Fibroids
Fibroids are tumors that grow in the muscle layer of the uterus (myometrium) and are almost always benign (not cancerous). Sometimes they grow to be large and painful while in other cases, they cause no symptoms. There are several different types of fibroids depending on where they are in your uterus. It is estimated that 70-80% of women will develop fibroids in their lifetime.
What causes fibroids?
At this point, what causes fibroids is not well understood although there are certain populations that face a higher risk than others.
Who is at a higher risk?
There are several factors to consider as we think about fibroids.
Age is one of them. The prevalence of fibroids increases as you get older. Usually in the reproductive years, in the mid-30s, you could start to have symptoms.
Race plays a part as well. African American women tend to have symptoms earlier, around their late-20s. This may be in part because Black patients tend to get their periods at a younger age and the earlier you get your menstrual cycles, the more at risk you are for developing fibroids. Differences in things like diet, lifestyle, and psychosocial stress are also thought to contribute.
There is a genetic component to fibroids. Your family history matters. For example, if your mother or sister has had fibroids, you are more likely to have them too.
Obesity and lifestyle increase risk too. It is still being looked at, but many believe a high BMI puts you at risk for fibroids. Many also think too much red meat, smoking, drinking alcohol, and a Vitamin A or D deficiency can be risk factors for fibroids.
Symptoms
The main symptom of fibroids is heavy bleeding with your period. It is not the norm to need to change a pad every hour or to have regular accidents. If your bleeding is so heavy it is causing you to miss work, you should get checked for fibroids. Fibroids can also sometimes be painful and cause constipation, issues with urination, chronic pelvic pain, pain while having sex, or even issues with pregnancy.
If you think you are bleeding too much, bring it up with your primary care doctor or OBGYN. The doctor will likely give you a pelvic exam and may have you get an ultrasound as fibroids are visible on an ultrasound. Your doctor may also refer you to a specialist.
Possible Treatment
Most women can function and move around with fibroids. The issue is when you develop symptoms which is how your doctor will determine your treatment. If you are dealing with heavy bleeding, for example, we may start you with some hormonal methods like a birth control pill or patch to help control the bleeding. But if you have big fibroids, those medications don’t shrink the fibroids. One less minimally invasive approach is called
uterine artery embolization. That's done with radiology to shrink the fibroids and decrease the amount of bleeding you have. But it's only temporary and usually not recommended for women that plan for pregnancy.
There is also surgery. The definitive way to take care of fibroids is a
hysterectomy, where we remove your uterus. This surgery means the end of your menstruation and you will lose the ability to get pregnant. However, it doesn’t mean you will go into menopause as we would leave your ovaries. We also offer a
myomectomy where we take out the fibroids. I recommended this procedure for people who want to have kids in the future or want to keep their uterus. There are three main approaches to a myomectomy: abdominal, laparoscopic, or hysteroscopic. The
Abdominal Myomectomy is a major procedure requiring a big incision. The incision can be horizontal and usually around the same location as a C-section incision or can be a midline vertical incision if a patient has extremely large fibroids. It usually takes 6 to 8 weeks to recover. There is also
Laparoscopic and Hysteroscopic Myomectomy. This is one of my specialties as a Minimally Invasive Gynecologic Surgeon. Both options allow patients to go home on the same day.
Laparoscopic Myomectomy is also a major procedure that uses tiny incisions on your abdomen. It generally only takes a patient up to 4 weeks or less to get back to work.
Hysteroscopic Myomectomy allows the surgeon to remove fibroids through the vagina and cervix. Recovery is usually 2-3 days.
Fibroids or Endometriosis?
Fibroids and
Endometriosis are often confused. A painful period can generally be attributed to endometriosis. If it’s heavy bleeding, it is generally caused by fibroids. If you are experiencing either painful periods or heavy bleeding, it is best to see your doctor.
Disclaimer: While I am a doctor, I am not your doctor. The content in this blog is for informational and educational purposes only and should not serve as medical advice, consultation, or diagnosis. If you have a medical concern, please consult your healthcare provider, or seek immediate medical treatment.
