It may also cause pain or a feeling of pressure or heaviness in the lower pelvic area (the area between



the hip bones), the back or the legs. Some women have pain during sexual intercourse.

Fibroids are an enormous health care problem because they are the primary reason given for surgery in 199,000 hysterectomies and 30,000 myomectomies performed yearly in the US. The cost of inpatient surgery for fibroids is about $2 billion a year.

They may press against, or block the entrance to, the fallopian tubes, thus preventing the egg from reaching the uterus. Submucous fibroids that grow inwards into the womb are thought to cause recurrent miscarriage. They also can put pressure on the bladder, causing frequent urination.

Fibroids tend to grow very slowly. Their growth is related to the hormonal changes that occur during the menstrual cycle and is affected by the female hormones.

They also can press on the bladder or bowel causing women to pass urine more frequently or to have difficulty in passing a bowel motion. Sometimes the pressure can be uncomfortable or painful. Fibroids are often diagnosed during a routine gynaecological examination (they are felt by the examiner).

The diagnosis can be confirmed by ultrasound scan . Fibroids are common in women of the reproductive age group and tend to reduce in size after the onset of the menopause. They are particularly common in black women and grow to an extremely large size when compared with women who are of a Caucasian background.

Many can be removed via laparotomy (traditional open operation to access the abdominal cavity), laparoscopy (key hole surgery to access the abdominal cavity) or hysteroscopy (viewing the uterine cavity via the cervix with the aid of a telescopic instrument).

The review assesses the differing surgical methods for treating fibroids with regard to improving fertility outcomes with minimal side effects. Fibroids are hormonally sensitive so symptoms are likely to be cyclical, like menstruation.

As estrogen levels tend to increase prior to the onset of menopause, this may cause the size of many uterine fibroids to increase. Fibroids also can make it hard for you to get pregnant. Sometimes fibroids can cause problems with pregnancy, labor or delivery, including miscarriage and premature birth.

They are likely to increase in size each year until menopause. Changes in fibroid size should not be an indication for a fibroid procedure unless accompanied by disabling symptoms. They also can sometimes cause problems becoming pregnant and maintaining a pregnancy.

Fibroid growth seems to be dependent on hormonal fluctuations. Many occur in up to 50% of women, causing symptoms such as heavy periods, pain, infertility, frequent passing of urine and bowel symptoms in up to 25% of cases. Uterine fibroids are the most common reason for women to undergo hysterectomy in the United Kingdom.