• Heavy periods, longer cycles and bleeding between periods
• Period pain, backache and lower abdominal discomfort
• Pressure symptoms on the bladder and ureters giving rise to frequency of micturition and recurrent UTI, bowel problems such as constipation
• Infertility and miscarriage
• Pregnancy complications, uterine pain and premature labour
• Abdominal swelling from large size fibroids
• Some fibroids are asymptomatic discovered during routine examination

At the London Obstetrics & Gynaecology Clinic Mr Mahfouz will perform abdominal and pelvic examinations. This will be followed by an ultrasound scan to ascertain size, number and location of the fibroids. Occasionally operative diagnostic procedures are required as hysteroscopy to delineate fibroids which can be overgrown on the inside of the uterine cavity (as fibroid polyps). Also laparoscopy to diagnose and remove some accessible fibroids. Other tests currently used such as MRI (magnetic resonance imaging) which can be used as a follow up to monitor fibroid growth.

Most fibroids do not cause symptoms and are discovered during routine examination. Dr Mahfouz will advise you whether it requires treatment or not. Treatment will be tailored depending on womens symptoms, age, desire, fertility and association of other problems. Treatment can be:

• Medical - using oral contraceptive pill to control bleeding. Also use of Zoladex (LHRH) analogue injection. This is used as a short term solution as the fibroids grow again and usually used before surgery to reduce blood loss. Also Tranexamic acid to minimise blood loss. Mirena IUCD can be used in certain cases.
• Surgical - excision of fibroids is the best (myomectomy). This can be done laparoscopically, by conventional abdominal surgery or by hysteroscopic fibroid resection in fibroids of endometrial cavity (polyps). Also uterine artery embolization (UAE), however, complications can occur with this outpatient procedure.

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed.

Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy.

• Hysteroscopy - This technique is used to remove fibroids that protrude into the cavity of the uterus. A resectoscopeis inserted through the hysteroscope. The resectoscope destroys fibroids with electricity or a laser beam. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. Hysteroscopy often can be performed as an outpatient procedure (you do not have to stay overnight in the hospital).
• Endometrial ablation - This procedure destroys the lining of the uterus. It is used to treat women with small fibroids (less than 3 centimeters). There are several ways to perform endometrial ablation.
• Uterine artery embolization (UAE) - In this procedure, tiny particles (about the size of grains of sand) are injected into the blood vessels that lead to the uterus. The particles cut off the blood flow to the fibroid and cause it to shrink. UAE can be performed as an outpatient procedure in most cases.