Uterine Fibroids

Uterine fibroids, also called myomas or leiomyomas, are benign growths of the muscle of the womb. They range from pea-sized to larger than a melon and can sit within the wall, on the outer surface, or bulge into the cavity. By the age of 50 most women have at least one, and they are more common and often larger in women of African descent.

Fibroids are not cancer and most cause no symptoms, in which case they are left alone. Treatment depends on symptoms, fibroid size and position, and above all on whether you want to become pregnant in future. They shrink naturally after menopause.

Symptoms

• Heavy or prolonged periods, sometimes with clots and anaemia
• A feeling of pressure, heaviness or a visible swelling in the lower abdomen
• Passing urine frequently or difficulty emptying the bladder
• Constipation or back ache from pressure
• Pain during sex
• Difficulty conceiving or repeated miscarriage when the cavity is distorted
• Often no symptoms at all

Causes and risk factors

Each fibroid grows from a single muscle cell that has acquired a genetic change, and its growth is driven by oestrogen and progesterone, which is why fibroids appear after puberty, may enlarge in pregnancy and shrink after menopause. Risk is higher with a family history, African ancestry, early first period, obesity, high blood pressure, vitamin D deficiency and never having given birth. Having children and long-term use of hormonal contraception are linked to lower risk. The cancerous counterpart, leiomyosarcoma, is rare and is thought to arise separately, not from an existing fibroid.

How it is diagnosed

• Pelvic examination: An enlarged, irregular, firm womb may be felt.
• Transvaginal and abdominal ultrasound: Confirms the number, size and position of fibroids, classified with the FIGO system from 0, entirely inside the cavity, to 7, on a stalk outside.
• Saline infusion scan or hysteroscopy: Shows how far a fibroid protrudes into the cavity, which decides whether it can be removed through the cervix.
• MRI: Maps multiple or large fibroids before myomectomy or embolisation, distinguishes adenomyosis, and flags unusual features.
• Blood count and ferritin: To detect anaemia from heavy periods.

Treatment options

• Observation: Fibroids without symptoms need no treatment, only a review if symptoms develop.
• Medical control of bleeding: Tranexamic acid, the levonorgestrel intrauterine system if the cavity is regular, or the pill. These treat bleeding but do not shrink fibroids.
• GnRH antagonist tablets and GnRH analogue injections: Relugolix combination therapy, or injections for 3 months before surgery, reduce bleeding and shrink fibroids temporarily. Fibroids regrow after stopping.
• Hysteroscopic myomectomy: Removal of fibroids inside the cavity through the cervix with no incisions. Day case. The best option for submucous fibroids causing bleeding or infertility.
• Laparoscopic, robotic or open myomectomy: Removal of fibroids with repair of the womb for women who wish to keep fertility. Caesarean delivery is often advised afterwards. New fibroids can form.
• Uterine artery embolisation: A radiologist blocks the fibroid blood supply through a catheter in the wrist or groin. Fibroids shrink by about a third to a half over months. The effect on future pregnancy is less certain.
• Radiofrequency ablation and MRI-guided focused ultrasound: Heat-based shrinking of selected fibroids. Less invasive, with more limited long-term and fertility data.
• Hysterectomy: The definitive treatment for women who have completed their family, by keyhole, vaginal or open route. Ovaries are usually preserved.

When it is urgent

Go to a local emergency department for very heavy bleeding with dizziness, fainting or a racing heart, for sudden severe pelvic pain, which can occur when a fibroid degenerates or twists, for inability to pass urine, or for fever and worsening pain after embolisation or surgery. Severe pain in pregnancy with known fibroids also needs same-day assessment.

Travelling to Türkiye for treatment

Fibroid surgery and embolisation are planned procedures that suit travel. Typical stays are 3 to 5 days for hysteroscopic removal, 7 to 10 days for laparoscopic myomectomy, embolisation or keyhole hysterectomy, and up to 2 weeks after open surgery. Send ultrasound or MRI reports in advance so that the right technique can be advised, and correct anaemia before you fly. Wait times before trying to conceive after myomectomy, usually 3 to 6 months, should be followed up by your own gynaecologist.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions