Fibroids (myomas) are benign tumours of the uterus, most often seen in women aged 30-40. Although the exact cause is not known, the hormone oestrogen is thought to play a major role in their growth. Fibroids are more common during the reproductive years, when oestrogen levels are high, and less common as menopause approaches; after menopause they have been observed to shrink and calcify. Genetic factors, never having given birth and obesity may also contribute.

Types of Fibroids

Depending on their location in the uterus, four types of fibroids are described:

• Pedunculated fibroids: Seen in both subserosal and submucosal fibroids, these are attached to the uterus by a thin stalk. They can sometimes twist and cause pain, or hang down outside the uterus.
• Intramural fibroids: These grow within the muscular wall of the uterus and can enlarge it, pressing on surrounding tissues and organs. They are the most common type.
• Subserosal fibroids: These form on the outer layer of the uterus. Large ones can cause visible swelling of the abdomen.
• Submucosal fibroids: These develop on the inner surface of the uterus. Although uncommon, they can cause heavy bleeding and miscarriage.

Symptoms

Small fibroids usually cause no symptoms. The main symptoms of growing fibroids are:

• Irregular periods
• Prolonged periods and resulting anaemia
• Painful, heavy menstrual bleeding
• Pressure, a feeling of fullness or pain in the abdomen
• Pain or bleeding during or after intercourse
• Frequent urination, incontinence or a feeling of incomplete bladder emptying
• Constipation
• Back and leg pain
• Infertility, miscarriage and premature birth
• Dark, foul-smelling discharge due to infection

Diagnosis

Some fibroids reveal themselves through symptoms, while others are found during a routine examination. After a physical examination and detailed history by a gynaecologist, ultrasound is used to determine the location, size and type of the fibroid. MRI and CT are also used when needed.

Treatment: Fibroid Embolisation

Depending on the patient's condition and the type of fibroid, treatment can be open or minimally invasive surgery. In recent years, however, with advances in technology and the wider use of interventional radiology, fibroid embolisation, also known as non-surgical fibroid treatment, has become very common.

The aim of embolisation is to cut off the blood supply by blocking the arteries that feed the fibroids. Deprived of blood, the fibroids begin to shrink and the patient's symptoms improve.

The procedure is performed by an interventional radiologist under light sedation, like a routine angiogram, through a needle puncture in the groin. Using a catheter of suitable size, the arteries feeding the fibroids are filled with tiny blocking particles. All fibroids in the uterus, large and small, can be treated in the same session.

Because the uterus continues to receive blood from other vessels, it is not harmed; the treatment targets only the fibroids.

After the procedure a follow-up MRI is performed and patients are observed for a few hours or overnight. With no surgical incision, suitable patients return to normal life faster and more comfortably after fibroid embolisation. Because no procedure is performed on the ovaries or the uterus itself, fertility is not affected.