“Fibroids are benign growths that develop in the womb, or uterus. They are very common, affecting 30 to 40 per cent of women in reproductive age and 70 to 80 per cent of those near the menopause,” explains Mr Ertan Saridogan, consultant in gynaecology, reproductive medicine and minimal access surgery at University College London Hospitals (UCLH) and The Portland Hospital, London.

Often asymptomatic

Typically, symptoms develop only in a relatively small number of affected women. They may include heavy menstrual bleeding, discomfort in the pelvic area, and pressure on the bladder or bowels that increases the need to go to the toilet. Some women may also have difficulties getting pregnant.

Many treatment options

Most uterine fibroids don’t need treatment. But this may be necessary if there are symptoms, and should be tailored to individual needs and family plans.

“Options may include medical treatments aimed at relieving symptoms, such as the contraceptive pill or a coil that releases the hormone progesterone into the womb, both of which reduce blood loss due to heavy periods,” says Mr Saridogan.

“If fibroids need to be removed, this can be done through the neck of the uterus and the vagina with a procedure called hysteroscopy. An abdominal operation, or myomectomy, may be needed if the fibroids are large. In this case, the fibroids are removed from the abdomen through either a single large incision, as in traditional open surgery, or multiple small cuts, with a minimally invasive operation called laparoscopic or keyhole surgery. A hysterectomy – the removal of the womb – may be a good option for women who have severe symptoms and are not planning to have children.”

Other, non-surgical options include uterine artery embolization, which involves blocking the blood supply to the fibroids causing them to shrink, and a new technique (high-intensity focused ultrasound) that uses high-energy waves to destroy fibroid tissue.

A novel drug with fibroid-shrinking effects is also available. Called ulipristal acetate, it can be particularly useful for managing symptoms in older women, until they reach the menopause, when fibroids begin to shrink naturally.

Low awareness

The problem is that, despite uterine fibroids being common, public awareness is generally low.

Mr Saridogan says: “Not all women know about them, and not all medical professionals are aware of the many ways in which they can be managed. Hence, women with the condition may not be told about all the available treatment options.”

Greater awareness can increase the chances of all affected women receiving the most appropriate treatment and enjoying a better quality of life as a result.