Uterine fibroids are a very common disease, it occurs in almost half of women. The main feature of fibroids is that they develop under the influence of hormones. That is, by changing the hormonal background in the body, fibroids can be taken under control.
Often, fibroids are asymptomatic. But sometimes they cause pain in the lower abdomen, bleeding, and other unpleasant fibroid symptoms.
As a leading Interventional Radiologist and a recognized authority on Uterine Fibroids, Dr. John Lipman has heard his share of myths about uterine fibroids.
Uterine Fibroids: Myths And Reality
Even though the embolization procedure, know as UFE, has been regularly used for over 25 years, there are still a number of mistaken impressions that persist to this day. Dr. Lipman finds that he hears the following ten misconceptions most frequently:
1. If a woman has uterine fibroids, she will have symptoms.
One in three adult women of all races and up to 80% of adult African-American women have uterine fibroids.
These tumors are made up of smooth muscle and fibrous tissue (which makes them hard as a rock) and are most commonly seen in women between 30 and 55 years of age. Most women who have these benign tumors have no symptoms whatsoever.
2. If a woman has fibroids, she must seek medical attention to treat them.
Women who have fibroids but do not have any symptoms [for example, heavy menstrual bleeding, pelvic pain and/or pressure, increased urinary frequency/nocturia (waking up at night to urinate)] do not need any treatment for their fibroids.
One exception to this is the woman whose fibroid(s) have been determined to be responsible for recurrent miscarriage or preventing her from becoming pregnant.
3. If a woman has fibroids, they will eventually turn in to cancer.
Fibroids are benign, non-cancerous tumors. While no imaging test (for example, x-ray, ultrasound, CT scan, and MRI scan) can absolutely exclude a cancer in the uterus, the chance of an unsuspected cancer in a woman with fibroids is rare (approximately 1 in 2,000).
4. If a woman has fibroids and significant symptoms, she must have surgery.
Medical treatment (for example, birth control pills/hormone-containing IUD, nonsteroidal anti-inflammatory medication [for instance, ibuprofen], and tranexamic acid) is often the first line of therapy.
If this does not significantly improve or resolve the symptoms, women are often encouraged to proceed with surgery. Surgery can involve trying to remove some of the fibroid burden surgically (myomectomy) or removing the entire uterus (hysterectomy).
While surgery is an option for treating these women, in the majority of cases this is completely unnecessary thanks to Uterine Fibroid Embolization (UFE).
5. If a woman has significant symptoms from her fibroids and she is not interested in future fertility, hysterectomy is her only option.
Hysterectomy for uterine fibroids should be the option of absolute last resort. Unfortunately, it is often the one and only option mentioned to the woman suffering with fibroids.
Hysterectomy is the second most common surgery performed in the United States. The most common reason it is performed is not cancer (which would be appropriate) but rather benign fibroids. The average age for hysterectomy in the United States is less than 40 years.
6. If my physician doesn’t tell me about UFE or says I’m not a candidate for UFE, then UFE is not a treatment option for me.
Every woman suffering with uterine fibroids who has been told that hysterectomy is a treatment option should also be informed about UFE with a second opinion by an experienced Interventional Radiologist.
IRs are physicians specifically trained in non-surgical procedures like UFE which are performed under x-ray guidance. These procedures treat a number of medical conditions all over the body and are safer, less invasive, less expensive, and have a much shorter recovery than surgery.
With over 90% success rate for UFE, there is no reason women need to lose their uterus over a benign tumor.
7. If a woman is suffering with fibroids and is either finished having children, or not interested in having children, her uterus is no longer important to her.
Women are often told by their physician that they don’t need their uterus once they’re finished having children.
The uterus has a number of important functions for women besides simply bearing them children. Women who have undergone hysterectomy often struggle psychologically without their womb (i.e. like a man being castrated), sexually (for example, loss of orgasm, loss of libido), have increased bone loss which increase their risk for osteoporosis (weak bones), and have an increased cardiovascular risk (heart disease), particularly if the hysterectomy is done before age 50.
There are also a number of risks to the woman in undergoing surgery (hysterectomy). These include but are not limited to bleeding complications requiring transfusion or re-operation, infection, blood clots, and injuring adjacent structures (bowel, ureter most commonly).
8. Endometrial (uterine lining) ablation is a suitable treatment for women suffering with fibroids who are looking to avoid surgery.
Endometrial ablation is a procedure that is designed to burn the thin lining of the uterus to diminish menstrual flow. It is intended for women with heavy menstrual bleeding which is not due to an anatomic cause (i.e. fibroids or polyp related bleeding) and the woman is not interested in future fertility.
Unfortunately, this procedure is often done unsuccessfully to treat fibroid-related bleeding. This commonly fails for two main reasons:
- First, the problem is not the lining in these patients, the problem is the fibroids which cannot be completely addressed by ablation.
- Second, these fibroid patients often also have bulk-related symptoms in addition to their heavy bleeding which cannot be treated at all by ablation.
9. Ultrasound exam is the best imaging tool for fibroids.
While a pelvic ultrasound exam is the most common imaging tool to diagnose fibroids, its resolution is poor compared to a pelvic MRI examination. Ultrasound dramatically underestimates a woman’s fibroid burden (i.e. size, number, location).
This is particularly important when a woman is considering myomectomy and is an absolute requirement for any woman considering UFE.
10. Uterine fibroids grow forever.
Fibroids grow with estrogen stimulation. That is why they grow (sometimes very rapidly) during pregnancy and why they are not typically an issue for women in menopause.
With menopause the fibroids will start to die off naturally, but occasionally, some women early in menopause have bulk-related symptoms due to their fibroids which can be effectively treated non-surgically with UFE.