Fibroids are benign (non-cancerous) tumours of the muscle in the uterus (womb). Fibroids are extremely common and are believed to affect to affect one in five women of childbearing age. Most Women with fibroids are in their late reproductive years, that is, their 40's or early 50's.

Fibroids can range in size. They begin small and grow slowly over a period of years. The cause of fibroids is not clear, but it is known that they grow more quickly when levels of the female hormone oestrogen content. Fibroids usually stop growing and shrink, when oestrogen levels drop during the menopause.

Fibroids may not cause any symptoms. They may, for example be discovered by accident during a routine pelvic examination. However, some women with fibroids may experience excessive bleeding during menstruation or irregular bleeding during the cycle, which can lead to anaemia. Large fibroids may place pressure on surrounding organ such as the bladder or intestine, leading to symptoms such as difficulty in urinating or sometimes the frequent need to urinate. Fibroids can also cause discomfort ranging from a low backache to a sharp pain which can occur if the fibroids becomes twisted or outgrows its blood supply. The severity of symptoms varies with the size, number and location of the fibroids.

There sometimes may be a connection between fibroids and infertility. If you have fibroids, you will probably want to discuss treatment with your doctor before becoming pregnant.

If your fibroids are relatively small and causing no discomfort, your doctor may decide that no treatment is necessary. Instead, he or she may recommend pelvic examinations and ultrasound studies so that the fibroids can be monitored. If you are already pregnant doctor will not prescribe anything more than pain killers accompanied by careful monitoring throughout pregnancy.

For women who experience symptoms such as pain or excessive menstrual bleeding due to fibroids, possible treatments include hormonal therapies such as progestogens. Progestogens given in high doses make the body 'believe' it is pregnant - thus stopping menstruation. Side effects are similar to those experienced before menstruation, such as water retention (bloating) or occasionally mood swings.

For younger women who wish to retain their ability to become pregnant, a myomectomy may be the preferable procedure. There may also be psychological reasons why a women does not want to lose her uterus. However myomectomy may be a more complicated procedure than hysterectomy, particularly if there is more than one fibroid. As the uterus is still intact, there is always the possibility that new fibroids will grow. Hysterectomy is often recommended for older women who either have had their families or do not wish to have children. Hysterectomy can either be performed vaginally or abdominally, depending on the circumstances.

A new class of medication known as GnRH agonists, are now available as an aid to preparing patients with fibroids for surgery. GnRH agonists work by almost completely stopping oestrogen secretion by the ovaries. As a result, fibroids, which are dependent on oestrogen, shrink in size. Shrinking the fibroids can make surgery both simpler and shorter. For women with busy schedules, there can be greater flexibility in terms of choosing a date for their surgical procedure. In addition, because menstruation stops, women who suffer from severe blood loss due to fibroids have time to gain strength so that they are in better health for their operation. Finally, because the operation itself often requires a smaller incision in the uterus following GnRH therapy, there is likely to be less blood loss, and post - operative recovery time can be shorter as well as less painful.

Because fibroids will return to their former size once therapy with GnRH agonists ends, these agents are not considered a long-term treatment, but rather as preparatory therapy prior to surgery. Side effects of GnRH agonists include those associated with menopause, such as hot flushes, night sweats, vaginal dryness and loss of bone calcium, which is largely reversible following the end of therapy.