It's time we rethink fibroids, the silent epidemic affecting 70% of women

It's time we rethink fibroids, the silent epidemic affecting 70% of women

Despite their prevalence, awareness of these potentially harmful growths is shockingly low.

Photo credit: Getty

Published: January 8, 2025 at 5:42 pm

Ever heard of fibroids? I wouldn’t be surprised if you hadn’t. They’re not widely discussed or even known about. And yet they can affect as many as 70–80 per cent of women by the age of 50 and despite their higher prevalence among black women, are critically underdiagnosed in women of colour.

Fibroids are growths of muscle and fibrous tissue in the uterus (womb), typically developing in women aged 30–50. Women can experience one or multiple fibroids, and they can vary significantly in size,
shape and location. 

Doctors may refer to fibroids as ‘benign’ growths, but this just means they’re not cancerous. They can still cause a myriad of problems.

A CT scan of the abdomen of a patient showing a large solid mass arising from the uterus into the upper abdomen. These are uterine fibroids

The uterus is like an onion, made up of several layers. Fibroids are classified depending on which layer of the uterus they appear in, as this affects the symptoms a woman can experience.  

If the fibroid is inside the muscle wall it’s ‘intramural’; ‘subserosal’ fibroids grow nearer the outside wall of the uterus; ‘submucosal’ ones grow nearer the centre of the uterus, where a baby would develop.

It doesn’t matter where the fibroids are based though, they all cause heavy periods. In fact, fibroids are the most common cause of heavy bleeding. They can also cause lower abdominal, pelvic and back pain, often felt as a constant, dull ache. 

If fibroids are big enough to put pressure on other organs, they can also lead to frequent peeing, constipation and pain during sex. Some women may also experience bloating and an enlarged abdomen.

Woman holding tummy in pain.
Symptoms of fibroids include heavy menstrual bleeding, pelvic pain, and pressure on the bladder or bowel. - Photo credit: Getty

Despite all the problems they cause, we still don’t fully understand how or why fibroids develop. We know genetics plays a part, so family history and ethnicity are risk factors, and that two hormones – oestrogen and progesterone – promote their growth. This is why fibroids tend to enlarge during pregnancy, when levels of these hormones are higher. 

Fibroids are typically diagnosed through an ultrasound scan and are often discovered incidentally during routine pregnancy check-ups. Many women may have experienced symptoms without knowing that fibroids were the cause of their pain

While there are several treatment options, a woman should be guided by her symptoms and her decisions around planning a pregnancy. For smaller, possibly asymptomatic fibroids, it makes sense to monitor them through repeat scans.

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Women with symptomatic fibroids can be offered medication to reduce oestrogen and progesterone levels, stopping any further growth and often leading to the fibroids shrinking. 

Gonadotrophin-releasing hormone (GnRH) agonists (such as Goserelin) are typically used in treatment, although they can’t be recommended for long-term use. Reducing essential hormones like oestrogen and progesterone can cause serious side effects, including infertility, hot flushes and vaginal dryness, as well as significant bone mineral density loss, which can lead to osteoporosis.

The maximum treatment course is usually six months and many women report a return of their symptoms once it has ended. 

However, the National Institute for Health and Care Excellence recently granted approval for doctors to prescribe the GnRH antagonist Linzagolix. This reduces oestrogen and progesterone in a different way, making the reported side effects much milder, so the medication is suitable for longer-term use.

Surgical treatment is also available to remove the fibroids, either directly through a procedure known as a myomectomy, or by removing the uterus – a hysterectomy. Alternatively, surgeons can cut off the blood supply to the fibroids through uterine artery embolisation.

But these procedures aren’t feasible for those hoping to conceive. In fact, fibroids are extremely obtrusive at every stage of pregnancy. As they can drastically change the shape of the uterus and be a barrier to conceiving. They can also increase the risk of miscarriage, premature labour and the need for a Caesarean section. 

If they didn’t already have enough to worry about, women who are found to have fibroids during pregnancy need careful monitoring and must be vigilant for signs of ‘red degeneration’.

This is when the fibroids have grown so fast – due to the increase in pregnancy hormones – that their centres break down. When this happens, women experience vomiting, fever and extreme pain over the abdomen and pelvis, and require immediate medical attention. 

Although treatment options are available, awareness around fibroids remains dismally low. It’s paramount that stigma around menstrual health and complications in pregnancy are broken down to prevent delays in seeking, what could be, life-changing treatment.

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