Uterine Fibroids: Symptoms, Treatment & UK Online Doctor Guide

Uterine fibroids, medically known as leiomyomas, are non-cancerous (benign) growths that develop in the muscular wall of the uterus (womb). According to NHS guidance, fibroids are extremely common, affecting around 1 in 3 women at some point in their lives, most frequently occurring in those aged 30 to 50.

Fibroids can vary significantly in size; some are as small as a seed, while others can grow large enough to distort the shape of the womb. They are made of muscle and fibrous tissue. While the exact cause is unknown, they are linked to the hormone oestrogen. This is why they tend to grow during reproductive years and often shrink after the menopause when oestrogen levels drop.

Types of Fibroids

• Intramural fibroids: The most common type, which grow within the muscular wall of the womb.
• Subserosal fibroids: These grow outside the wall of the womb into the pelvis and can become quite large.
• Submucosal fibroids: These grow in the muscle layer beneath the womb's inner lining and grow into the womb cavity.

Many women with uterine fibroids do not experience any symptoms. However, for about 1 in 4 women, the impact on daily life can be significant. The symptoms you experience often depend on the location and size of the growths.

Typical symptoms include:

• Heavy periods (menorrhagia): Needing to change sanitary products frequently or experiencing flooding.
• Painful periods: Intense cramping that may not respond well to standard over-the-counter painkillers.
• Pelvic pain: A chronic feeling of heaviness or pressure in the lower abdomen.
• Urinary frequency: If a large fibroid presses on the bladder, you may feel the need to urinate more often.
• Constipation: Fibroids pressing on the bowel can lead to digestive discomfort.
• Pain during intercourse: Known as dyspareunia, this can occur if fibroids are located near the cervix.

If you suspect you have fibroids, the first step is a consultation with a GP. The clinical pathway usually involves a physical pelvic examination. During this, a doctor may feel an irregular shape to the womb or an enlarged uterus.

To confirm the diagnosis, the NICE (National Institute for Health and Care Excellence) guidelines recommend an ultrasound scan. This can be a transabdominal scan (over the tummy) or a transvaginal scan (where a small probe is inserted into the vagina) to provide a clearer view of the womb's structure. In some complex cases, an MRI scan or a hysteroscopy (using a small camera to look inside the womb) may be required to plan surgical intervention.

Treatment is not always necessary if your fibroids are small and not causing symptoms. In these cases, a 'watch and wait' approach is often adopted. However, if symptoms are distressing, several medical and surgical options are available.

Medication

First-line treatments usually focus on managing heavy bleeding rather than shrinking the fibroids themselves:

• Levonorgestrel intrauterine system (IUS): Often the first choice, this device is inserted into the womb and releases progestogen to thin the lining.
• Tranexamic acid: Tablets taken during your period to help the blood clot more effectively.
• Hormonal contraceptives: The combined pill or progestogen-only pill can help regulate the cycle.
• GnRH analogues: These are injections that induce a temporary menopause-like state to shrink fibroids before surgery.

Surgical and Procedural Interventions

If medication is ineffective, you may be referred for procedures such as Uterine Artery Embolisation (UAE), which cuts off the blood supply to the fibroids, or a Myomectomy (surgical removal of the fibroids while leaving the womb intact). A Hysterectomy (removal of the womb) is considered a final option for women who no longer wish to have children.

Navigating women's health issues can often feel overwhelming, and waiting for an in-person appointment is not always convenient when you are in pain. You can speak to a GP online to discuss your menstrual history and symptoms in a private, calm environment.

A UK online doctor can provide:

• Advice on symptom management and lifestyle adjustments.
• Prescriptions for medications like tranexamic acid or hormonal contraception to manage heavy bleeding.
• A sick note if your symptoms are so severe that you are unable to work during your period.
• Professional guidance on whether your symptoms necessitate a specialist referral for an ultrasound.

Seeking help early is essential to prevent complications like iron-deficiency anaemia, which can result from long-term heavy menstrual bleeding.

While you cannot prevent fibroids through diet alone, maintaining a healthy weight may reduce your risk, as fat cells produce oestrogen which can stimulate growth. For pain management at home, paracetamol and anti-inflammatory drugs like ibuprofen can be effective. Applying a heat pad to the lower abdomen may also provide temporary relief from pelvic pressure and cramping.