Uterine fibroids

Many women who have fibroids don’t notice that they have them. Some may just have one, while others have several. Fibroids most commonly cause symptoms between the ages of 30 and 50. Typical symptoms include the following:

• Heavy or prolonged menstrual bleeding
• Severe, cramping period pain
• Diffuse pain and pressure in the abdomen

Fibroids usually cause symptoms if they affect the function of the womb, for example during menstruation. Fibroids that grow just under the lining of the womb are particularly likely to cause heavy menstrual bleeding. Regular heavy periods can lead to anemia, which often makes you look pale and feel tired.

Larger fibroids sometimes push against nearby organs like the bladder or bowel. This can cause digestion problems (constipation, abdominal pain) or an increased need to pee. Back pain or trouble peeing (urinary retention) are possible too, but rare.

“Pedunculated” fibroids may cause sudden and severe pain. These fibroids can grow inside or outside the womb. They are connected to the womb by a thin, stalk-like structure. Abrupt movements can cause pedunculated fibroids to rotate on these stalks. This interrupts the blood flow to the fibroid, which is extremely painful.

It is not known exactly why fibroids develop. Experts suspect that genetic factors play a role.

The sex hormones estrogen and progesterone have a big influence, but to different degrees. Fibroids need hormones produced by the body to grow, which is why they develop before menopause. Artificial hormones, such as those used in contraceptives, tend to slow fibroid growth.

Fibroids are more common in the following groups of women:

• Black women. Fibroids are two to three times more common in black women – but the exact reason is not known.
• Women who have never been pregnant
• Women whose mother or sister has had fibroids
• Women who are very overweight. But it’s not clear whether the extra weight itself is the cause.

Fibroids are less common in:

• Women who have had several children
• Women who have used birth control pills for several years

It is not clear whether there’s a link between your diet and the development of fibroids.

Experts estimate that about 40 to 80% of all women have fibroids. Many of the fibroids are very small, and most women never notice that they have them. Fibroids only sometimes cause symptoms, but it’s difficult to say exactly how often, and how likely they are to do so.

It is hard to predict how a fibroid will continue to develop over time: Fibroids grow to different sizes and at different speeds. Some fibroids and the related symptoms hardly change. Other fibroids grow bigger, and the symptoms get worse over time. The symptoms may also gradually go away on their own.

Fibroids usually become smaller after you have reached menopause, and then the symptoms nearly always disappear as well. Having hormone therapy for menopause symptoms may delay this natural improvement, though.

Fibroids usually don’t have any other negative effects aside from the symptoms described above and the related problems. But many women worry that fibroids may affect their fertility. This is only true of certain types of fibroids. Experts estimate that only 1 to 2% of infertility cases in women are caused by fibroids. Most women who have fibroids can still become pregnant.

Fibroids that grow just under the lining of the womb are particularly likely to prevent fertilized egg cells from settling into the lining. Fibroids that grow on the outside of the womb probably don’t affect fertility. It is not known whether fibroids in the wall of the womb affect fertility.

Fibroids also don’t usually increase the risk of complications during pregnancy. Fibroids in general hardly affect the risk of a baby being born too soon. But the risk can be higher if there are many fibroids or they are large. It is believed that fibroids in the wall of the womb and under the lining of the womb may increase the risk of miscarriage. A fibroid that is very low down in the womb may stop the baby’s head from entering the lower pelvis during birth, making a Cesarean section necessary.

Fibroids can make it hard to empty your bladder properly (a problem known as urinary retention), but that is very rare. This happens if large fibroids press against a ureter – a tube that carries urine from a kidney to the bladder. If a ureter becomes completely pinched off, surgery is needed quickly to prevent urine from flowing back to the kidney, which may permanently damage the kidney on the affected side.

Fibroids that don’t cause any symptoms are often first detected in an ultrasound examination during a visit to the gynecologist to diagnose a different illness. Fibroids are also often diagnosed when women see a doctor because of problems like period pain or heavy periods.

Larger fibroids are sometimes discovered by feeling during a gynecological examination. Then an ultrasound examination from inside the vagina can provide more information about the number, shape, position and size of the fibroids. Depending on the results, a magnetic resonance imaging (MRI) scan may be needed to find out more about the fibroids or plan the treatment.

Fibroids usually only need to be treated if they are causing fertility problems or could cause problems during pregnancy.

The treatment goals may include the following:

• Reduce menstrual bleeding
• Relieve pain, cramps and pressure
• Help with difficulties emptying the bladder and digestion
• Preserve or improve fertility

The treatment options include:

• Hormone treatments, mainly with hormonal contraceptives to reduce menstrual bleeding, and hormones that prevent the production of estrogens (GnRH analogues)
• Surgical removal of the fibroids or the entire womb
• Closing off the blood vessels that supply the fibroid with blood (uterine fibroid embolization) to shrink the fibroids.
• Other procedures for getting rid of the fibroids, including focused ultrasound surgery (FUS), which uses high-intensity ultrasound waves to heat and destroy the fibroid. A newer method is radiofrequency ablation (RFA), which uses an electrode to heat and destroy the fibroid. There has not yet been enough research on the pros and cons of these methods, though.

NSAID (non-steroidal anti-inflammatory drug) painkillers like ibuprofen or diclofenac have been proven to relieve period pain. But there are no studies that have specifically looked into the effects of NSAIDs in women with fibroids. This is also true for acupuncture. Herbal remedies have been studied more, but there’s no evidence that they are effective in treating fibroids.

Fibroids typically grow very slowly. So there is no rush to decide on a treatment: You can take your time to get plenty of information on the various options. The issue of whether you would still like to get pregnant is important when choosing a treatment. The severity of the symptoms and the size and position of the fibroids may also determine which treatments are an option.

Sometimes a second medical opinion can help. This is especially important if the doctor recommends removing the womb (hysterectomy): In that case you have a legal right to discuss the decision once more with a specialist.

Severe period pain and heavy periods can be a real problem. Most women aren’t aware that they might be caused by fibroids. If you have been diagnosed with fibroids, it’s a good idea to get enough information to help you understand what they are and find the best way for you to deal with them. This is especially true if you would still like to have children.

It is important to manage the symptoms and keep them from affecting your life at home and at work too much. For instance, many women find heavy periods bothersome or embarrassing. They may even find it frightening. Severe pain can have a major impact on everyday life for days at a time every month. But there are things you can do to make things easier. Many women learn how to better manage their symptoms over time. Understanding and support from their partner, friends and family can also make a real difference.

You can see your gynecologist or family doctor about problems caused by fibroids. Information about health care in Germany can help you to navigate the German healthcare system and find a suitable doctor. You can use this list of questions to prepare for your appointment.

Some types of treatment and surgery can only be performed at a hospital. It is worth preparing for a hospital stay: You can find out about what to expect, what documents you’ll need in order to be admitted, and which procedures involve extra costs, for example.