Fibroids are non-cancerous growths that develop in or around the uterus. They can vary in size and may cause a variety of symptoms. However, many women don’t experience any symptoms from fibroids, only discovering their presence as a result of a routine test or scan.
I will often see somebody as a result of a GP referral because fibroids have been found in the course of an examination. When we first meet at Circle, I will talk through your symptoms with you to help me understand the impact the fibroids are having on your life. Particular questions I may ask include:
- Are the fibroids affecting your bowel and/or bladder function because of pressure symptoms?
- Are you going to the toilet frequently (and are you being kept awake at night because of the need to go to the toilet frequently)?
- Are they pressing on your bowel?
- Are they making you constipated and/or are you having difficulties opening your bowels as a result?
- Do you feel pregnant or do you have a lower abdominal discomfort swelling?
- Does it impact on your menstrual cycle? (You may find that your periods are very heavy and painful. You may also be bleeding between your periods, therefore not experiencing the natural break?)
While I will be interested in any tests your GP has carried out, I will also want to thoroughly investigate everything to ensure you receive the best care and treatment possible. I will carry out an ultrasound scan to help determine the location of the fibroids. This would either be an abdominal scan, where the probe with gel moves across the skin of the tummy or it would be an internal examination, where a small probe goes in through the vaginal opening.
The ultrasound scan helps me to assess the pelvis and the structures within the pelvis to determine the exact location of the fibroids. The location is important as that will influence the treatment options available. From the ultrasound scan, we will be able to narrow down potential treatment choices.
There are a range of treatment options for fibroids, and I will talk through these with you once any tests results are known. The size, location and number of fibroids are all factors that need to be taken into account when planning treatment, as well as your preferences.
Medical treatments are available, and these can achieve a number of things. Certain types of hormonal contraception can help stop any unusual or excessive bleeding. If we want to shrink the fibroids and stop the bleeding at the same time, we would use a different type of medication which would be taken on a daily basis on a cyclical nature (i.e. taking them for three months, then having three months off.) N.B. this is an overview, exact timings etc. will depend on the medication used.
Sometimes, we can give patients an injection to shrink the fibroids and stop the bleeding. This can also have the ‘knock on’ effect of correcting any anemia you may have that was caused by heavy bleeding. Correcting anemia can be particularly helpful if you’re considering surgery to treat these fibroids.
Should these non-surgical treatments not be as effective as we would like, surgery can be considered, and I would talk through the different options with you so that you have the information you need to make an informed choice.
There are three main types of surgery that can be used to treat fibroids:
- Laparoscopic: a form of keyhole surgery, uses very small cuts and tiny surgical instruments to remove the fibroids. This approach is minimally invasive, meaning recovery can be quicker and you will only have very small scars as a result.
- Hysterectomy: This is more definitive surgery and involves removing the uterus (womb) in its entirety. A hysterectomy is a major operation with a long recovery time, so should only be considered once other options have been tried/considered.
Hysteroscopy: Sometimes fibroids can be removed without needing a big operation. This is performed via a procedure called a hysteroscopy, where no cuts on the tummy are needed because the fibroids are growing inside the cavity of your womb and they're not having any pressure effects. To remove these, we use a general anaesthetic and then shave the fibroids away by going in through the vagina and therefore avoiding any cuts on the tummy.
Your recovery from any surgery will depend on the type of surgery and the location and extent of the fibroids that were removed. Before you have any surgery, I will talk you through recovery times and what to expect. Should you have any queries at any stage, please do ask as I am always very happy to help.
If you are experiencing symptoms from fibroids, or if your GP has picked up their presence on a scan or examination, you will understandably want to ensure any treatment you receive is tailored to your specific needs.
I am very much an advocate of patient-centered care and believe that patients should be involved at every stage of the treatment process. Treatment should be focused around what suits you best within your lifestyle choices, and I am very keen for patients to make decisions about what they need, as long as it's within the realms of clinical safety.
With different treatment options, ranging from conservative to surgical, I can help ensure you receive care that is tailored to your needs.