Fibroid tumours are one of the most common conditions affecting the uterus, but they can now be treated in a variety of ways

Fibroids are benign (non-cancerous) tumours of the muscle of the womb that occur quite commonly, especially in women who are reaching the end of their reproductive years. These benign tumours often cause no symptoms and may never need treatment, but for many women fibroids, depending on their location, can cause a range of problems, including painful periods, heavy menstrual bleeding and infertility. They are the reason for around one third of all hysterectomy operations.

Fibroids form in different parts of the uterus.

• Intramural fibroids are confined within the uterine wall and may cause symptoms of pain, abnormal bleeding and infertility; the average affected uterus has six or seven fibroids
• Subserosal fibroids grow from the uterine wall to the outside of the uterus and can push on the bladder, bowel or intestine, causing bloating, abdominal pressure, cramping and pain
• Submucosal fibroids grow from the uterine wall into the uterine cavity, sometimes distorting it, and are the fibroids most likely to cause infertility; these are the least common type, making up about five per cent of cases

One out of every four or five women over the age of 35 has symptoms due to fibroids, but many more women have them without realising. They are most commonly found in women between the ages of 35 and 45 years old. If there are women in your family who already have been diagnosed with fibroids, there is an increased risk that you may get them as well. Risk of development is higher in women who are overweight or have no children.

Symptoms
Half of the women who have fibroids never experience symptoms and require no treatment, but even small fibroids can cause heavy and/or longer menstrual bleeding. They may contribute to infertility in some women, possibly because they interfere with an embryo's ability to attach itself to the uterus, but they are thought to be the direct cause in only about three per cent of infertile couples. They do not prevent a successful pregnancy in most women.

Urinary symptoms such as needing to go to the loo more often than normal and incontinence due to pressure on the bladder of an enlarged uterus are common. Difficulty or pain with bowel movements and constipation may occur due to pressure on the bowel. Some women will experience backache, lower abdominal or pelvic pain, and sometimes pain during intercourse.

Fibroids are associated with infertility, but they are thought to be the direct cause in only about three per cent of couples. Also, fibroids do not prevent a successful pregnancy in most women.

Diagnosis of fibroids
A pelvic examination performed by a doctor is usually the first attempt at diagnosing fibroids. Your doctor should be able to feel a uterus with fibroids because the uterus often feels enlarged and/or irregular and, if large enough, may also be felt abdominally above the pubic bone.

You may have an ultrasound scan if a potential problem is detected, and this will be able to tell exactly where the fibroids are within the womb and give an idea of their size. Sometimes they are detected by seeing them on laparoscopy, a minor operation where a small telescope is passed through an incision in the abdominal wall, or on hysteroscopy, where the telescope is passed up into the uterine cavity through the vagina.

If you have heavy or prolonged bleeding or multiple miscarriages, your doctor may recommend an assessment of the uterine cavity because a submucous fibroid might go undetected on a regular ultrasound. The assessment can be done by hysteroscopy, as above, or by the X-ray examination known as hysterosalpingography, when a dye is injected into your uterus and then pictures are taken.

Treatment of fibroids
If your symptoms are not severe and the fibroids are small, your doctor may just 'watch and wait' rather than going on to treat them immediately. A scan or pelvic examination every six months is a good idea to check that there has been no sudden rapid growth of a fibroid. Many women find that their fibroids decrease in size of their own accord after the menopause.

Asymptomatic fibroids will rarely need therapy unless the fibroids press on the kidneys or ureters, which can lead to kidney damage.

Surgical interventions depend on where the fibroids are located, how big they are, the type of symptoms they are causing, your age and fertility concerns.

Surgical options
Hysterectomy is the most common way to treat fibroids. Around one third of the hysterectomies performed in the UK each year are to treat complications associated with them. It offers the only real cure since they don't recur after the surgical procedure, but other treatment options are available and a woman should never feel that a hysterectomy is her only option.

Myomectomy may be the treatment of choice if you would still like to try to become pregnant. This operation involves the removal of the fibroids, while leaving the uterus intact. The procedure is performed either through an open incision in the abdomen (a laparotomy) or by laparoscopy. Your doctor will decide which procedure to use based on whether the fibroids are superficial or deep (which is too difficult for laparoscopy).

Open myomectomy is considered major surgery - it requires a lengthy recovery and can involve substantial blood loss. As with any surgery to the reproductive tract, this procedure may cause scar tissue that can impair fertility. Both types of myomectomies are performed under general anaesthesia.

Uterine artery embolisation is a radiological alternative to surgery that involves placing a catheter into an artery in the leg and guiding the catheter via X-rays to the arteries of the uterus; once the catheter gets there, the blood vessels that supply the fibroids are blocked off and the fibroids should rapidly diminish in size

New surgical techniques are also becoming available to treat fibroid-related bleeding, such as MRI (magnetic resonance imaging) guided laser ablation and MRI guided focused ultrasound.

No surgical treatment, except hysterectomy, can guarantee that fibroids won't recur.

New fibroids may develop in the years following some surgical options. No surgical treatment, except hysterectomy, can guarantee that fibroids won't recur.

Medical treatment
If bleeding is the major symptom, some women with fibroids opt for medical treatment as the first stage before surgery, or as a way to delay surgery if close to menopause (this is because fibroids generally shrink and cause few or no problems after menopause). The most common treatments are oral contraceptives and progestogens.

Another treatment is called GnRH agonists (gonadotropin-releasing hormone), which is a class of hormones that have been shown to help temporarily shrink fibroids by blocking the oestrogen production that stimulates their growth.

GnRH agonists are considered a short-term treatment because side effects include menopausal symptoms triggered by oestrogen deprivation, such as hot flushes, vaginal dryness and significant bone loss. The usual course of treatment is three to six months. Once these drugs are discontinued, fibroids usually grow back to near pre-treatment size or larger within several months.

Fibroids and pregnancy
Some doctors recommend women with large fibroids or severe symptoms to consider having an assessment of the entire uterine cavity (with a hysterosalpingography or by a hysteroscopy) before trying to get pregnant. If fibroids are found on the inside of the uterus and distorting the uterine lining they can lead to reproductive problems if they aren't removed.