Uterine fibroids

Uterine fibroids are benign (non-cancerous) growths that develop in or around the womb (uterus) in women. Learn more about the condition, its diagnosis and the different treatment options available.

 
The majority of fibroids are asymptomatic and therefore require no treatment.

However when fibroids cause discomfort for patients, there are several treatment options to alleviate symptoms:

  • Medical treatment: analgesic medicines may be used to reduce pelvic pain. Various medications may be prescribed to reduce heavy periods but these may be less effective for larger fibroids.
    • Levonorgestrel intrauterine system (LNG-IUS) is a small plastic device implanted in the womb that releases the progestogen hormone levonorgestrel over time. This makes the womb lining thinner and makes the periods lighter.
    • Tranexamic acid tablets stop the small blood vessels in the womb lining bleeding, so may reduce blood loss by 50%.
    • The contraceptive pill stops ovulation and thereby can help make bleeding lighter
    • Progestogens reduce bleeding by slowing the growth of the womb lining
    • Ulipristal acetate tablets cause fibroids to shrink, by killing cells and by inhibiting the formation of new cells
  • Other medication can be used to shrink the fibroids, in cases where the symptoms have not responded adequately to other drugs. GnRHas (gonadotropin-releasing hormone analogues) are given by injection and work by affecting the pituitary gland which stops the ovaries producing oestrogen. They can ease heavy periods and relieve any pressure on the stomach, as well as improving symptoms of frequent urination and constipation. GnRHas can reduce fibroid size prior to surgery to remove them. GnRHas can cause a number of menopausal-like side effects and therefore should be used for a maximum of 6 months due to their possible thinning effect on bone.
  • Surgery to remove fibroids may be considered in patients with severe symptoms where drug treatment has been ineffective. Depending on the number, size, and location of the fibroids and the patient’s individual situation, the surgical options available are:
    • myomectomy – a technique to remove the fibroids from the wall of the womb. Depending on the size and position of the fibroids the procedure can either be via keyhole surgery or an open larger incision. Following a myomectomy there is always a chance of regrowth of fibroids. Where fibroids are submucosal and fertility is desired, hysteroscopic resection of fibroids may be possible.
    • hysterectomy – a surgical procedure to removethe womb.This is the most effective way of preventing recurrence of fibroids.
  • Non surgical procedures for treating fibroids are also available :
    • Uterine artery embolisation (UAE): an alternative to a hysterectomy or myomectomy, particularly for women with large fibroids.. It involves blocking the blood vessels that supply the fibroids, causing them to shrink. A solution is injected through a small tube (catheter) under X-ray guidance through a blood vessel in the leg.
    • Endometrial ablation is a relatively minor procedure that involves removing the lining of the womb to remove small fibroids in the womb lining as well as reduce heavy bleeding. It can be carried out by using a laser, a heated wire loop or hot fluid in a balloon.
    • MRI procedures: these techniques use MRI guidance to introduce small needles into the targetted fibroid. Then laser or ultrasound energy is passed through the needles to destroy the fibroid.

Fibroids are common, with around 1 in 3 women developing them at some point in their life.

Sources :

NHS Choices website – Fibroids http://www.nhs.uk/Conditions/Fibroids/Pages/Introduction.aspx. Last accessed 18/07/2017

Adverse events should be reported. Reporting forms and information can be found at wwww.mhra.gov.uk/yellowcard

Adverse events should also be reported to the Ipsen Medical Information Department on 01753627777 or medical.information.uk@ipsen.com

Date of preparation January 2018 / ALL-UK-000455