Fibroids: symptoms, treatment, causes and pregnancy

The NHS says fibroids do not always cause symptoms, so you may not know you have them. If you do have symptoms, they may include the following, and the NHS adds that these are not all the symptoms fibroids can cause.

• Heavy periods or painful periods.

• Stomach (tummy) pain.

• Lower back pain.

• Peeing more often than usual, needing to pee suddenly or not being able to control when you pee.

• Problems pooing, such as bloating, not being able to poo or pain when you poo.

• Pain or discomfort during sex.

• Difficulty getting pregnant.

Leeds Teaching Hospitals explains that fibroids vary in size and position within the womb, and symptoms vary with them. Large fibroids, or those mostly on the outer surface of the womb (subserous), are more likely to cause pressure symptoms. Fibroids that mostly face inwards (submucous) are more likely to cause heavy periods and may cause fertility problems.

Fibroids are often found by chance when other symptoms are being investigated. The NHS says they can sometimes be found during other tests or scans, such as a pregnancy scan. Leeds Teaching Hospitals adds that they are rare in teenagers and shrink after the menopause.

The NHS says treatment is not always needed if fibroids are not causing any symptoms. If symptoms are painful or cause heavy bleeding, you may be given painkillers such as ibuprofen, naproxen or diclofenac, and tranexamic acid or a hormone medicine such as the combined pill to help with heavy bleeding. If medicine does not help, your fibroids are too large or your symptoms are getting worse, you may need surgery.

Leeds Teaching Hospitals describes medical treatments as usually recommended if symptoms are mild, if surgery is not safe or appropriate, if you are approaching the menopause when the fibroids will shrink, or to improve iron levels before an operation.

Fibroids can matter for fertility and pregnancy in a few ways. The NHS lists difficulty getting pregnant among the symptoms, and says that being unable to have children or having miscarriages is a rare complication of untreated fibroids. Leeds Teaching Hospitals says fibroids can be associated with risks in pregnancy including miscarriage, premature labour and a higher chance of caesarean delivery because the baby lies in an unusual position, plus a higher risk of heavy bleeding during pregnancy and after the birth.

The NHS says some treatments can stop you having children or increase the risk of problems during pregnancy, so if you plan to have children it is important to talk to a doctor about your options. Leeds says that after a myomectomy you are advised to avoid pregnancy for 3 months so the womb scar can strengthen, and that a pregnancy after UAE is possible but UAE is generally not recommended if you still want children.

If you have symptoms, the NHS says your GP may ask about them and examine you, which may include checking your tummy and pelvic area and an internal vaginal examination. If they think you may have fibroids they will usually refer you to a specialist for an ultrasound scan. The scan can show whether you have fibroids, how many there are, where they are and how big they are.

The NHS says the exact cause of fibroids is unknown. You are more likely to get them if you have not reached the menopause, have never had a full-term pregnancy, are overweight or obese, have high blood pressure or diabetes, are from a Black or Asian background, or have a close relative who has fibroids.

The NHS says to see a GP if you have symptoms of fibroids, if your symptoms are affecting your everyday life, work and relationships, or if painkillers are not helping. Leeds Teaching Hospitals says to get in touch with your doctor if your bleeding pattern changes, your abdomen is swelling, you have bladder or bowel pressure symptoms, or you feel your treatment is not working.

Untreated fibroids can sometimes cause problems. The NHS lists iron deficiency anaemia caused by heavy bleeding, urinary tract infections or problems peeing or incontinence caused by large fibroids pressing on the bladder, and, rarely, being unable to have children or having miscarriages. The NHS separately notes on its heavy periods page that heavy periods can mean needing to change a pad or tampon every 1 to 2 hours or passing clots larger than about 2.5cm, and to see a GP if you bleed between periods or after sex.

The NHS lists several conditions that can cause heavy periods, so symptoms alone cannot confirm fibroids. A scan and examination help tell them apart.

On the NHS, fibroids are usually assessed by a GP and, where needed, a specialist for ultrasound and treatment. Treatment depends on the size, number and location of fibroids and on whether you want children.

Private gynaecology services also assess and treat fibroids. Whichever route you use, it is sensible to ask which options preserve fertility if that matters to you, and to ask how follow-up will be shared with your GP.