Help for Women with Fibroids
As women, we must take better care of ourselves and each other. If you think you may have fibroids, this post is for you. If you know someone who has been diagnosed with fibroids, please pass this informative and in-depth post on to them. Dr. Lorie Johnson is dedicated to promoting good health for women and is committed to healing them as well.
Fibroids (also known as fibroid tumors) are the common name for benign solid uterine growths called leiomyomata (lie-o-my-o-ma-ta). They are known to occur in approximately 55 % of all women, but some studies suggest that they may be as common as 80%.
Fibroids are known to be somewhat more prevalent (they occur more often) in women of color; however, many women of European descent are also affected. They tend to occur least in women of Asian descent — this may be due to the diet of Asian women and their overall lower body fat ratio. They also appear to have a hereditary component in that they tend to occur within many or all of the women in a particular family.
There are many theories about the cause of fibroids, but to date, none have been definitely proven. It is postulated that fibroids occur as a result of a high fat diet or a diet high in dairy products. It is this theory that supports the reason why they occur less in Asian women.
Asian women tend to eat a diet that is low in saturated fats and animal protein. We do know that fibroids respond to elevated levels of estrogen. This may be a contributing factor to the development of fibroids in obese women or in those who have elevated circulating estrogen levels for various reasons. Some studies have shown that women of African descent may have higher levels of circulating estrogen than their European counterparts, which may be the cause for the higher incidence in that population.
Fibroids tend to increase in size during pregnancy, and usually decrease after menopause. What we do know is that whatever the underlying cause, fibroids are a problem that many women, and the doctors who treat them, must deal with. Fibroids are the leading cause for hysterectomy and are the reason for thousands of other surgical procedures, and millions of doctor visits each year. They can range in size from very small (the size of a pea) to very large (the size of a cantaloupe) and can be in various locations in and around the uterus.
While they do play a role in infertility, that is certainly not the most pressing problem that fibroids can create. The vast majority of women with fibroids have problems with bleeding. They bleed heavily, and for long periods of time (more than 7 days). Now, most women bleed “heavily” for one or two days of their period and then it tapers off. Women with symptomatic fibroids tend to bleed heavily for 3-5 days or longer. Bleeding of this nature often leads to iron deficiency anemia, which causes decreased energy, fatigue, shortness of breath and sometimes syncopal episodes (fainting).
Another common problem with fibroids is pelvic pain and pressure. Because fibroids expand the volume of the uterus, they can put pressure on the pelvic floor and cause the uterus to feel very heavy. They can also cause back pain (especially in a retroverted uterus) and abdominal pain. Fibroids can distend the abdomen and cause bloating. They can also cause pain during intercourse. If fibroids press on the bladder, they can cause frequent urination from reduced bladder capacity. They can also cause constipation from compressing the large bowel.
So, what do you do if you have fibroids?
Well that depends. If you have fibroids and they are not bothering you in any way, don’t do anything! There is no need to intervene in any way for an asymptomatic small fibroid. As long as your periods are normal, you are not experiencing any pain and the fibroid is small, you are okay just to “watch” it. You and your doctor may simply decide to monitor it with frequent ultrasound and annual examinations. Should it begin to grow or should problems arise, discuss treatment.
If you are having problems with your fibroids, please see your doctor and don’t wait to get treated. Some women may require hospitalization and blood transfusions all because of bleeding from fibroids! At that point, your problem becomes an emergency, and you lose options for treatment.
That being said, let’s talk about treatment. In years past, a hysterectomy was the primary treatment for symptomatic fibroids and is still used quite frequently. However, in recent years, advances in medicine have led to the development of less invasive techniques for the treatment of fibroids. Additionally, women have become more informed of their options and now seek ways to preserve their femininity and avoid surgery.
Options for the treatment of fibroids will depend on the size, number and location of the tumors, the severity of symptoms and the age and reproductive status of the patient.
Please allow me to describe each treatment.
Oral Contraceptives (Birth Control Pills) — Although oral contraceptives are not recommended for the treatment of fibroids, nor have they ever been proven to control bleeding from fibroids, many physicians will prescribe birth control pills to patients with fibroids who may be experiencing heavier than normal periods and to those who are younger who want to preserve their fertility. Unfortunately, they usually do not work, or appear to work for a short time, before bleeding resumes. It is important to note that all causes of abnormal bleeding must be explored before assuming it is a fibroid.
GnRH Analogs — GnRH is a hormone that is naturally made in the human brain. When given from an outside source, it prevents the brain from excreting it naturally. When this occurs, the ovaries temporarily “shut down” and stop making hormones. Estrogen levels decrease and can no longer “feed” the fibroid, causing it to shrink and causing bleeding to stop. The most popular brand is called Lupron.
GnRH is best used in the treatment of fibroids to help prepare the patient for surgery. GnRH will help to shrink the fibroid, thereby making surgery somewhat easier. It will also stop bleeding and allow the body time to replenish its iron stores and raise hemoglobin. Because of its side effects, it cannot be used long term. Additionally, once the medicine is stopped, the bleeding will return and fibroids have been known to return to their original size. There are also severe side effects on the body including hot flashes, night sweats, dryness, mood swings and other menopausal type symptoms.
Uterine Artery Embolization (UAE) — This has become a popular treatment option in recent years and has been shown to be effective in certain situations. UAE is usually performed by an experienced invasive radiologist after a thorough evaluation. In UAE, a small probe is placed into a large blood vessel in the groin. That vessel is then followed until it leads to the uterine artery. A small plug is placed in the artery, which subsequently diminishes blood supply to the uterus. In doing so, it diminishes blood supply to the fibroids and causes them to shrink. This procedure is most useful in women who have symptomatic fibroids that are not excessively large, and want to avoid surgery, or those who may not be able to tolerate surgery. This procedure is not recommended for women who have not completed their childbearing. Diminished uterine blood flow can lead to major complications during pregnancy. Therefore, those who intend to become pregnant should not undergo this treatment.
Myomectomy — A myomectomy is a surgical procedure in which the fibroids are physically removed from the body of the uterus. The uterus is then repaired and hopefully restored to its normal size. A myomectomy is generally done for women with symptomatic fibroids who want to preserve their fertility. The approach of the surgery will again, depend on the size, number and location of the fibroids, but also on the skill of the surgeon. A myomectomy can be performed in one of 3 ways.
Abdominal — With this approach, your scar and healing time will be similar to a hysterectomy or C-section scar, but you will still have your uterus. Again, the purpose is to preserve fertility. This approach is best for the removal of large and/or multiple fibroids.
Laparoscopic — This approach is less invasive and requires more specialized skills and training. You will likely be able to go home the same day and will only have 3 or 4 small (about ½ inch) incisions and a faster recovery time. This approach is best suited for moderately sized or smaller subserosal fibroids that may be causing pain due to compression.
Hysteroscopic — This is the least invasive approach and recovery time is quite simple. This approach as well, requires the surgeon to have skill and experience in this technique. All of the work is done via the vagina and the fibroid(s) is/are shaved off of the inner layer of the uterus. Success rates will vary depending on the size of the tumors and the amount that can be safely removed. This works best for small tumors that may be causing heavier than normal bleeding.
Hysterectomy — This is still the definitive approach for the complete cure of fibroids. This involves removal of the entire uterus and possibly, but not necessarily, the cervix with or without the removal of the tubes and ovaries. I won’t get into the discussion about whether or not to leave the cervix, etc., here, but for the sake of this conversation, let’s just say that hysterectomy will fix the symptoms associated with fibroids.
In summary, if you have fibroids, you do have options. Discuss your symptoms and treatment plan with your doctor. Do your research, ask questions and don’t be afraid to get another opinion.
Dr. Lorie Johnson is a practicing OB/GYN at Just For You OB/GYN in Locust Grove, Georgia. She is a Fellow of the American College of Obstetrics and Gynecology and the American Academy of Anti-Aging Medicine.