again.

Surgical treatment of fibroids  

Surgery is the principal method of treating uterine fibroids. It's recommended when the size of the fibroids leads to constipation or other complications, when heavy and unusual bleeding occurs, or when the patient is unable to conceive or suffers repeated pregnancy losses.

Depending on the type of procedure performed on the fibroids, your doctor may carry out the following:

• Hysterectomy: removal of the uterus – recommended for patients who aren't planning a pregnancy, who are susceptible to other conditions, or who suffer heavy bleeding and don't respond to other treatments.
• Myomectomy: removal of the fibroids while preserving the uterus – recommended for patients who wish to become pregnant or want to keep their womb. The drawback of myomectomy is that the risk of new fibroids forming in future remains.
• Endometrial ablation: usually recommended alongside a myomectomy when the fibroids cause heavy menstrual bleeding.
• Uterine artery embolisation: recommended to relieve fibroid-related symptoms in women who aren't planning a pregnancy but wish to keep their uterus.
• Myolysis: destruction of the uterine fibroid using heat (thermal coagulation) or cold (cryoablation).
• MRI-guided focused ultrasound: allows the fibroid tissue in the uterus to be heated and destroyed using high-intensity ultrasound waves guided by magnetic resonance imaging (MRI).

Uterine fibroids – possible complications 

In most cases, uterine fibroids don't lead to serious complications. Where complications do arise, the most common are unbearable pain, swelling in the abdominal and pelvic area, excessive bleeding with resulting anaemia and – extremely rarely – infertility.

Uterine fibroids and fertility 

Uterine fibroids rarely cause fertility problems. Most women can conceive without difficulty even with uterine fibroids.

Can a uterine fibroid affect fertility? 

Whether fibroids affect the ability to conceive depends very much on where they're located. If they sit within the uterine cavity, they certainly can cause infertility. The same applies to older women with multiple fibroids.

If the growths develop outwards, however, they aren't associated with fertility problems as long as they don't exceed 10–15 cm in size.

Risks in pregnancy 

Research shows that most women can conceive and carry a pregnancy to term without complications even with uterine fibroids. Nevertheless, women with at least one fibroid larger than 5–6 cm are at increased risk of miscarriage, a pregnancy that stops developing, or premature birth.

Treating fibroids before conception 

Treatment of fibroids before pregnancy depends on their position, size and the symptoms they cause.

Where there are no symptoms, treatment consists of monitoring and regular check-ups.

If symptoms are present, drug therapies and surgical procedures such as myomectomy, which preserves the uterus, may be recommended.

Pregnancy after a myomectomy: what you should know

Pregnancy is possible after a myomectomy, but patients are advised to wait until they have fully healed following the procedure.

There's no single agreed optimal time frame, but on average the uterine wall takes around three months to heal completely. It's generally accepted that pregnancy should be avoided during this period. Healing time varies from person to person and, depending on how the operation went, may even take 6–12 months.

Sometimes doctors recommend delivery by caesarean section for pregnancies following a myomectomy.

Uterine fibroids – can they be prevented? 

At present there's no scientific evidence for any effective way of preventing uterine fibroids. In principle they can't be prevented, but the risk can be reduced by:

• Maintaining a healthy body weight
• Leading a healthy lifestyle
• Managing stress

Regular gynaecological check-ups are crucial for detecting fibroids early. If the growths are small, agree a monitoring plan with your doctor.

Frequently asked questions about uterine fibroids

After all this information about uterine fibroids, are you still worried or do you have further questions? You're not alone. Below we've gathered the most frequently asked questions about how these growths form, how quickly they grow and how they may develop – with simple, clear answers to help you understand it all better and feel more informed.

Can a fibroid shrink without treatment?

Yes, fibroids sometimes shrink on their own, particularly after the menopause when hormone levels naturally decline. This process can take years, however, and some fibroids continue to grow without treatment and cause significant symptoms – which is why ongoing monitoring by your doctor is important.

At what age are fibroids most common?

Fibroids are most common in women aged between 30 and 50. Around 40% of them are affected. The development of fibroids is linked to hormone levels, particularly oestrogen and progesterone, which are higher during this stage of life.

Can a uterine fibroid become malignant?

It's extremely rare for uterine fibroids to become malignant. They're almost always benign growths, and turning cancerous is highly unlikely. That said, it's precisely why it's important to have them monitored by a doctor, so that other conditions can be ruled out.

How quickly can a uterine fibroid grow?

The rate and pattern of growth differ from patient to patient. Some fibroids grow slowly over months or years. Others grow more quickly, especially during periods of raised hormone levels such as pregnancy. That's why regular check-ups are so important.

Are there effective natural treatments for uterine fibroids?

Some women turn to natural remedies to ease their symptoms, but their effectiveness isn't scientifically proven. Any alternative treatment should be discussed with your doctor beforehand, to avoid worsening existing symptoms or delaying necessary medical care.

Is pregnancy possible with a uterine fibroid?

Yes! Most women with a uterine fibroid can conceive and carry a pregnancy to term without complications. There are cases, however, where fibroids affect fertility or cause complications in pregnancy – depending on their size and position.

Is there a risk of the fibroid returning after surgery?

Yes, fibroids can come back after surgery, particularly where the uterus has been preserved, as with a myomectomy. Recurrence depends on age, hormonal imbalances and the type of procedure carried out.

When is surgery necessary for a fibroid?

Surgery is recommended when the fibroid causes significant symptoms – such as heavy bleeding during or between periods, persistent pain or a strong feeling of pressure on the organs in the abdomen.

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