My first patient this morning, a normally chipper young lady, greeted me with a somber nod. When I asked what was wrong, she took a deep breath, bit her bottom lip, thrust an ultrasound report in my face, and dramatically sighed, “I have a FIBROID.” I reviewed the report. It showed a tiny fibroid that was causing no issues – other than emotional angst.
My next patient, though she had not listed any issues or concerns on her “new patient” forms, had a visibly swollen abdomen. When I examined her, her uterus was swollen with fibroids and felt like a giant lumpy soccer ball. She admitted that her periods were so heavy that she had needed blood transfusions before. When I asked why she didn’t get her fibroids treated, she said with a shrug that she didn’t know they were there.
Fibroids (tumors of the uterus) can vary in size, symptoms and the amount of stress they produce. And they’re extremely common – affecting around 60% of women. It may sound scary that more than half of all women are walking around with tumors lurking in their uteri, but there is no need to fret. Fibroids are non-cancerous, and the great majority do not cause much drama. They can generally be safely ignored unless they are bothering you or interfering with your health.
The uterus is an organ that is made of muscle, and fibroids are muscular growths. With fibroids, much like real estate, it’s all about “location, location, location”. There are 2 main types of fibroid locations: in the muscle/body of the uterus (mucousal); and in the inner lining/endometrium (submucousal), which tends to cause the most problems.
Fibroids deep in the muscle (mucousal) of the uterus are the most common type. These fibroids usually only cause issues if they are large. The most common symptoms are heavy, painful menstrual cycles and pelvic pressure. Fibroids increase the size of the uterus. As the uterus gets bigger, it requires more and more blood flow. The increased blood flow and size of the uterus can stimulate extra tissue to grow in the inner lining, causing heavier periods. The heavy menstrual cycles can lead to passing large, painful blood clots and anemia from the amount of blood loss. The tumors can also push on the organs around the uterus. Tumors on the front on the uterus can cause bladder issues like frequent urination or inability to empty the bladder. Fibroids on the back of the uterus can push on the colon, adding to constipation or causing a weird pressure sensation with bowel movements. Occasionally fibroids will get so large that they can compress the ureters (the tube between the bladder and the kidney). This can, though rarely, lead to kidney damage.
Fibroids on the inside of the uterus (submucousal) often cause more bothersome symptoms. They can interfere with your ability to get pregnant if they are impinging on the inner part of the uterus where the baby implants. Also, even when they are small, they can cause heavy, painful cycles. It’s like having a little rock stuck in your uterus – so when the uterus contracts to push out the blood, it’s contracting around a rock. Ouch.
There are a lot of different treatment options for fibroids, based on the patient’s symptoms. If the fibroids are not causing any problems, we will usually monitor them with exams and/or ultrasounds. If heavy bleeding and pain are an issue, then the fibroids can be treated with hormones or surgery.
Fibroids that grow on the inside of the uterus (submucousal) are best treated surgically. This is usually a minor procedure, similar to a D&C where the fibroid is scraped out.
Surgery on bulky fibroids in the muscle of the uterus is a little trickier. If a women is not planning on having children in the future then removing the uterus itself is often less complicated to then trying to dig the fibroids out and then attempt to reassemble the uterus. If she wants to maintain her fertility then a myomectomy (removal of the fibroid) can sometimes be performed, but it is often a major surgery.
While hormonal therapy doesn’t decrease the size of the fibroids, it can lessen the heavy, painful periods that the tumors can cause. Hormonal therapy can come in the form of pills, shots or an IUD made of progesterone. The hormones work by thinning the uterine lining so there is less tissue to shed off with the cycles. The progesterone IUD (Mirena) has the additional advantage of applying the hormone topically and not having systemic side effects that some women get with the hormonal pills or shots.
Another therapy is uterine artery embolization, this involves a radiologist inserting coils in the arties leading to the uterus – this cuts off the fibroid’s blood supply and shrinks it (this therapy is usually not recommended if you plan to have more children). There are a variety of other surgery and hormonal therapies that can also be used in specific circumstances.
Fibroids are common, and are typically not dangerous. If they are not bothering you and your gynecologist confirms they aren’t annoying any of the organs around them, they can be safely left alone and monitored. But if they are causing pain or bleeding, there is no need to suffer – we have lots of great tools to deal with fibroids and their symptoms.