Treating Uterine Fibroids Before Menopause.

Perimenopause is the time leading up to a woman’s last menstrual period when ovary production slows, causing hormones to rise and fall like a roller coaster. Women in this season of life often become familiar with symptoms like hot flashes, sleep disturbances, emotional fluctuations, and more. In addition, some women develop debilitating uterine fibroids, which are benign tumors that can cause excessive bleeding, cramping, and bloating. The good news is there’s a full spectrum of treatment options that can relieve symptoms and help women live a vibrant life despite these naturally-occurring changes to their body before menopause.

What are uterine fibroids?

The uterus is made of mostly muscle tissue. Occasionally, mutations in the cells of the uterine muscle can cause fibroids to grow in the uterine wall. These noncancerous tumors are common, but they can be incredibly disruptive to a woman’s life. Fibroid symptoms vary by individual, but many women experience:

• Heavy bleeding during periods (called menorrhagia)
• Low blood count because of excessive bleeding 
• Debilitating pain or cramping right before or during their period
• Bloating or heaviness in the stomach
• Urinary frequency and urgency because of added pressure on the bladder

Uterine fibroids thrive on excess estrogen and a good blood supply, which is why they frequently develop in women in perimenopause. In addition, fibroids tend to affect women who:

• Are African American
• Began menstruating at a young age
• Have never been pregnant
• Have female family members who’ve had fibroids
• Eat excessive amounts of red meat
  
  

When do uterine fibroids require treatment?

Every woman's body responds differently to hormone fluctuations in the years leading up to menopause. Some women with fibroids have no symptoms and therefore don’t need treatment, as fibroids tend to shrink and completely resolve when they are starved of hormones after menopause. However, for other women, uterine fibroids disrupt daily life, making it harder to sleep, work, and enjoy hobbies. Excessive bleeding can require women to change their pads or tampons every 30 minutes to an hour. Such blood loss can cause extreme fatigue and require iron infusions or supplements. In addition, painful cramping can be debilitating, appetite may be suppressed by a feeling of heaviness, and bladder pressure can lead to urinary frequency and urgency, causing women to wake up multiple times at night. When these symptoms make it very hard to live with fibroids, it’s time to seek treatment.

Sometimes, these symptoms can be related to other conditions, so it’s important to get a thorough exam by your gynecologist. After a physical exam and asking questions about your family and personal medical history, your gynecologist may perform an ultrasound to see what’s happening in the uterus.

A spectrum of treatment options.

For women suffering from hot flashes and other perimenopause symptoms, hormone replacement therapy (HRT) is an effective way to find relief. However, it’s always best to discuss treatments with your doctor, as women who have had breast cancer or other conditions can’t take HRT. Lifestyle changes can also be highly effective at balancing hormones, so consider lowering your sugar, limiting caffeine, and eating lots of green vegetables. 

When treating uterine fibroids, we often begin with the most conservative options before considering minimally invasive or open surgery. We know that fibroids will shrink after menopause, so treatment is intended to be a bridge to help women live without symptoms until they reach menopause. The least invasive treatments include birth control pills or placing an intrauterine device (IUD), which can help to stabilize bleeding. If these treatments don’t effectively decrease bleeding, cramping, and other symptoms, we may try uterine fibroid embolization before considering a hysterectomy, the most invasive option on the treatment spectrum.

Uterine fibroid embolization has a success rate of 90%.

Women with fibroids that don’t respond to conservative treatments may be eligible for uterine fibroid embolization, or UFE. This minimally invasive procedure is performed by an interventional radiologist who specializes in treating blood vessels throughout the body. During this same-day procedure, an interventional radiologist will insert tiny catheters the diameter of a spaghetti noodle through the wrist or groin and place it in the blood vessels feeding the fibroid. This blocks the blood flow to the fibroid, starving it of nutrients so that it shrinks and leads to improved symptoms.

The entire procedure takes up to one and a half hours, and most women notice decreased symptoms within one month. It’s normal to feel some cramps for 48 to 72 hours after the procedure, but women are generally back to work within seven to ten days. By the next period, bloating and bleeding is typically improved. In fact, the procedure has a 90 percent success rate for well-screened women, with most fibroids shrinking at least 40 percent three months after the procedure.

Shrinking fibroids leads to significant improvement in symptoms, with women reporting a wide range of benefits as a result of decreased bleeding and bladder pressure, such as:

• Hemoglobin counts rising back to the normal ranges
• Not spending as much on tampons and pads because of decreased bleeding
• Better energy levels
• Less urinary urgency and frequency
• Better appetite without bloating and stomach pressure 

Seek care if uterine fibroids are affecting your daily life.

If perimenopause symptoms or uterine fibroids are seriously impacting your emotional and physical health, we can help. Our gynecologists and interventional radiologists work closely together to consider all treatment options that will lead to a resolution for your hot flashes, heavy bleeding, painful cramping, and other disruptive symptoms that are common before menopause. 

To request a gynecology appointment, call the Women’s Health Specialists at MedStar Good Samaritan Hospital at 443-444-5711.