Fibroids and menorrhagia

Uterine fibroids are benign tumours of the uterus occurring in 20-50% of women of reproductive age. Fibroids are associated with a spectrum of signs and symptoms, including menorrhagia, and are the most common indication for hysterectomy in the UK. Ultrasound scanning is the most appropriate and cost-effective tool for diagnosing and planning the management of fibroids. Women with asymptomatic fibroids do not require treatment and the vast majority of these fibroids will shrink after the menopause. Medical treatments (e.g. mifepristone or GnRH analogues) aim to alleviate symptoms but will not permanently shrink fibroids. Myomectomy involves removing the fibroid while preserving the uterus and is popular with women who wish to preserve their fertility. Myomectomy successfully resolves menorrhagia and pressure symptoms in approximately 80% of cases. Hysterectomy is popular with women who have completed their family. It eliminates both menstrual disturbance and the risk of fibroid recurrence and is associated with satisfaction rates in excess of 90%. However, hysterectomy is a major operation associated with a mortality of 0.2% and a morbidity rate of 3-14%. Uterine artery embolization is a useful technique for women who wish to preserve their fertility or find surgery unacceptable. Small embolic agents are injected, via the uterine artery, to block the blood supply of the fibroids, causing them to undergo ischaemic necrosis and shrink or disappear completely. The most appropriate treatment depends not only on size, number and location of the fibroids but also on the woman's preference, age and desire for future fertility.