A fibroid is an overgrowth of the muscular layer of the uterus - the womb. They can grow in different places. For example, they can grow on the outside of the uterus, facing the abdomen, or they can be in the uterine cavity. Cysts are fluid-filled cavities lined with mucous membrane and can also grow in different places. In general, fibroids and cystic changes are benign tumours and are usually found by chance during an ultrasound scan. They only cause symptoms when they get bigger or when there are several of them. These can range from pain and cramps to bleeding problems, constipation or even an inability to have children.

This affects many women

Cysts and fibroids are common, and many women of childbearing age have this type of growth in their uterus. This can happen for a number of reasons. Most cysts and fibroids are spontaneous - they have no real cause and are not associated with any other condition. There are also conditions, such as endometriosis, where cysts are more common and can be felt in different parts of the body. They can vary in size. From 3-4 cm, they become problematic and can cause symptoms. Cysts of this size can rupture because of the fluid inside, causing severe pain and circulatory problems. A ruptured cyst causes colicky pain that comes on suddenly, often after exercise or physical exertion. The pain is usually so severe that women have to go to A&E. Cysts caused by endometriosis - called chocolate cysts - also cause pain. These are mainly cycle related and are usually removed to relieve the symptoms.

Malignant findings are rare

In some cases, the tissue growth can become malignant. This is very rare, but if you have symptoms such as fever, severe tiredness, weight loss and night sweats, you should see a doctor. As cysts are usually easily accessible through the uterus or through a small incision in the abdomen, a biopsy can be taken or the cyst or fibroid removed and sent to a pathologist. The tissue will be examined under a microscope and you will soon know whether it is a malignant growth.

Getting pregnant with these findings is not always a problem.

In young women without symptoms, doctors usually advise against surgical removal or medication. The tissue can be monitored and an explanation of possible symptoms will tell you when to see your doctor again. If you are trying to get pregnant, you should see your doctor again. You do not necessarily have to interfere with a possible pregnancy. The most important factor is the location of the growth. If the ulcer is on the outside of the uterus, it will not restrict the uterus and the foetus will be able to implant and grow normally. However, if it is on the inside of the uterus and reduces the size of the amniotic cavity, the situation is different. The fertilised egg can then travel through the fallopian tubes to the uterus, but there it encounters the mechanical obstacle and either fails to implant or does so with difficulty. This can lead to either an early or late miscarriage. However, troublesome fibroids can be easily seen on ultrasound. This means that the possibility of surgical removal can be discussed individually during fertility treatment. The first step in the diagnosis is imaging. Either ultrasound, MRI or CT can show the cyst or fibroid in detail and assess its blood supply. Other cysts or fibroids may also be seen. Depending on the location and size of the fibroid, it may be removed by laparoscopy or endoscopy of the uterus. The fibroid or cyst is detached from the surrounding mucosa and removed. There are few complications. However, bleeding, infection and pain can occur. A laparoscopy is the much bigger option and is only done as an inpatient. However, if you have a hysteroscopy without complications, you are likely to be treated as an outpatient and go home after the procedure. The lining of the womb usually recovers very quickly after ablation. However, you are advised not to get pregnant for about 6 months. This is to allow the lining to fully regenerate.

Few treatment alternatives available

Research into non-surgical treatments for fibroids and cysts has also intensified in recent years. These are now quite varied. For example, it is possible to reduce the size of fibroids with drugs. However, these drugs are not yet approved for use as a stand-alone treatment without surgery. But they can reduce the size of the operation and make it less complicated. It is also possible to embolise the fibroid. This involves cutting off the blood supply to the fibroid and sclerosing the blood vessels that feed the fibroid. The fibroid will stop growing, but the tissue will remain in the body. If the fibroid is small, this may be a way to avoid surgery. It is also possible to melt the fibroids with X-rays. However, this can cause a lot of pain. It is not known whether this treatment also reduces fertility. Surgical removal is currently the safest way to get pregnant with troublesome fibroids and is still considered the gold standard.

If it is a malignant fibroid or cyst, the doctor will probably need to remove part of the uterus or ovary. Only if the abnormal tissue is completely removed and no tumour cells remain in the body is there a chance of a complete cure. If you want to have children, you will need detailed counselling. This may range from IVF with a preserved womb to womb transplantation. In severe cases, fertility cannot be preserved.

Can fibroids grow during pregnancy?

Yes, because they grow in response to hormones. When oestrogen or progesterone levels rise, fibroids can grow rapidly. This is why they should be checked and measured regularly during pregnancy. This also applies to fertility treatment, which actively changes your hormone levels. This can also stimulate the growth of a fibroid.