The list of symptoms is depressingly familiar: constipation, pain during sex and heavy, painful periods – it reads like a tick list of many women’s gynaecological health history. But the cause of these issues is often surprisingly common: fibroids.

Given just how many women develop fibroids (the NHS suggests around two in three women will develop at least one fibroid at some point in their life) they’re relatively under-reported and often misunderstood. 

Most fibroids are relatively harmless. Essentially, they are growths of varying sizes, made up of muscle and fibrous tissue, which develop in or around the womb.

“Fibroids are non-cancerous growths that develop in or around the uterus (womb),” says Dr Deepali Misra-Sharp, an NHS GP and women’s health clinical lead. “Also known as ‘uterine leiomyomas’ or ‘myomas’, fibroids are a common condition, particularly in women of childbearing age, and they may persist into perimenopause. They are made up of muscle and fibrous tissue and can vary in size from very small to large enough to cause visible swelling in the abdomen.”

Fibroids can be as small as a pea or, in some cases, they can grow as large as 20cm.

You might be wondering what on earth can cause a growth that can be the size of a melon around your womb but unfortunately, the cause of fibroids isn’t fully understood.

“The exact cause of fibroids isn’t completely understood but there appears to be a link to higher oestrogen levels,” says NHS GP Dr Helen Wall. “Fibroids tend to happen in women during their reproductive years and shrink once hormone levels fall in menopause. They can also get bigger in early pregnancy, again, possibly due to rising oestrogen levels.”

Genetics are a factor too: women with a family history of fibroids are more likely to develop them, while certain ethnicities are also more predisposed to them.  

Not all fibroids will cause symptoms but, according to Dr Misra-Sharp, the common ones include:

• Heavy or prolonged periods (menorrhagia), which may lead to anaemia.
• Pelvic pain or pressure: a feeling of fullness or heaviness in the lower abdomen.
• Frequent urination or difficulty emptying the bladder, especially if a fibroid is pressing on the bladder.
• Constipation or bloating: large fibroids may press on the rectum or bowel, causing digestive issues.
• Pain during intercourse, depending on the location of the fibroids.
• Lower back pain or leg pain, if the fibroid presses on nerves in the pelvis.

Fibroids are most common in women of childbearing age, in particular between the ages of 30 and 50. Other risk factors include:

Family history

Women with a close relative who had fibroids are more likely to develop them, especially a mother, aunt or sister.

Ethnicity

“Fibroids are more common in Black women, who are also more likely to develop them at a younger age and to have more severe symptoms,” says Dr Misra-Sharp.

Hormonal factors

Women with high levels of oestrogen, such as during pregnancy or in perimenopause, are at higher risk.

Obesity

Excess body fat can increase oestrogen levels, raising the risk of fibroids.

Diet

A diet high in red meat and low in green vegetables, fruit and dairy may increase the risk.

There is some good news here, in that fibroids in themselves are generally harmless. That said, the consequences of large fibroids can be harmful.

“In most cases, fibroids are not dangerous,” reassures Dr Misra-Sharp. “They are usually benign (non-cancerous) and do not typically lead to cancer. However, they can cause significant discomfort and complications, such as severe iron deficiency anaemia due to heavy menstrual bleeding or complications during pregnancy. Rarely, fibroids can interfere with fertility, and their size or location may lead to miscarriages or other pregnancy-related issues.”

Given that many fibroids will go either unnoticed or symptomless, treatment isn’t always necessary, but if your fibroids are causing unpleasant side effects, options are available. 

“The treatment options depend on several factors such as the size, location, and severity of symptoms, as well as the age and life stage of the woman,” says Dr Wall. “If a woman is approaching menopause, treatment may not be necessary, as the fibroids should shrink. However, if the patient is hoping to get pregnant, treatment may be required to avoid potential fertility issues.”

Treatment options include:

1.  Watchful waiting: If symptoms are mild or absent, fibroids may be monitored without intervention.
2.  Medications: “Hormonal treatments, such as birth control pills or gonadotropin-releasing hormone (GnRH) agonists (drugs that prevent oestrogen production), can help manage symptoms by regulating hormone levels,” says Dr Misra-Sharp. “Non-hormonal treatments for pain and heavy bleeding, such as NSAIDs or tranexamic acid, may also be prescribed.”
3.  Minimally invasive procedures: techniques such as ultrasound or uterine artery embolization (UAE) – a procedure that uses a catheter to block blood flow to the fibroid – can reduce blood flow to fibroids, thereby shrinking them.
4.  Surgery: “Myomectomy (surgical removal of fibroids) can be an option for women who wish to preserve their uterus,” says Dr Misra-Sharp. “In severe cases, a hysterectomy (removal of the uterus) may be recommended, particularly if childbearing is not a concern.”

While there is no guaranteed way to prevent fibroids, certain lifestyle choices may help reduce the risk of developing them. Maintaining a healthy weight, eating a balanced diet and taking regular exercise can all help to minimise risk factors, but it’s important to note that if you have any of the risk factors, regular GP check-ups are advised.

As always, don’t suffer in silence. If you’re struggling with symptoms, don’t hesitate to contact your GP for diagnosis and treatment or to rule out any other potential causes. 

Images: Getty