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 and I am increasingly fatigued and 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. Your periods are heavy due to the fibroids. Fibroids are the #1 reason why women have heavy periods. You’re losing too much blood each month with your period.
Craving And Chewing Ice: Anemia And Fibroids?
The blood contains iron and hemoglobin which are found in your red blood cells and are responsible for carrying oxygen to your tissues throughout your body.
This continued deficit leads to iron deficiency anemia (IDA).
Some of the clinical signs of IDA are marked fatigue, lethargy, brain fog (“cloudy thinking”), migraine-like headaches, heart palpitations, hair thinning/hair loss, and chewing/craving ice (pagophagia).
Why Does Anemia Make You Crave 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/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. However, patients whose hemoglobin levels are in the moderate or severe range cannot undergo fibroid surgery due to the added blood loss the surgery causes.
If the patient is unaware of the nonsurgical option Uterine Fibroid Embolization (UFE), she may receive intravenous iron infusions and/or medication to temporary 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 intraveonus iron is trying to “keep the patient afloat”, but does not directly address the underlying problem (i.e. the fibroids).
Alternatively, I recommend investigating 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, nonsurgical 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 (exs. 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.
Good luck to you. I hope you find relief very soon. Dr. L.