Fibroids: What every woman should know

Uterine fibroids, also known as leiomyomas or myomas, are benign growths that develop from the smooth muscle tissue of the uterus. 

They are one of the most common gynaecological conditions affecting women of child-bearing age.

What are uterine fibroids?

“Although these growths are non-cancerous, they can significantly affect your health and quality of life, particularly when associated with heavy menstrual bleeding, chronic pelvic pain or fertility challenges,” says Dr Nomaphelo Mbungu, an obstetrician, gynaecologist and fertility specialist at Mediclinic Louis Leipoldt. “Many women, however, are unaware they have fibroids because they often don’t cause noticeable symptoms. Uterine fibroids consist of muscle cells and fibrous connective tissue and can range from tiny lesions to large growths that enlarge the uterus and place pressure on surrounding organs,” says Dr Mbungu.

What causes fibroids?

The exact cause of fibroids isn’t clear, but research suggests that a combination of hormonal, genetic and environmental factors contribute to their development.

“The female hormones oestrogen and progesterone are known to stimulate fibroid growth, which explains why fibroids typically develop during the reproductive years and often shrink after menopause when hormone levels naturally decline,” says Dr Mbungu.

These factors may increase your likelihood of developing fibroids:

• A family history of fibroids
• Being between the ages of 30 and 50
• Early onset of menstruation
• Obesity
• Never having been pregnant

Symptoms of uterine fibroids

“Many fibroids cause no symptoms and are discovered incidentally during a routine pelvic examination or ultrasound,” says Dr Mbungu. “When symptoms do occur, they usually depend on the size, number and location of the fibroids.”

 Common signs include:

• Heavy or prolonged menstrual bleeding
• Painful periods
• Pelvic pain or pressure
• Lower back pain
• Frequent urination caused by pressure on the bladder
• Constipation due to pressure on the bowel
• Pain during sexual intercourse
• Abdominal swelling or a feeling of fullness

Fibroids are classified according to where they develop within the uterus:

• Intramural fibroids develop within the muscular wall of the uterus.
• Submucosal fibroids grow into the uterine cavity and are more likely to cause heavy menstrual bleeding and fertility problems.
• Subserosal fibroids develop on the outer surface of the uterus and can press against nearby organs such as the bladder or bowel.
• Pedunculated fibroids are attached to the uterus by a stalk and may occur either inside or outside the uterus.

Can fibroids affect fertility?

While many women with fibroids conceive naturally and have healthy pregnancies, certain fibroids can affect fertility depending on their size, number and location. “Fibroids that grow within the uterine cavity (submucosal fibroids) are most likely to interfere with embryo implantation or increase the risk of miscarriage by distorting the shape of the uterus,” says Dr Mbungu. “Large fibroids may also block the fallopian tubes or alter the blood supply to the uterine lining, making conception more difficult.” If you are experiencing infertility or recurrent pregnancy loss, your gynaecologist can determine whether fibroids are contributing to the problem, and what your treatment options are.  

Treatment options

Treatment depends on several factors, including the severity of symptoms, the size and location of the fibroids, your age and whether you plan to have children in the future. “Women with small, symptom-free fibroids often require no treatment other than regular monitoring,” says Dr Mbungu.

Medical treatment focuses primarily on controlling symptoms. “Hormonal medications may help reduce heavy menstrual bleeding, relieve pain or temporarily shrink fibroids. While these treatments can be effective, they do not permanently get rid of fibroids and symptoms may return once treatment is stopped.”

Several minimally invasive procedures are available for suitable patients. “Uterine artery embolisation works by reducing the blood supply to the fibroids, causing them to shrink over time,” Dr Mbungu explains. “MRI-guided focused ultrasound is another non-invasive option that uses targeted ultrasound energy to destroy fibroid tissue while preserving the surrounding uterus.”

When symptoms are severe, fibroids are large, or fertility is affected, surgery may be recommended. “A myomectomy removes fibroids while preserving the uterus and is often the preferred option for women who wish to have children in the future,” she adds. “Depending on the fibroids’ size and location, the procedure may be performed laparoscopically or through open surgery.”

For women who have completed their families or whose symptoms cannot be managed effectively with other treatments, a hysterectomy provides a definitive solution by removing the uterus.

When should you see a doctor?

“Many women assume that heavy periods or ongoing pelvic discomfort are simply part of normal life,” says Dr Mbungu. “However, you should never ignore these symptoms, especially if they interfere with daily life or worsen over time.”

Remember, seeking medical advice early can lead to an accurate diagnosis, more treatment options and better long-term outcomes.