Recognizing the Symptoms of Uterine Fibroids

GnRH analogues are used to shrink a fibroid before a planned myomectomy, since a smaller fibroid means less bleeding during surgery; a monthly or three-monthly dose is given for this. The second use is in a perimenopausal woman, where these hormones hasten the natural shrinkage that would occur anyway as menopause approaches, since fibroids are otherwise known to delay menopause.

The two are not alternatives for diagnosis. MRI is a radiological procedure with no radiation that gives a detailed, thin-sliced view of a fibroid, and it is used when there is diagnostic doubt on ultrasound, for instance the rare possibility of a cancerous change. Hysteroscopy is a minimally invasive endoscopic procedure passed through the cervix, and it is never used as an investigative tool for diagnosing a fibroid. It is a treatment modality: it is used once a fibroid or polyp inside the cavity has already been identified, so it can be removed under direct vision.

Weight control through exercise and diet is important, since fibroids are more common in obese patients. An anti-inflammatory, broadly Mediterranean diet is recommended: plenty of green leafy vegetables, omega-3 sources like walnuts, flax seeds and olive oil, and less caffeine, alcohol and smoking. Red meat is considered inflammatory, so white meat such as fish, turkey and chicken is the better choice.

Myomectomy is a surgical procedure requiring hospitalization, done by a gynaecologist through open surgery, laparoscopy or robotically. Uterine artery embolization is an outpatient procedure done by an interventional radiologist together with a gynaecologist, who passes a catheter through the groin artery into the vessel feeding the fibroid and injects small particles to cut off its blood supply, so the fibroid shrinks over time. It is less invasive and generally preferable to myomectomy, but it has limitations: it is not suitable for very large fibroids, for fibroids with any suspicion of malignancy, or where there is an active uterine infection.

Yes, hysterectomy is a good option for a woman over 40 who has completed childbearing and wants to be free of ongoing fibroid symptoms and medication. If she is under 50 and the ovaries are healthy, they are usually left in place; if she is over 50, the ovaries are usually removed as well. If healthy ovaries are removed before the natural age of menopause, hormone replacement therapy is given until the patient reaches the normal menopausal age, to avoid the more severe mood swings, hot flushes, breast pain and anxiety that a sudden surgical menopause can cause compared with a natural one.

Heavy menstrual bleeding is the most common symptom, usually caused by intramural fibroids, though many women with fibroids have no symptoms at all.

Yes. Fibroids growing into the uterine cavity, particularly submucosal fibroids, can prevent an embryo from implanting and can also cause early miscarriage by occupying the space needed for a pregnancy to establish.