A Medical Perspective: Dr. Gidon explains fibroids, what causes them and what to do with them

Gidon Lieberman is our Chief Medical Officer. He’s a leading consultant gynaecologist and fertility specialist with over 25 years of experience. He’s accredited for laparoscopic and hysteroscopic surgery, gynaecological ultrasound and management of the menopause. He’s especially interested in helping patients combat infertility – and is very well known for his excellent analogies.

I encounter many people who have fibroids. In fact I come across many people with many fibroids!

What are fibroids?

Fibroids are benign growths that are found in the womb muscle. They vary in their size and position in the womb and can be single or multiple.

Some fibroids grow up to 25 or even 30 cm in size, but it’s not only their size that matters, but their position in the womb too. Small fibroids found on the inside of the womb cavity (think of it like a grape on a stalk) can cause a lot of problems – even if they are very small. While bigger fibroids that sit on the outside of the womb are often not a problem. Fibroids can cause irregular, heavy and prolonged bleeding, pregnancy loss and problems with embryo implantation during fertility treatment.  

Fibroids that are larger in size, can cause issues by putting pressure on other organs like the bladder (making you want to pass urine more often) or the bowels, causing constipation.

Some patients can press on their fibroids and wobble them (we don’t recommend doing this…) and fibroids can actually move about with exercise or sex which can cause an uncomfortable sensation.

What to do with fibroids?  

Most people with fibroids don’t require any sort of treatment. I only recommend treating them if they are causing problems. There are many types treatment including medication and surgery. Some medicines will be non-hormonal and taken only during the person’s period, whilst hormonal treatment can be useful for many fibroids and patients too.

Unfortunately, there’s no tablet or medication that will take fibroids away permanently (if only!). Some medication is used to shrink fibroids before surgery but can only be used for a limited amount of time.

What about fibroid surgery?

Fibroids that sit inside the womb cavity (the technical term is sub-mucous fibroids) can be removed by a vaginal approach, so there’s no skin cuts. The medical term for this procedure is ‘Trans-cervical resection of Fibroid’ (TCRF). It is performed under sedation or general anesthetic and it takes around 30 minutes. Post-operatively patients may have some cramping discomfort that settles with paracetamol or ibuprofen. If the fibroid is quite big then two operations may be necessary, but this is quite uncommon.

If the fibroids are on the outside (sub-serous) or in the in the middle of the muscle (intra-mural) then removing them needs to be done through from above (so skin incisions are necessary). The choice is either via a keyhole approach (laparoscopic) or an open operation (for example like a caesarean section incision).  

If there aren’t too many fibroids found, and they’re not too big then a keyhole procedure can be done. The surgery will take longer but your recovery is much quicker and is a lot less painful afterwards.  However, if you have very large or multiple fibroids then it is normal to need a larger skin incision. This can normally be done quite low down in your abdomen so it can be hidden as much as possible.

Get in touch with us today!

If you are worried about fibroids and want to talk through investigations and treatment, feel free to reach out to your Fertifa care advisor. We’d love to hear from you and help you if we can.