Question: I’m 35 years old and have uterine fibroids. My periods are heavy and painful and my doctor wants to do a hysterectomy. My hemoglobin is low, I am always tired and I have difficulty concentrating at work. I also notice that I constantly chew and crave ice? I feel addicted to it. What is going on with me? Should I just get a hysterectomy to be done with all of this?
Answer: Your situation is very common for a woman with fibroids. Fibroids are the #1 reason women have heavy periods. Your periods are heavy due to the fibroids. You’re losing too much blood each month with your period that results in iron deficiency anemia.
Craving And Chewing Ice: Iron Deficiency Anemia
A general condition called Pica describes people who consume non-edible foods such as chalk, coal, clay, sand, ice, etc. Craving and chewing ice is a form of pica and is known as pagophagia. The cause of Pagophagia is unknown, however, in most cases, craving ice is associated with iron deficiency anemia.
The hemoglobin in red blood cells contains iron among other elements. The hemoglobin is responsible for carrying oxygen to tissues throughout the body. When iron is insufficient, the body cannot produce enough hemoglobin (read red blood cells) and consequently cannot deliver enough oxygen from the lungs to the rest of the body. Iron deficiency is normally caused by:
- blood loss,
- Iron poor diet,
- inability to absorb iron, and
- pregnancy.
Heavy prolonged periods are the most common symptoms of uterine fibroids in women. When suffering from fibroid bleeding, a woman can lose a lot of blood. Chronic blood loss leads to iron deficiency anemia (IDA) resulting in marked fatigue, lethargy, brain fog (“cloudy thinking”), migraine-like headaches, heart palpitations, hair thinning, and hair loss.
Another clinical sign of IDA is chewing and craving ice or pagophagia.
Women with Fibroids: How Can I Stop Craving Ice?
Pagophagia is an addiction and part of a larger group of craving edible and non-edible items called pica. Some of the other more commonly craved items include chalk, corn starch, flour, or in my neck of the woods Georgia white dirt (kaolin).
When fibroid patients have heavy periods and are chewing and craving ice, 100% of them have iron deficiency anemia. Craving ice and anemia are often interconnected.
This can be confirmed with a simple blood test to check the Hemoglobin level in the blood. Normal is >12g/dL, while 10-12 mild, 7-10 moderate, and <7 severe anemia.
The treatment for IDA due to fibroids is to treat the fibroids. While patients whose hemoglobin levels are in the moderate or severe range cannot undergo fibroid surgery due to the added blood loss the surgery causes, these patients can undergo Uterine Fibroid Embolization (UFE).
If the patient is unaware of the nonsurgical option UFE, she may receive intravenous iron infusions and/or medication to temporarily stop her period in an attempt to boost iron levels high enough to safely perform a surgical operation.
These measures are analogous to bailing water in a leaky canoe. The intravenous iron is trying to “keep the patient afloat”, but does not directly address the underlying problem (i.e. the fibroids).
Fibroid Symptoms Can Be Eliminated with UFE
Alternatively, I recommend investigating uterine fibroid embolization (UFE). With UFE there is no need for any of those temporizing measures because UFE is not surgery, and there is no blood loss with this outpatient, non-surgical procedure.
Once the patient undergoes UFE, her periods will get progressively lighter over the next several cycles. This will allow her to correct the iron and hemoglobin deficit on her own by eating healthy iron-rich foods (e.g. red meat, beans, lentils, dark leafy greens, molasses, etc.). Once her anemia is corrected, she will notice a dramatic increase in her energy level. She will no longer chew or crave ice and the rest of her anemic symptoms will also cease.
In summary, no, I wouldn’t get a hysterectomy. Hysterectomy for uterine fibroids should be the option of absolute last resort, not the first and only option as you were presented.
With UFE, you get the relief of symptoms that you’re looking for, you avoid the significant risks and long recovery of a surgical operation, and importantly you get to keep your uterus! I suggest you find a very experienced Interventional Radiologist who has treated hundreds if not thousands of fibroid patients; preferably in an outpatient setting like the Atlanta Fibroid Center.
