As July and Fibroid Awareness Month comes to a close, I wanted to take this opportunity to discuss a common issue affecting many women. Fibroids can affect up to 80% of women by the age of 50 and is even more common in African-American women. Here’s what you need to know:
What are fibroids?
Fibroids are benign (NOT cancerous) growths in the uterus. Each fibroid starts from abnormal growth of one muscle cell in the uterus. They can occur in 3 locations in the uterus. Submucosal fibroids push into the cavity on the inside of the uterus, intramural fibroids are within the muscle of the uterus and subserosal fibroids sit on the outside of the uterus. While fibroids are not cancerous and do not turn into cancer, there are some rare types of uterine cancer that can look and behave like fibroids, so it’s important to have suspected fibroids evaluated.
What problems do fibroids cause?
Some fibroids don’t cause any symptoms at all, but others can cause one or more issues depending on their size, location, and number. If you have any of the symptoms below, you should be evaluated for possible fibroids.
- Bleeding: fibroids can cause heavy, prolonged and irregular periods. Sometimes heavy bleeding and clots are severe enough to cause anemia, even requiring blood transfusion at times.
- Bulk symptoms: large fibroids or multiple fibroids can cause symptoms due to bulkiness. They can give a sensation of pelvic pressure and fullness and even cause protrusion of the belly. They can put pressure on the bladder causing urinary frequency, leakage and difficulty emptying the bladder. They can put pressure on the bowels causing constipation and difficulty with bowel movements and reflux or heartburn. On rare occasions, fibroids can be large enough to put pressure on and even block off the ureters, which are the tubes connecting the kidneys to the bladder. When this occurs, urine backs up into the kidneys and can cause kidney damage and even kidney failure. Similarly, the fibroids can put pressure on the veins in the pelvis decreasing blood flow and leading to dangerous blood clots.
- Pain: fibroids can cause pain, most often cramping pain during periods or pain with sex. However, as fibroids grow, they can temporarily outgrow their blood supply, which leads to degeneration of the fibroid and pain even outside of menses and sex. Pressure from fibroid bulk can also cause pain.
- Fertility issues: while many women can and do get pregnant with fibroids, some fibroids can cause issues with pregnancy. Submucosal fibroids can distort the endometrial cavity causing difficulty with implantation. This can lead to miscarriage. If a pregnancy does continue, fibroids tend to grow during pregnancy and can cause issues of pain during pregnancy. They can also make it more difficult to monitor the size and growth of the baby. They can block the birth canal impeding vaginal delivery and can cause more bleeding during both vaginal deliveries and c-sections.
How do you treat fibroids?
If fibroids are not causing you any problems, you don’t need to do anything about them. However, fibroids tend to grow during the reproductive years and treating larger fibroids can be more difficult than treating smaller fibroids. After menopause, fibroids tend to decrease in size. They may cause some pain while they degenerate, but this is typically temporary. Treatment of fibroids depends on several factors including a woman’s symptoms, her desire for pregnancy and the size, location and number of fibroids.
- Diet: there are no specific dietary factors that have been shown to treat fibroids. There is some evidence to suggest that fibroids are more common in women who eat more red meat and less vegetables and that fibroids are less common in women with more dairy and vitamin A in the diet.
- Hormonal treatment: hormonal treatments like birth control pills, patches and rings, as well as, IUDs can help to manage the bleeding of fibroids and sometimes reduce pain, but they do not help the bulk symptoms. GnRH agonists like Lupron injections can decrease the size of fibroids, reducing both bleeding and bulk symptoms, but this is a temporary option, usually to aid in surgical management. Once the treatment is stopped, the fibroids will return to their larger size. While there are some additional hormonal options, these are either experimental, not widely available, or less frequently used due to side effects.
- Uterine artery embolization: uterine artery embolization is a procedure done by interventional radiologists to shrink the size of fibroids. This involves accessing the blood vessels in the groin, which connect to the uterine blood vessels. Small beads are placed within the uterine blood vessels to decrease the blood flow and cause degeneration of the fibroids. While this procedure does not eliminate the fibroids, it can reduce the size by 30-60%, which can be enough to manage symptoms in some women. However, this is not a good procedure for women who still desire pregnancy.
- Hysteroscopic treatment: there are 2 procedures done hysteroscopically that can help treat fibroid symptoms in some women. Hysteroscopy means using a camera and instruments through the vagina and cervix to operate in the uterus without incisions. A hysteroscopic myomectomy removes submucosal fibroids, which can be very helpful in treating bleeding and fertility issues with minimal recovery time. An endometrial ablation is a procedure which burns the lining of the uterus to stop or reduce bleeding. This does not treat the fibroids themselves, but can manage the bleeding. Endometrial ablation is not recommended for women who want pregnancy in the future.
- Procedures to ablate or remove fibroids: there are several different techniques to ablate fibroids including high-frequency ultrasound, cryoablation, and radiofrequency ablation. These options are newer and some still experimental. They show promise in offering minimally invasive options for women, but it is still unclear how they may affect future pregnancy. For women who desire pregnancy and have symptomatic fibroids other than submucosal fibroids, myomectomy (surgical removal of fibroids) is the best option.
- Hysterectomy: for women with symptomatic fibroids who have completed childbearing and desire definitive treatment, hysterectomy is a good option. This eliminates bleeding, bulk and pain symptoms and makes recurrence very unlikely. Hysterectomy can usually be accomplished in a minimally invasive approach, sometimes with the use of GnRH agonists to temporarily decrease the size of larger fibroids prior to surgery.
Fibroids are common and can decrease the quality of life for many women and in some cases, can become dangerous. If you suspect that you have fibroids, consult a qualified gynecologist for further evaluation and to discuss which treatment options are best for you.