Uterine Fibroids: Four Things Every Woman Should Know

Are you familiar with uterine fibroids?  

If you’re a woman, chances are you may gain firsthand experience with fibroids at some point in your lifetime. In fact, the National Institutes of Health estimates that 80 percent of all women will develop one or more uterine fibroids by age 50.  

Fibroids develop when a muscle cell in the uterus clones itself and expands. The good news is, these growths are not cancerous or even pre-cancerous, never spread beyond the womb, and are not life-threatening.  

Many remain small and cause no symptoms or issues; however, others may enlarge and affect a woman’s quality of life by causing excess bleeding or by placing pressure on abdominal organs. Here are four things to know about uterine fibroids: 

#1—Your Risk of Uterine Fibroids May Be Fairly High

Because fibroids are so prevalent in adult females, every woman is considered potentially at risk. That risk increases if your mother or sister has experienced fibroids. African American women are more likely to develop fibroids and tend to experience them earlier as well, often by age 30.  

What causes uterine fibroids? The female hormones estrogen and progesterone stimulate their growth, so fibroids may occur at any time during the reproductive years, from onset of menses through menopause. They rarely disappear on their own, although they do tend to shrink post-menopause. 

It’s suspected that exposure to certain elements in the environment—for example, certain plastics, hair care products, cosmetics, and even repeated handling of printed cash register receipts—may affect hormone levels and increase a woman’s risk. 

Diet may play a role, too. Foods containing plant-based estrogen, such as tofu and other soy products, could increase risk; likewise, diets high in red meat and low in fruit and vegetables are suspect, as is alcohol consumption. 

To date, there are no known ways to prevent fibroids. But choosing a diet high in whole grains, vegetables, fruit, and lean meats; maintaining a healthy weight; and limiting alcohol are recommended to help protect against these growths and a host of other diseases. 

#2—Uterine Fibroid Symptoms Can Vary

Fibroids can develop anywhere in or on the womb and can range in size from undetectable by the human eye to much larger. Smaller fibroids with no symptoms may eventually be detected during a woman’s routine gynecologic visit or prenatal exam.  

Other signs of uterine fibroids may be more problematic: 

• If or when a larger uterine fibroid outgrows its blood supply and begins to die, it can cause sharp pain in the process. 
• Heavy and prolonged bleeding during menstrual cycles is a common symptom of fibroids. As the uterus contracts in an attempt to slow the bleeding, pain from cramping can also occur. 
• Depending on their size or location, one or more fibroids can create undue pressure on nearby organs. For example, if a fibroid presses on the bladder, it can cause urinary frequency or urgency. If the rectum is compressed, the patient may experience bloating and constipation. When a fibroid is low in the pelvic region, the patient may have discomfort sitting or during intercourse. And if a fibroid is high on the uterus, the patient may notice or feel an abnormal bulge in her belly. 

#3—Uterine Fibroids Can Affect Pregnancy

Fibroids within the womb may interfere with an embryo’s ability to attach to the uterine lining, resulting in infertility, miscarriage, or preterm labor. 

When a woman with one or more uterine fibroids does become pregnant, the developing fetus is rarely affected; however, the fibroids can make the pregnancy more uncomfortable. Increased hormone levels during pregnancy can also accelerate fibroid growth. 

And if a fibroid mass begins to die, the expectant mother may require pain management until it shrinks.

#4—Treatment of Uterine Fibroids Has a High Success Rate

If we suspect the presence of uterine fibroids, we first conduct a physical exam and a review of the patient’s personal and family history. If fibroids appear likely, we will typically perform some form of imaging to better characterize the fibroids. This might be an ultrasound or MRI.  In selected cases, we perform hysteroscopy in the office, using a thin tube with lights and a camera to examine the interior of the uterus.  

Even when fibroids are found, not all growths call for treatment. Some women will choose to delay treatment until and unless they experience problematic symptoms.  

In cases where uterine fibroid treatment is indicated, a main consideration is whether or not the patient plans to become pregnant. If she does:  

• We can remove fibroids via a procedure called myomectomy, leaving the uterus intact and preserving potential fertility. In patients with fibroids in the endometrial cavity or womb, the same hysteroscope camera used during diagnosis can be fitted with instruments to aid fibroid removal. Patients typically recover quickly from this hysteroscopic same-day surgery, with all symptoms resolved.  
• When a fibroid growth is too large to be removed via hysteroscope, we perform minimally invasive laparoscopic surgery using keyhole-sized incisions. Even large growths can be eliminated this way, with faster recovery time and fewer complications.  
• Although oral contraceptives may be used to reduce bleeding, they may actually spur further growth of the fibroid. Oriahnn® is the only oral medication approved by the FDA to control heavy bleeding due to fibroids; it’s been well tolerated so far, and long-term studies are underway. Non-steroidal anti-inflammatory drugs like ibuprofen and naproxen can also help reduce a patient’s discomfort and bleeding. 

If a patient does not plan to become pregnant, we can offer additional options such as laparoscopic hysterectomy, a measure that can resolve bleeding or fear of recurrence.  

Be assured, today’s hysterectomy procedure is minimally invasive and very well tolerated by most women. Over 98 percent of hysterectomies are completed same day, laparoscopically, via keyhole incisions. Ovaries and the hormones they produce are left intact. The vagina is unaltered, so sexual function is preserved. Supportive pelvic structures are untouched, for less risk of prolapse or incontinence.  

Recovery typically takes about two weeks, and many of our patients say they wish they’d had the procedure years earlier. 

Other Approaches to Treatment

In occasional cases where surgery is not viable, our interventional radiology team may be able to shrink the growth by inserting a small catheter into a blood vessel in the groin or wrist and threading it to the artery supplying oxygen to the fibroid. The procedure blocks the growth’s blood and oxygen supply, forcing it to shrink and die. Most patients who feel pressure from fibroid growths notice improvement following this treatment; 85 percent see a significant decrease in bleeding. 

In addition, a new approach called The Sonata® Treatment can deliver radio-wave energy directly to a fibroid. This procedure can be performed in an outpatient setting with light anesthesia or sedation, similar to what is administered during a colonoscopy. This promising technology enables significant decreases in bleeding with very low complication rates. 

Another approach to treatment is use of a drug such as Lupron to block production of the estrogen and progesterone feeding the fibroid; however, these drugs tend to be used for a short time because of potential side effects. We may use them, for example, to reduce bleeding while a woman recovers from anemia, or in cases when blood transfusion is not an option.  

We’re Here for You

If you endure routinely heavy menstrual bleeding, feel persistent pelvic pain or pressure, or have had recurring miscarriages, reach out to the team at MedStar Washington Hospital Center. Our multidisciplinary team includes gynecologists, interventional radiologists, and some of the best-trained surgeons performing minimally invasive surgery in the country, many of them at the forefront of research activities spurring advances in the field.  

Team members collaborate to offer a full range of treatment options that meet the individual needs of every patient. Surgeons and specialists will often meet with the patient together.  

Remember: it isn’t necessary to tolerate pain, bleeding, or discomfort from fibroids. The earlier we can work with you to address the issue, the more quickly we can have you comfortable and pain-free!