Lots of women will develop uterine fibroids at some point in their lives. More accurate: the prevalence in women in their childbearing years varies from 20 to 80 percent, according to Womenshealth.gov. Not all women notice that they have fibroids. Few women talk about them. Nevertheless, these non-cancerous growths of the uterus can cause serious complaints, like heavy menstrual bleeding or severe cramps. To put the spotlights on this common, but also rather underexposed condition, July is Fibroid Awareness Month.
Tiny as a grape seed or huge as a grapefruit
Uterine fibroids, also called leiomyomas or myomas, can be as tiny as a grape seed, or even undetectable by the human eye. They also can form a bulky grapefruit-sized mass that enlarges the uterus. You can have a single fibroid or multiple ones. Generally, fibroids aren’t dangerous. They aren’t associated with an increased risk of uterine cancer and almost never develop into cancer. Seeing as they often cause no complaints, many women are unaware of the fact they have fibroids. However, in some cases uterine fibroids do cause serious complaints. They can lead to heavy menstrual bleeding (HMB or menorrhagia), intermediate menstrual bleeding (spotting) and severe menstrual pain. Pain in the lower abdomen, pain during sex, pressure on the bladder and intestines, increased urination, constipation, anaemia and fatigue are also common symptoms.
Black women are more likely to have fibroids
Fibroids can be discovered incidentally during a pelvic exam or a prenatal ultrasound. The exact cause of uterine fibroids is still unclear. Research and clinical experience point to genetic changes and hormones. Estrogen and progesterone, the hormones that stimulate the development of the uterine lining during the menstrual cycle, appear to trigger the growth. Fibroids tend to shrink after menopause due to a decrease in hormone production. There are few known risk factors, other than being a woman in her childbearing age. These include starting your menstruation at an early age, the use of hormonal birth control and obesity. Black women are more likely to have fibroids than women of other racial groups. Also, if your mother or sister has fibroids, you have an increased risk of developing them as well.
Watchful waiting is an option, since fibroids tend to shrink after menopause
Fibroids are categorised by their size and location in the uterus. For example: intramural fibroids grow within the muscular uterine wall, submucosal fibroids bulge into the uterine cavity and subserosal fibroids project to the outside of the uterus. Depending on the location, there are several possible treatments. Watchful waiting is also an option. Many women with uterine fibroids or uterine polyps* experience only mild symptoms that they can live with. Fibroids aren’t cancerous, usually grow slowly and rarely interfere with pregnancy. Also, they tend to shrink after menopause due to a decrease in hormone production. Problem solved.
Medication is usually a short-term solution
As explained, myomas can have a significant impact on everyday life. If they do, it can be wise to look for possible treatments. A medical examination is always a good idea if you suffer from complaints in the abdominal or pelvic region. There are several options for treating fibroids. For starters, there is medication. Hormonal medication (birth control pill or IUD) doesn’t remove the fibroids, but it can shrink them and treat symptoms like heavy menstrual bleeding. Sometimes non-hormonal medication is subscribed, like Tranexamic acid or NSAIDs, to ease the symptoms. Medication is usually a short-term solution though. Your symptoms may come back when you stop taking the medicine.
Good to know: surgery can be performed in several less invasive ways
Surgical treatment is a more permanent solution. Depending on the size and location of the fibroids (or polyps*), there are several techniques. Of course, there is the dreaded hysterectomy. Fibroids are the main reason to perform a complete removal of the uterus – via a cut in the abdomen or performed through the laparoscope. This is without a doubt the most permanent and proven solution for uterine fibroids and other gynaecological problems. However, it’s also a major surgery that puts an end to your ability to bear children for good. Luckily, there are also less invasive (surgical and non-surgical) options.
Yes, a hysteroscopic myomectomy can be done on an outpatient basis
Surgery to remove fibroids without taking out the healthy tissue of the uterus, is called a myomectomy. This treatment can, depending on the size, type and location, be done via surgery, laparoscopy or hysteroscopy. During a laparoscopic or robotic myomectomy, the fibroids are removed with slender instruments inserted through small incisions in your abdomen. The least invasive method is a hysteroscopic myomectomy (MyoSure). This can be done on an outpatient basis, meaning that you can return home the same day.
Moral of this story: there are options if you suffer from fibroids
Last but not least, there are non-surgical procedures that can destroy uterine fibroids. For example via sound waves (ultrasound surgery), freezing (cryomyolysis), radiofrequency energy (myolysis) or by blocking the blood supply (embolisation). Not every procedure is suited for all types of fibroids and polyps. Of course every procedure has its pros and cons. Take your time to study all the possibilities that are suited to your personal condition. Most important moral of this story: there are solutions if you suffer from menstrual complaints because of fibroids. Also, you usually have more options than only a hysterectomy.
* Uterine polyps – also known asendometrial polyps – are growths attached to the inner wall of the uterus. They are usually non-cancerous, although there are pre-cancerous polyps. They commonly occur in menopausal women, although younger women can get them too.