What are fibroids?
Uterine Fibroids are benign (non-cancerous) tumors of the uterus composed of smooth muscle found normally in the uterus. They are also called myomas or leiomyomas. Fibroids are located in different parts of the uterus.
Why do I have them?
No one knows how fibroids occur. Fibroids affect 40% of women of childbearing age and an even higher percentage of African-American women. There is a link between fibroids and estrogen. That is why fibroids will often grow during pregnancy and that is why they will often cease to be a problem after menopause.
What are the symptoms caused by fibroids?
The most common symptoms from fibroids are heavy menstrual bleeding, pelvic pain, increased urinary frequency, constipation, and painful intercourse. The symptoms result from the fibroids being hard and firm (i.e. like rocks). Depending on their location, fibroids will cause any or all of the above symptoms. If the fibroids are located centrally in the uterus near the lining, they will stretch that lining not allowing it to heal. The result is often heavy menstrual bleeding. Patients often report increasingly heavy flow. They might have episodes of blood flooding or gushing out when the stand up. They might pass large clots.
Patients can become anemic and tired. Other signs of anemia the patient might experience include: chewing/craving ice (or dirt/clay, or laundry starch), migraine-like headaches, lightheadedness, changes in hair (hair loss/brittle hair) or nails, heart palpitations. Sometimes, patients who have been bleeding heavily for a long time, do not realize that this is abnormal. If you change pads more frequently than every 2-3 hours or 8 or more pads per day, this is too frequent.
If the fibroids are near the bladder they can act as a paperweight, not allowing the normal amount of urine to enter the bladder before feeling the urge to urinate. The bladder cannot fill normally and the result is the patient goes to bathroom much more frequently and often wakes up in the middle of the night to go to the bathroom. Often the women feels like her bladder is going to burst if she doesn’t go and is surprised by how little she actually goes when she does empty her bladder. It is because her bladder is being compressed by the rock-like fibroid on her bladder and she actually has relatively little urine in it (it just feels really full).
Fibroids in the back of the uterus can press on the colon and cause constipation. Fibroids near the cervix can cause painful intercourse.
Does everyone need to be treated?
No. Patients who have fibroids with no symptoms do not need any treatment. They will be followed for the development of symptoms.
What are the treatment options available for symptomatic fibroids?
When symptoms are mild, trying to eat healthy, lose weight, and exercise are all very helpful. Fibroids are estrogen-sensitive, and estrogen is stored in fat. Therefore, reducing body fat will help retard fibroid growth. There are some naturopathic medicines that can help with mild fibroid symptoms. Your doctor may also try non-steroidal anti-inflammatory medications (exs. Motrin/ibuprofen, Naproxen, etc.) or birth-control pills to treat mild symptoms.
As the symptoms worsen, in the past surgery was often performed. If a woman was interested in future fertility she underwent myomectomy (removing a portion of the fibroids and sewing the uterus back together). If she had completed childbearing, she would undergo hysterectomy (complete removal of the uterus with or without the ovaries).
Today, there are excellent non-surgical solutions that are safer than surgery, performed as an outpatient (i.e no hospital stay), and have much less recovery time than surgery. These non-surgical options are not only highly successful at treating the symptoms from fibroids, they allow women (even those who have completed their childbearing) to keep their uterus. One of the most important of these are Uterine Artery Embolization (UAE) also known as Uterine Fibroid Embolization (UFE).