Private fibroids clinic in London, same-day women's health.

Symptoms

• Heavy or prolonged periods, often with clots — the commonest symptom, and a frequent cause of iron deficiency
• Pelvic pressure, bloating, or a swollen lower abdomen
• Urinary frequency, or difficulty emptying the bladder
• Constipation, or pressure in the back passage
• Pain during sex, and lower back pain
• Occasionally difficulty conceiving or recurrent miscarriage

Diagnosis

Usually a pelvic examination followed by ultrasound, which is the first-line test. Where the cavity needs assessing, saline infusion sonography or hysteroscopy gives a clearer picture, and MRI is used for mapping before surgery or embolisation. A full blood count and ferritin should always be checked, since iron deficiency from heavy bleeding is very common and frequently untreated.

Treatment

• No treatment if they are not causing symptoms — entirely reasonable, with monitoring.
• Tranexamic acid and anti-inflammatories taken during periods to reduce bleeding, without affecting the fibroids themselves.
• The hormonal coil reduces bleeding substantially and is recommended first-line, though it is less suitable where fibroids distort the cavity.
• The combined pill or progestogens to control bleeding.
• GnRH analogues to shrink fibroids temporarily before surgery, usually with add-back HRT.
• Hysteroscopic resection for submucosal fibroids — day case, no abdominal incision, and often transformative for bleeding.
• Myomectomy — removing fibroids and preserving the womb. The option where fertility is a priority.
• Uterine artery embolisation — blocking the blood supply, avoiding surgery. Effective, with a shorter recovery.
• Hysterectomy — definitive, for women who have completed their family and want a permanent solution.

Fibroids and fertility

Most women with fibroids conceive normally. Those distorting the cavity have the clearest effect on fertility and miscarriage, and removing them improves outcomes. In pregnancy, fibroids often grow and can cause pain; they occasionally affect the baby's position or the placenta. If you are planning a pregnancy, say so early — it changes which treatments are appropriate, and embolisation in particular is generally avoided if you want children.

After the menopause

Fibroids are oestrogen-dependent and usually shrink and become symptom-free after the menopause. New growth or new symptoms after the menopause is unusual and should be investigated.