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F is for Fibroids

Fibroids are tumors of the uterus and are the most common pelvic tumors in women. They are benign and arise from the muscle layers of the uterus.

The reason I write about them is because probably 80 percent of all women will have a fibroid in their uterus by menopause. Most of the time, they will not cause any problem for the woman, but sometimes they can lead to abnormal bleeding, pelvic pain or pressure, or affect a woman’s chance to conceive.

There are different locations for fibroids in the uterus. They can be in the outer layer (subserosal); they can be within the wall of the uterus (intramural); and they can be inside the uterus (submucosal). Sometimes fibroids can be found in the cervix. The outer layer fibroids can make the uterus enlarged and distorted, and the inner fibroids can cause heavy bleeding when a woman is menstruating. The fibroids are affected by women’s hormones: estrogen and progesterone.

African-American women seem to be more susceptible to fibroids. They can also develop symptoms earlier in their lives and their symptoms can be more severe.

What are some of the risk factors for developing fibroids? Early menarche (younger than 10 years old), not having children, high blood pressure, and family history all increase the risk for developing fibroids. Eating a lot of red meat, ham, soy products or alcohol (especially beer) appear to increase the risk of developing fibroids. Consuming green vegetables and dairy products will decrease the risk of fibroid development. Birth control pills do not cause fibroids to grow. And postmenopausal  hormone replacement therapy may increase the growth of fibroids already present in a woman’s uterus, but will not cause new fibroids to grow.

When a woman has problems with fibroids, it can be debilitating. Urinary frequency, back pain and constipation can occur. Bad cramping before and during her period, along with pain with intercourse, can affect their lives. And heavy prolonged periods with passing of clots can cause anemia and social issues.

One of my patient’s shared that she was at a restaurant in white pants and started bleeding so heavily that she had to leave the restaurant in total embarrassment. This same patient went on to have surgery (hysterscopic resection of the fibroid) and told me that afterwards she used less pads in a year than she had used in each month before the surgery. Bleeding from fibroids does not occur in between your periods but rather it makes your normal periods abnormal. If a woman has a fibroid sitting inside the cavity of her uterus, it can make it difficult for her to conceive, increase her risk of miscarriage, and cause problems during her pregnancy.

Women need to see their gynecologists at least yearly, and if there are any of these symptoms, a patient should undergo a transvaginal sonogram. It is an extremely sensitive test and will be able to give results to the patient immediately.

If heavy bleeding is the problem, we put saline into the uterus and can find if the fibroid is in the cavity and the culprit. This procedure is called a saline sono HSG. It is done in the office. MRI of the pelvis also can help discover where the fibroids are in the uterus. Surgery can resect the fibroids and allow a woman to live a normal life.

The incidence of cancer in fibroids is extremely low — 3-7 per 100,000. If a woman has a fibroid in her uterus and is bleeding after menopause, a red flag should go up that this could possibly be cancer. And, if fibroids grow rapidly they should come out, because it could be cancer.

The good news is that fibroids will shrink after menopause. If a woman can hang in there, and even try birth control pills to control the abnormal bleeding, she could buy some time until menopause. If surgery needs to be performed, there are myomectomies, where only the fibroids are removed; there are hysterscopic resection of fibroids; D&C, where a fibroid in the cavity can be shaved down; there are hysterectomies, where the uterus is removed; and also embolization procedures performed by a radiologist to decrease the blood supply to the fibroids and allow them to shrink.

I hope this has been informative. I know for me as a gynecologist, it is so rewarding when I have cured a patient of their symptoms from their fibroids. Just for my patient to feel normal and have easier periods can make all the difference in the world.

Stay tuned for G  — Getting through Perimenopause– A Patient’s Story

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