Fibroids

Fibroids are growths of muscle in or around the womb. The NHS website calls them common and non-cancerous, and says they do not always need treating. Doctors may write myoma or leiomyoma on a report. It means the same thing.

Women's Health Concern says they range from the size of a pea to the size of a melon, and that symptoms depend on how many there are, how big and where they sit. That is why two women with "fibroids" can have very different months.

Sometimes, nothing. The NHS website says fibroids do not always cause symptoms, and are sometimes found during scans for something else, such as a pregnancy scan.

When there are symptoms, the NHS website lists:

• Heavy periods or painful periods.
• Pain in your tummy or lower back.
• Needing to pee more often or more suddenly. More in bladder and urinary symptoms.
• Bloating, constipation or pain when you open your bowels.
• Pain or discomfort during sex.

Heavy bleeding month after month can leave you anaemic. The NHS website names iron deficiency anaemia as a complication, and it looks a lot like the tiredness everyone blames on perimenopause.

Nobody knows exactly why fibroids grow. Women's Health Concern says they respond to estrogen and progesterone, and are most common in women in their 30s and 40s.

The NHS website lists what makes them more likely: not having reached menopause, never having had a full-term pregnancy, being overweight, high blood pressure or diabetes, a close relative with fibroids, and a Black or Asian background.

Because fibroids are sensitive to estrogen, menopause changes the picture. Women's Health Concern says they often shrink once your periods stop. Often, not always.

• The NHS website says a GP who suspects fibroids will usually refer you for an ultrasound scan, which shows how many there are, where they are and how big.
• The Pakistan Menopause Society asks doctors to look into abnormal bleeding rather than put it down to menopause (Table 1), and lists sudden heavy or prolonged bleeding, bleeding between periods, bleeding after sex and any bleeding after menopause as red flags (2.3).
• The British Menopause Society's guideline on unexpected bleeding during HRT notes that fibroids can stop an ultrasound seeing the whole womb lining, and asks for further assessment when the view is incomplete.

The NHS website says fibroids that cause no symptoms do not always need treatment. For pain or heavy bleeding it lists painkillers, tranexamic acid, and hormone medicines such as the combined pill. If those do not help, it lists surgery to remove the fibroids (myomectomy), to remove the womb (hysterectomy) or to remove the womb lining, and a procedure that blocks a fibroid's blood supply so it shrinks (uterine artery embolisation). Which one depends on the size, number and place of yours.

On HRT, Women's Health Concern says having fibroids is not a reason to refuse or stop it, and that HRT may slow their shrinking a little, though probably not by much. If you have fibroids and are thinking about HRT, tell your doctor about them.

If a hysterectomy is on the table, hysterectomy and menopause explains what it means for your hormones.

The NHS website says to see a GP if you have symptoms of fibroids, if they are affecting your daily life, work or relationships, or if painkillers are not helping.

Do not wait on bleeding after menopause. Once a year has passed without a period, any bleeding needs checking, fibroids or not. The Pakistan Menopause Society treats it as a red flag that needs prompt investigation (2.3, 7.3).

Heavy, unpredictable bleeding runs straight into prayer and fasting. Women ask how to count days when the bleeding will not settle, and what it means for salah or a fast. Those are questions for a qualified scholar. What is causing the bleeding is a question for your doctor, and both deserve an answer.

Many women put up with years of flooding because their mother did too. Heavy periods are common. They are not something you are meant to just live with.