uterine fibroids and what to do about them, if anything
“My uterus went to the Dark Side.”
That’s how Ann-Marie Archer described life before discovering she had fibroids. “It was horrendous,” she told us: period flow so heavy, she had to plan around it, vaginal pain, incontinence.
And the worst of it was not knowing what was going on or if her experience was normal. Her doctor kept brushing off her concerns as “just menopause,” and searching the Web didn’t really help – there just wasn’t much information out there. But when she twice bled hard enough to soak her surroundings, she knew she had to push for answers.
Turns out, she had uterine fibroids. But that wasn’t all. Surgery revealed she was at the tipping point for uterine cancer, with pre-cancerous cells already developing. Insisting on answers probably helped save her life.
Fortunately, the vast majority of fibroids are benign (not cancerous), and many women don’t even know they have them. However, even the benign ones can cause unpleasant and sometimes dangerous symptoms, depending on location and size, so if you have them, it may be worthwhile to investigate your options.
To get more information on fibroids, their causes and treatments and what to look out for, we talked with Dr. Suzanne Gilberg-Lenz, ob/gyn, integrative medical doctor, and Clinical Ayurvedic Specialist.
Also: Dr. Gilberg-Lenz discusses the opioid epidemic and why women in midlife may be at a higher risk of addiction
What are uterine fibroids?
Womenshealth.gov describes uterine fibroids as “muscular tumors [i.e. made up of muscle cells] that grow in the wall of the uterus.” A woman may have one or many, and they range in size from apple-seed small to grapefruit, though in rare cases, they can grow much larger.
How do I know I have them?
For women like Ann-Marie, the symptoms are extreme enough to prompt further testing. Other symptoms include heavier, longer, more painful periods, pain during intercourse, incontinence, pelvic, back, and leg pain, and fertility issues, so women experiencing these should talk with their doc.
For women with lesser symptoms or no symptoms at all, the fibroids may initially be discovered (or suspected) when a gynecologist detects an irregularity during a routine pelvic exam. Often an ultrasound will then be used to confirm, map, and measure the fibroids.
How common are uterine fibroids?
According to Dr. Suzanne, they are the most common benign tumor in women. Prevalence rates vary from 5-25 percent, with a lifetime risk of 70 percent for women. However, fibroids are approximately three times more common in African American women than white women.
Are they hereditary?
Dr. Suzanne tells us there does seem to be a familial inheritance pattern and some racial differences. Based on those tendencies, newer research is focusing on possible genetics as a target for therapies, but the exact cause of fibroids remains elusive.
What should I do if I think I have uterine fibroids?
The treatment depends on the symptoms caused, says Dr. Suzanne, as well as on the location, size, rapidity of growth, and number of lesions.
For instance, a large fibroid in the anterior wall of the uterus may put pressure on the bladder and cause urinary symptoms; fibroids growing into the uterine lining can cause irregular or very heavy vaginal bleeding. In these cases, women may opt for a hysterectomy. And indeed, fibroids are the number one reason for hysterectomies. However, Dr. Suzanne says, you should talk with your doc about all your options: minimally invasive outpatient surgical options like myomectomy (removal of only the fibroids) are available and an excellent option for many women.
Although cancer in a fibroid is rare, says Dr. Suzanne, occurring in approximately one in a thousand fibroids, rapidly growing fibroids in post-menopausal women should be managed by hysterectomy, as the risk of cancer increases substantially in that situation.
For women experiencing heavy bleeding, there are hormonal options such as birth control pills or progestin-containing IUDs, and there may shortly be a new daily oral therapy available to manage symptoms and shrink fibroids.
Womenshealth.gov cautions against using power morcellators to break up fibroids because they could spread cancer. Should I avoid this treatment?
According to Dr. Suzanne, the American College of Obstetricians and Gynecologists (ACOG) and other professional guidelines at this time do not recommend the use of power morcellators.
However, she adds, “I think that in the hands of skilled and experienced laparoscopic gynecologic surgeon, the morcellator with a bag attached is an option. If you have already had the procedure, and the pathology on your tumors was benign, there is nothing to worry about. For added peace of mind, you could consult with a gynecological expert in fibroids or a gynecological oncologist.”
Once I’ve had fibroids removed, is there a chance they’ll come back?
Unfortunately, yes, says Dr. Suzanne, especially if you are pre-menopausal. “Fibroids are notorious for re-growing, and there are often tiny seedlings that we cannot see or feel at the time of surgery deep in the uterine wall that can grow over time.”
Can I do anything to minimize my risk of getting fibroids (or getting them again)? Diet, exercise, HRT, etc.?
There are no proven strategies that prevent fibroids from growing or returning, Dr. Suzanne says; many lifestyle studies have been conducted, and none have demonstrated any efficacy from abstaining from alcohol, changing diet, increasing exercise, and so on.
Should all fibroids be removed or otherwise treated? Is it dangerous to leave them untreated?
If fibroids are not symptomatic or rapidly growing, they really don’t need any treatment, Dr. Suzanne reassures us. “Watchful waiting is a reasonable strategy; as we pass through menopause, they often shrink, and symptoms disappear or diminish,” she says.
So there you have it: quite common, often problematic, rarely dangerous. If you suspect you may have fibroids, especially if you’re experiencing symptoms and you have a family history, mention it to your gynecologist. While the chances are high any fibroids discovered will be harmless, they can still cause discomfort and annoyance. Plus, you know … peace of mind.
Have you dealt with uterine fibroids? What did you do about them, if anything? We’d love to hear your story about symptoms, diagnosis, and treatment, so leave a comment below, shoot us an email at email@example.com, or talk to us on Facebook or in Gennev’s closed Facebook group.
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