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Do I have Fibroids? Symptoms, treatments, and diagnosis explained

Fibroids

Fibroids are benign (non-cancerous) growths that develop in or around the uterus (womb). And while they may not cause cancer or other life-threatening complications, in some women they can cause health problems.

The uterus is made mostly of smooth muscle, and fibroids are overgrowths of smooth muscle cells along with other cells from the lining of the uterus. They start as single-cell growths then slowly get bigger over many years. Also called uterine myomas, leiomyomas or fibromyomas, fibroids can vary substantially in size – according to the NHS, some fibroids can be the size of a pea while others can grow as big as a melon.

Fibroids found in different places on the uterus are classed as follows:

  • Intramural fibroids
    These are the most common type of fibroid and are found within the muscle wall of the uterus.

  • Submucosal fibroids
    Fibroids that grow into the cavity of the uterus after developing in the muscle layer under the inner lining are called submucosal fibroids.

  • Subserosal fibroid
    These grow in the pelvis on the outside wall of the uterus and can become very big.

  • Pedunculated fibroids
    Submucosal or subserosal fibroids that are attached to the uterus by a narrow stalk are called pedunculated.


Fibroids are thought to be the most common reproductive system problem in women in the UK. According to the NHS, around one in three women develop them at some point in their life. Other sources suggest even more may be affected, since fibroids don’t always have symptoms – which means many women may have them without realising it.


What are the symptoms?

Women who do experience fibroid symptoms will find they tend to vary according to the fibroid’s size and where they are found in and around the uterus. These symptoms range from very mild to so severe that they can have a serious impact on your quality of life.

The most common symptoms are painful and/or heavy periods. Other symptoms include:

  • Bleeding between periods

  • Bleeding during sex

  • Pain during sex

  • Anaemia

  • Extended stomach/bloating

  • Pelvic pain

  • Low back pain or leg pain

  • Frequent urination/difficulty emptying your bladder

  • Constipation

  • Depression/low mood

  • Difficulty getting pregnant

 

Are you at risk?

Fibroids develop typically in women who are in their thirties, forties or fifties, and are thought to be most prevalent in those approaching the menopause (peri-menopausal). But there are other factors that can affect your risk of having fibroids too.

  • Family history
    Fibroids are thought to run in families, so if some of your close relatives have or had them, your risk of developing one or more fibroids is higher-than-average too.

  • Ethnic background
    Women of African-Caribbean origin have a higher risk of developing fibroids than those from other backgrounds (according to Patient, for instance, they’re three times more common in African-American women than in white Americans).

  • Weight
    If you’re obese or overweight your risk of fibroids is higher than someone whose weight is in the healthy range. According to Patient, fibroids are more common in women who weigh more than 70kg (11st).

  • Age of puberty
    If you started having periods when you were 10 years old or younger, your risk of having fibroids is higher than a woman who had her first period when she was 12.

  • Childbirth
    Women who have given birth have a lower risk of developing fibroids than those who haven’t had any children. According to the NHS, the risk also gets lower with each time you give birth.

  • Physical activity
    If you exercise regularly your risk of developing fibroids may be lower than that of someone who has a more sedentary lifestyle.

  • Blood pressure
    Women with high blood pressure are more likely to develop fibroids than those with blood pressure within the normal range.

 

What causes them?

The exact cause of fibroids is still unknown. However, experts believe it may have a lot to do with hormones – particularly oestrogen, which is produced by the ovaries. Fibroids develop during a woman’s reproductive years, when oestrogen levels are high. It may also be no coincidence that women who are overweight are more likely to develop fibroids, as excess weight can make women’s bodies produce higher levels of oestrogen.

Meanwhile, fibroids tend to shrink when oestrogen levels are low after the menopause. However, women who take hormone replacement therapy (HRT) for menopause symptoms often find their fibroids only start to shrink when they finish their medication.


Fibroid complications

While they may not know exactly what causes them, experts do know that in a small number of cases fibroids can cause problems with fertility and pregnancy.

If you have one or more large fibroids it can affect your ability to become pregnant. In rare cases a fibroid or fibroids can stop a fertilised egg from implanting itself into the lining of the uterus, or even stop sperm from reaching an egg. Submucosal fibroids – which grow into the cavity of the uterus – can also block a fallopian tube, making it difficult for an egg to be released into the uterus. Fibroids have also been known to cause miscarriage, though this too isn’t common.

And while having fibroids isn’t usually a cause for concern during pregnancy, it can sometimes cause abdominal pain or lead to a higher risk of having a premature baby. Some women with fibroids have to give birth by caesarean section, as fibroids can block the vagina.


How are they diagnosed?

If you have one or more symptoms that suggest you could have fibroids, your GP will usually investigate by carrying out an internal pelvic examination. If they think you have fibroids, your GP may then refer you to a hospital specialist for further tests to confirm the diagnosis. Having one of these tests for other reasons – to look for other conditions, for instance – is also often the way women who don’t have any symptoms discover they have fibroids.

  • Ultrasound scan
    This is the main test used to diagnose fibroids. You may have one of two types of ultrasound scan – an abdominal scan where a probe checks the surface of your abdomen or a transvaginal scan, where a probe is inserted into your vagina.

    You may also have fluid injected into your uterus to help with the ultrasound scanning – this is called sonohysterography.

  • Hysteroscopy
    This is a five-minute procedure that involves a hysteroscope (a small telescope) being inserted into the uterus through the vagina and cervix.

  • Laparoscopy
    A small telescope with a tiny light and camera is called a laparoscope. If you have a laparoscopy, the laparoscope will be inserted in your abdomen through a small incision. This procedure is carried out under general anaesthetic.


Your surgeon may also take a biopsy (a small tissue sample) during a hysteroscopy or laparoscopy. This means the tissue can be analysed more closely.


Treatments for fibroids

If you have fibroids that don’t cause any symptoms – or just some mild symptoms – you may not need any treatment. But if your symptoms are more severe and have a negative effect on your everyday activities, there are several treatments on offer. These include medicines used to treat heavy periods (though if you have large fibroids they may not be particularly effective), including the following:

  • Anti-inflammatories
    Treatments such as ibuprofen and other anti-inflammatory painkillers may help ease period pain by reducing levels of a chemical called prostaglandin that is linked with heavy and painful periods.

  • Oral contraceptive pill
    The combined pill may also be used as it can make your periods lighter and reduce period pain. The mini pill – which doesn’t contain any oestrogen – may also be effective in some cases.

  • Intrauterine system (IUS)
    A plastic device that gradually releases small amounts of a progestogen hormone called levonorgestrel may also help with heavy periods. However, the device has to be inserted into the uterus, which can be difficult in some women with fibroids.

  • Progestogen treatments
    A synthetic version of the natural hormone progesterone, progestogen – either in tablet or as an injection – is sometimes used to reduce heavy periods.

  • Tranexamic acid
    Taken several times a day during your period, this may help by reducing bleeding, thereby making your period lighter.


Other medication used to treat fibroids include gonadotropin releasing hormone analogues (GnRHas) and ulipristal acetate, both of which aim to shrink your fibroids. These are often give to women who are waiting for surgery to remove fibroids. However, both are associated with potential unpleasant side effects, and in February 2018 a temporary ban was placed on ulipristal acetate after some women developed serious liver problems while taking it (at the time of writing this ban was still in place).


Other treatments

Women with severe fibroid symptoms who haven’t had any success with medication treatments are often asked to consider having a surgical or non-surgical procedure to remove the fibroids.

There are several procedures that may be used, including:

  • Hysterectomy
    If you have one or more large fibroids with severe symptoms and you’re not planning to have any more children, you may have your uterus surgically removed.

  • Myomectomy
    Women who want to have more children may be offered a myomectomy, which is when some types of fibroids are removed using keyhole or open surgery. Since the uterus isn’t removed, however, there’s a chance the fibroids will grow back.

  • Hysteroscopy
    There are two surgical procedures that involve the use of a hysteroscope to remove fibroids, namely hysteroscopic resection and hysteroscopic morcellation. Both procedures involve using very small surgical instruments to remove fibroids.

  • Uterine artery embolisation
    This non-surgical procedure is sometimes used instead of a hysterectomy or myomectomy. It involves injecting a substance that blocks the blood vessel supplying the fibroid via a catheter that’s inserted into an artery in the leg. With no blood supply, the fibroid shrinks.

  • Endometrial ablation
    This procedure is often used to reduce heavy periods, but it can also remove small fibroids found in the lining of the uterus as it removes the lining. There are a number of methods used to remove the uterus lining. Endometrial ablation isn’t recommended for women who want to have more children.

  • MRI-guided focused ultrasound
    This sends high-powered ultrasound pulses through the skin of the abdomen to the fibroid. However, while effective, it’s not yet known if it could cause problems with fertility.


How to help yourself

Fibroids may be unavoidable in many cases. However, there are some lifestyle factors that may influence your risk of developing fibroids.

In one study carried out in China, experts set out to look at the links between fibroids and diet, among other things (i). The study included 73 women who had been diagnosed with fibroids and 210 women who didn’t have fibroids. At the end of the study period the researchers found that, among the women who were premenopausal, those with a high body mass index had an increased risk while those who ate the most fruit and veg had a reduced risk. The same associations weren’t found in the postmenopausal women volunteers, however.

This isn’t the only study to suggest a relationship between diet and fibroids. An Italian report, published in the journal Obstetrics & Gynecology, has showed that women with fibroids report eating more beef, ham and other red meat and fewer green vegetables, fruit and fish than those who don’t have fibroids (ii).

The Italian researchers don’t offer any reason why these particular dietary habits could have an influence on the development of fibroids. However, a paper published in the journal Public Health Nutrition may suggest one possible answer, as it found women eating a semi-vegetarian diet had lower levels of oestrogen in their blood than those who said they ate more meat (iii). 

In 2016, another study from China also suggested eating fruit and veg may help reduce the risk of developing fibroids (iv). The study analysed the diets of 600 women with fibroids and 600 without fibroids, and found eating plenty of broccoli, cabbage, tomatoes and apples may protect against fibroids. In conclusion, the researchers suggested that eating more fresh fruits and cruciferous vegetables may reduce the incidence of fibroids.


Sugar connection

Could eating a diet high in refined sugar also contribute to the development of fibroids? Some researchers seem to think so, including those writing in the American Journal of Clinical Nutrition, who suggest diets with a high glycaemic index may increase the risk of fibroids in some women (v). The glycaemic index rates how quickly individual foods increase blood sugar levels, with sugar and sugary foods and drinks having some of the highest GI scores.

Meanwhile, alcohol may also be linked with fibroids. In at least one study, drinking alcohol – particularly beer – was found to increase the risk of developing them (vi). On the other hand, getting regular exercise may reduce your fibroid risk. Indeed, a study published in the American Journal of Epidemiology suggests that the more physically active you are, the less likely you may be to develop fibroids (vii).
 

Natural supplements for fibroid support

Eating a healthy balanced diet with lots of fruit and veg, taking regular exercise and drinking in moderation may help prevent the development of fibroids and the symptoms that can accompany them. But if you already have fibroids, there are several nutritional supplements used by nutritional therapists that may prove helpful.

A good quality multivitamin and mineral supplement may be a good start, to make sure your body is getting the nutrients it needs. Meanwhile, you may also like to try one or more of the following:


Vitamin A

Some experts believe being deficient in vitamin A could be linked with one of the main symptoms of fibroids, namely heavy periods (menorrhagia) (viii). In one study, vitamin A supplements reduced monthly heavy bleeding in 92 per cent of female volunteers. Vitamin A is also needed for the production of red blood cells.


B vitamins

Several texts also suggest a link between vitamin B deficiency and heavy periods (ix). Writing in The Journal of the Canadian Chiropractic Association, researchers propose that a vitamin B deficiency may reduce the liver’s ability to convert or ‘inactivate’ oestrogen, which suggests a lack of vitamin B may also play a part in the development of fibroids (x). Taking a vitamin B complex supplement may help normalise oestrogen metabolism, the researchers conclude.


Vitamin C

The same paper in The Journal of the Canadian Chiropractic Association also outlines the results of a small-scale study involving women with heavy periods, where bleeding improved in 16 out of the 18 women taking part after taking vitamin C and bioflavonoid supplements. Both vitamin C and bioflavonoids – a group of plant-derived compounds, also called flavonoids – are thought to strengthen capillaries, which may explain why taking such supplements could help reduce heavy bleeding.


Anthocyanidins

Another group of plant substances thought to help strengthen capillaries is called anthocyanidins. Classed as antioxidants, these are plant pigments found in dark and richly coloured fruit such as blueberries, blackberries, raspberries and red grapes. It’s thought that anthocyanidins strengthen capillaries and blood vessel walls by repairing the collagen in them.

Iron   It’s widely accepted that having heavy periods can lead to iron-deficiency anaemia. But it’s also thought that iron deficiency could even be a cause of menorrhagia (x). If you have heavy periods, it’s important to eat plenty of iron-rich foods or to take an iron supplement.

Another mineral that may be useful is zinc, as it’s important for hormone balance and may help keep your reproductive system healthy. 
 

High-strength fish oils

The omega-3 fatty acids found in oily fish are also thought to be important for hormone balance and for a healthy reproductive system.
 


References:

  1. , et al. Associations between Uterine Fibroids and Lifestyles Including Diet, Physical Activity and Stress: A Case-control Study in China. Asia Pacific Journal of Clinical Nutrition. ;P109 - 117. Available online: http://www.airitilibrary.com/Publication/alDetailedMesh?docid=09647058-201303-201301220029-201301220029-109-117

  2. , et al. Diet and uterine myomas. Obstet Gynecol. ;94(3):395-8. Available online: https://www.ncbi.nlm.nih.gov/pubmed/10472866

  3. , et al. Oestrogen levels in serum and urine of premenopausal women eating low and high amounts of meat. Public Health Nutr. ;17(9):2087-93. Available online: https://www.ncbi.nlm.nih.gov/pubmed/24050121

  4. , et al. Vegetarian diet and reduced uterine fibroids risk: A case-control study in Nanjing, China. J Obstet Gynaecol Res. ;42(1):87-94. Available online: https://www.ncbi.nlm.nih.gov/pubmed/26458740

  5. , et al. Dietary glycemic index and load in relation to risk of uterine leiomyomata in the Black Women's Health Study. Am J Clin Nutr. ;91(5):1281-8. Available online: https://www.ncbi.nlm.nih.gov/pubmed/20200259

  6. , et al. Risk of uterine leiomyomata in relation to tobacco, alcohol and caffeine consumption in the Black Women’s Health Study. Hum Reprod. ;19(8): 1746–1754. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876785

  7. , et al. Association of Physical Activity with Development of Uterine Leiomyoma. American Journal of Epidemiology, Volume 165, Issue 2. Pages 157–163. Available online: https://academic.oup.com/aje/article/165/2/157/97971

  8. , et al. Menopause without medicine. Rev. 5th ed. Alameda, CA: Hunter House Inc. Available online: https://www.harpercollins.co.uk/9780722536872/menopause-without-medicine

  9. , Textbook of natural medicine. 3. St. Louis, Mo.: Churchill Livingstone Elsevier. pp. 1901–1906. Available online: https://www.elsevier.com/books/textbook-of-natural-medicine/pizzorno/978-1-4377-2333-5 Menopause without medicine. Rev. 5th ed. Alameda, CA: Hunter House Inc. Available online: https://www.harpercollins.co.uk/9780722536872/menopause-without-medicine

  10. , et al. Menorrhagia: A synopsis of management focusing on herbal and nutritional supplements, and chiropractic. J Can Chiropr Assoc. ;51(4): 235–246. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077876