Fibroids

Also called Uterine fibroids, Myoma, Leiomyoma

Non-cancerous growths in the womb, present in most women by 50. Only a minority cause problems, and heavy bleeding is the main one.

What it is

Non-cancerous growths of muscle and fibrous tissue in or on the wall of the womb. They are extremely common: a majority of women have them by the age of 50, and most never know.

They are oestrogen-dependent, so they grow during the reproductive years and usually shrink after the menopause.

They are substantially more common, appear earlier and are more severe in Black women, who are also more likely to have hysterectomy rather than uterus-preserving treatment. That disparity is well documented and is a real inequality in gynaecological care.

Only around a third cause symptoms, and the position matters more than the size. A small fibroid distorting the cavity of the womb can cause much heavier bleeding than a large one on the outside.

The consequences that matter are heavy periods and consequent iron deficiency anaemia, pressure symptoms, and sometimes fertility and pregnancy problems.

Treatment options run from the hormonal coil and tranexamic acid, through newer hormonal drugs, to uterine artery embolisation, myomectomy and hysterectomy. Uterus-preserving options exist for almost everybody and should be discussed.

Very rarely a rapidly growing fibroid after the menopause can be a sarcoma, which is why post-menopausal growth needs assessing.

Signs you might notice

Heavy or prolonged periods, with clots and flooding.

Tiredness and breathlessness from anaemia, often the reason somebody presents.

Pelvic pressure, a swollen or bloated abdomen.

Needing to pass urine frequently, or difficulty emptying the bladder.

Constipation and back pain from pressure.

Pain during sex.

Difficulty conceiving, or recurrent miscarriage, depending on position.

Urgent: severe sudden pelvic pain, which may mean a fibroid has degenerated or twisted; heavy bleeding with dizziness or fainting; or new growth after the menopause.

How it can affect day-to-day life

Heavy bleeding is treated as a nuisance rather than a medical problem for years, and the resulting anaemia is often profound before anybody checks. Women describe organising their whole lives around their periods and being told it is normal.

Iron deficiency without anaemia still causes fatigue and is worth treating; ask for ferritin rather than just haemoglobin.

Pressure symptoms are embarrassing to describe, particularly urinary frequency and constipation, and are frequently not mentioned.

Treatment choice depends heavily on whether somebody wants future pregnancy, and that question should be asked before options are narrowed.

Hysterectomy is offered readily and is definitive, and it is not the only option; embolisation and myomectomy preserve the uterus and should be part of the conversation.

Supporting someone well

Keep a bleeding diary and count protection changes; it converts a vague complaint into evidence.

Ask for a full blood count and ferritin, and treat iron deficiency properly.

Ask for a pelvic ultrasound.

Ask about the hormonal coil and tranexamic acid first; both are effective and non-surgical.

Ask explicitly about uterus-preserving options, including embolisation and myomectomy.

Say clearly whether future pregnancy matters; it changes the recommendation.

Ask for gynaecology referral if treatment in general practice is not working.

Get sudden severe pain, or any growth after the menopause, assessed.

Where to get help

A GP practice for assessment, blood tests and initial treatment.

Gynaecology for imaging and treatment options.

A and E for severe sudden pain or heavy bleeding with faintness.

Endometriosis UK and the women's health charities publish information on heavy bleeding and its causes.