Uterine fibroids are a common but little discussed medical condition that far too many patients suffer from—often for years, or even decades, in silence.
According to Dr. Kelly Benabou, a minimally invasive gynecological specialist at Baystate Urogynecology, “One out four patients with a uterus develop fibroids in their lifetime. By the time they reach age 50, 70% of patients have them.”
While fibroids are often referred to as tumors, they are not cancerous. They can, however, cause uncomfortable, life-limiting symptoms and even impact fertility.
What are Uterine Fibroids?
Uterine fibroids are an abnormal growth, or tumor, made up of muscle tissue that grows either in or on the uterus. Some fibroids never get much bigger than a sesame seed while others grow as large as a grapefruit. While the exact cause of fibroids isn’t clear, Benabou says research shows that a high level of the hormone estrogen is partially responsible for fueling their growth.
In addition, there are several factors that may increase your risk for developing fibroids. These include:
- Having a family history of fibroids
- Being overweight or obese
- Being vitamin D deficient
- Early onset period (age 10 or younger)
- Eating a diet low in fiber, fruit, and vegetables and high in red meat
What Are Symptoms of Uterine Fibroids?
According to Benabou, the majority (70%) of patients with fibroids do not experience symptoms, while the remaining 30% may experience symptoms severe enough to interfere with daily living.
“Because fibroids can be different sizes and they can occur in different parts of the uterus, symptoms can vary dramatically,” says Benabou, “and can include things that one might not naturally associate with a uterine issue.”
Common symptoms include:
- A heavy menstrual flow (soaking through pads/tampons every 1-2 hours or large clots)
- Irregular menstrual cycle (varies from a normal 21 to 35-day cycle by 7 days or more)
- Pain, pressure, and sense of fullness in the abdomen
- Back pain
- Frequent urination
- Constipation or diarrhea
- Bloating or a protruding stomach
- Feeling full after eating small amounts of food
In some cases, fibroids may interfere with fertility or may even contribute to miscarriage.
As fibroids continue to grow, they can actually outgrow the blood supply available from the uterus. When this occurs, the fibroid actually begins to die from the inside out. When this happens, the fibroid sometimes shrinks but first it often marks its demise with severe abdominal pain, heavy bleeding, and sometimes a fever. These symptoms can last a few days or a few weeks.
How Are Uterine Fibroids Diagnosed?
Diagnosing uterine fibroids begins with taking a patient history.
Benabou says, “It’s ideal if a patient knows when they had their first period and if they track their period. Thanks to a lot of great apps, tracking your period is a lot easier than it was in the days of paper and pencil.” Among the apps with free version that Benabou recommends are Flo, Clue, and Eve.
She explains, “This information just offers us better insight into what’s happening and determining if fibroids could be contributing to symptoms.”
Beyond information, healthcare providers also rely on the following tools to help with diagnosis:
- Abdominal/pelvic exam
- Bloodwork
- Imaging; most often a pelvic ultrasound, and sometimes an MRI
- A biopsy of the uterine lining may also be recommended.
How Are Uterine Fibroids Treated?
Before diving into treatment options, it’s important to note that for some patients, a “watch and wait” approach may be warranted. Benabou notes that especially for those who have no symptoms, are not attempting pregnancy, are peri- or postmenopausal, and in cases where the fibroids don’t appear to be growing quickly no treatment may just be the best treatment.
“If a patient’s life isn’t being negatively impacted by fibroids, it may be appropriate to monitor closely without medical intervention,” says Benabou. “We of course monitor how the patient is doing and if things change, we’ll reconsider how to handle the issue.”
As for choosing a treatment option, there are a number of factors unique to each patient that should be considered.
“Among the most important considerations is whether the patient is looking for a fertility sparing versus non-sparing option,” says Benabou. “If preserving fertility is desired, we can certainly have options that can help with that.”
Another key consideration when choosing treatment is the size, number, and location of the fibroids.
“Size and placement may take some options off the table,” says Benabou. “But nothing is untreatable.”
Common treatment options include medication, non-surgical procedures, and surgery. With the exception of a hysterectomy, no treatment option can guarantee that fibroids will not return.
Here’s a closer look at each treatment option:
Medication
Hormonal Birth Control
The most common treatment for fibroids, birth control with estrogen-progesterone or just progesterone may be prescribed in either pill, injection, patch, IUD, or ring form to help with bleeding.
Gonadotropin
The next step in treatment of fibroid, gonadotropin puts your body into a state like menopause. While fibroids do shrink due to receiving less estrogen while taking the medication, patients also experience the symptoms of menopause, include night sweats, hot flashes, etc. In addition, gonadotropin is associated with serious side effects, such as bone loss. Given that, it’s not recommended to be used for more than six months to a year at a time. Therefore, it is not a permanent solution to the problem.
While not for everyone, gonadotropin can be a good choice if you’re looking to shrink fibroids before surgery, to stop heavy bleeding, or to treat symptoms for a short time before menopause.
Tranexamic Acid
A non-hormonal medication, tranexamic acid is taken orally specifically to address heavy bleeding. It does not impact the size of fibroids and is to only be taken during menstruation (up to 5 days maximum).
Non-Surgical Procedures
Uterine Artery Embolization
This uterine-sparing procedure involves cutting off the blood supply to fibroids. Found to reduce fibroid size by 50% and to help with bleeding, UAE provides relief in up to 90% of patients who undergo the procedure.
But because UAE affects blood supply to the uterus, it is not recommended for patients looking to preserve fertility.
High-Frequency Ultrasound
Using MRI-guided focused high intensity ultrasound or radiofrequency ablation, this procedure serves to kill fibroids and reduce their size by 30-50%. This procedure is ideal for patients with 3 or fewer fibroids measuring less than 10 cm. At this time, research suggests this may be a safe option for anyone looking to preserve fertility.
Surgical Procedures
Myomectomy
A uterine-sparing procedure, a myomectomy can be performed hysteroscopically (transvaginally), minimally invasively (laparoscopically / robotically), or open procedure removing fibroids growing in the uterus safely while preserving fertility.
Hysterectomy
The ultimate blow to fibroids, a hysterectomy involves removing the entire uterus and any fibroids. Depending upon the needs of each patient, the procedure can be performed as a minimally invasive surgery but, in some cases, a larger abdominal incision may be required. With the uterus removed, there is zero risk of fibroids returning.
If fibroid symptoms are interfering with your daily life, contact your healthcare provider. They can help you determine the best option for managing symptoms and treating fibroids in a manner that’s consistent with your life goals.