Book an Appointment
Mr Parijat Bhattacharjee, Private Consultant Gynaecologist, Harrow, Brentford, Northwood, London, UK / Media / Videos » Fibroid

Fibroid

Fibroid
Posted on: 03-Jul-2026

This video, titled "Fibroid" by Gynae Consultant, provides a comprehensive overview of uterine fibroids. It breaks down their prevalence, classification by location, diagnostic procedures, impact on fertility, and the full spectrum of medical and surgical treatment pathways.

What are Fibroids?

  • Definition: Fibroids are incredibly common, benign (non-cancerous) growths or condensations of the muscle tissue within the wall of the uterus. They affect an estimated 40% to 70% of women, with a higher prevalence noted in Black women compared to Caucasian women.
  • Hormonal Dependency: Fibroids thrive on the hormone estrogen. Consequently, they remain active while a woman is menstruating—with symptomatic peaks typically occurring between 30 and 40 years of age—and naturally shrink after menopause.
  • Asymptomatic Nature: Up to 90% of fibroids do not cause symptoms and are picked up incidentally during unrelated ultrasound scans.

Classifications by Location

Fibroids are categorized based on where they grow relative to the uterine layers:

  • Intramural: Completely confined within the muscular wall of the womb.
  • Subserosal: Pushing outward toward the outer surface (serosa) of the womb.
  • Pedunculated: Subserosal fibroids that extend far enough outside the wall to form a narrow stem or pedicle attachment.
  • Submucous: Growing inward into the cavity of the womb, actively distorting its internal space.

Impact on Fertility and Pregnancy

  • Submucous Fibroids: Because they distort the uterine cavity, these fibroids can interfere with embryo implantation, increase the risk of miscarriages, and cause fetal malpresentation (e.g., the baby failing to turn head-down before delivery). They should be removed if a woman is experiencing fertility issues.
  • Other Fibroids: If a fibroid does not protrude into the cavity but is larger than 5 cm or sits near the fallopian tubes, surgery may be considered if no other cause for infertility is identified.

Diagnostic Procedures

  • Ultrasound: Standard management involves both abdominal and transvaginal scans.
  • Saline Infusion Sonography: Injecting fluid into the cavity helps doctors get a highly clear look at intracavity (submucous) fibroids.
  • MRI: Used for "fibroid mapping" prior to surgery when multiple fibroids are present.
  • Hysteroscopy: A small telescope is guided through the cervix to evaluate the inner lining directly.

Treatment Pathways

1. Medical Symptom Management (For Bleeding)

  • Regular Heavy Bleeding: Managed temporarily with antifibrinolytics or NSAIDs like tranexamic acid and mefenamic acid.
  • Irregular Bleeding: Treated with combined contraceptive pills or progesterone tablets.
  • Mirena Coil: A levonorgestrel-releasing intrauterine system is highly effective for long-term bleeding management, provided the uterine cavity remains smooth and isn't heavily distorted.

2. Hormonal Shrinkage

  • GnRH Analogs: Short-term (3 to 6 months) injections induce a temporary, menopausal-like state. This starves the fibroids of estrogen, causing them to shrink and reduce their blood supply to make subsequent surgery easier or safer. It cannot be used long-term due to the risk of bone loss (osteoporosis).

3. Non-Surgical Procedures

  • Uterine Artery Embolization (UAE): Performed by an interventional radiologist, a catheter is guided through the thigh to the main blood vessels feeding the uterus. Tiny pellets are released to block the primary blood supply, causing the fibroids to shrink while the uterus continues to receive minimal blood from alternate sources.

4. Surgical Removal (Myomectomy)

  • Hysteroscopic Resection: Submucous fibroids completely inside the cavity are shaved away using a telescope inserted through the cervix, requiring no external cuts.
  • Laparoscopic Resection: One or two external or intramural fibroids can be excised via keyhole surgery through the tummy.
  • Open Surgery: Very large or numerous fibroids require traditional open abdominal surgery, usually using a horizontal line similar to a C-section scar.
  • Hysterectomy: If a woman's family is complete, removing the entire womb serves as the definitive solution.