“My uterus went to the Dark Side.”
That’s how Ann-Marie Archer described life before discovering she had fibroids. “It was horrendous,” she told us: period flow so heavy, she had to plan around it, vaginal pain, incontinence.
And the worst of it was not knowing what was going on or if her experience was normal. Her doctor kept brushing off her concerns as “just menopause,” and searching the Web didn’t really help – there just wasn’t much information out there. But when she twice bled hard enough to soak her surroundings, she knew she had to push for answers.
It turns out she had uterine fibroids. Fortunately, the vast majority of fibroids are benign (not cancerous), and many women don’t even know they have them. However, even the benign ones can cause unpleasant and sometimes debilitating symptoms, depending on location and size, so if you have them, it may be worthwhile to investigate your options.
To get more information on fibroids, their causes and treatments and what to look out for, we talked with Dr. Suzanne Gilberg-Lenz, ob/gyn, integrative medical doctor, and Clinical Ayurvedic Specialist.
Womenshealth.gov describes uterine fibroids as “muscular tumors [i.e. made up of muscle cells] that grow in the wall of the uterus.” A woman may have one or many, and they range in size from apple-seed small to grapefruit, though in rare cases, they can grow much larger.
For women like Ann-Marie, the symptoms are extreme enough to prompt further testing. Other symptoms include heavier, longer, more painful periods, pain during intercourse, incontinence, constipation, pelvic, back, and leg pain, and fertility issues, so women experiencing these should talk with their doctor.
For women with lesser symptoms or no symptoms at all, fibroids may initially be discovered (or suspected) when a gynecologist detects an enlarged or irregular contour of the uterus during a routine pelvic exam. Often an ultrasound will then be used to confirm, map, and measure the fibroids.
According to Dr. Suzanne, they are the most common benign tumor in women. Prevalence rates vary from 5-25 percent, with a lifetime risk of 70 percent for women. However, fibroids are approximately three times more common in African American women than white women.
Dr. Suzanne tells us there does seem to be a familial inheritance pattern and some racial differences. Based on those tendencies, newer research is focusing on possible genetics as a target for therapies, but the exact cause of fibroids remains elusive.
The treatment depends on the symptoms, says Dr. Suzanne, as well as on the location, size, rapidity of growth, and number of lesions.
For instance, a large fibroid in the anterior wall of the uterus may put pressure on the bladder and cause urinary symptoms; fibroids growing into the uterine lining can cause irregular or very heavy vaginal bleeding. In these cases, women may opt for a hysterectomy. And indeed, fibroids are the number one reason for hysterectomies. However, Dr. Suzanne says, you should talk with your doctor about all your options: minimally invasive outpatient surgical options like myomectomy (removal of only the fibroids) are available and an excellent option for many women, especially if fertility preservation is important.
Although cancer in a fibroid is rare, says Dr. Suzanne, occurring in approximately one in a thousand fibroids, rapidly growing fibroids in post-menopausal women should be managed by hysterectomy, as the risk of cancer increases substantially in that situation.
Uterine fibroid embolization (UFE) is a procedure done by an interventional radiologist in which the blood supply to the fibroids is blocked resulting in shrinkage. The recovery time is shorter than with surgery.
For women experiencing heavy bleeding, there are hormonal options such as birth control pills or progestin-containing IUD. Other medical options, both injectable and oral, may be used for up to two years to shrink fibroids. The primary indication for these medications is to shrink fibroids preoperatively since they tend to regrow after medication is stopped.
When it comes to using power morcellators to break up fibroids, Womenshealth.gov cautions against their use as they could spread cancer. And, according to Dr. Suzanne, the American College of Obstetricians and Gynecologists (ACOG) and other professional guidelines at this time do not recommend the use of power morcellators. However, she adds, “I think that in the hands of skilled and experienced laparoscopic gynecologic surgeon, the morcellator with a bag attached is an option. If you have already had the procedure, and the pathology on your tumors was benign, there is nothing to worry about. For added peace of mind, you could consult with a gynecological expert in fibroids or a gynecological oncologist.”
“Yes,” says Dr. Suzanne, “especially if you are pre-menopausal. Fibroids are notorious for re-growing, and there are often tiny seedlings that we cannot see or feel at the time of surgery deep in the uterine wall that can grow over time.”
There are no proven strategies that prevent fibroids from growing or returning, Dr. Suzanne says; many lifestyle studies have been conducted, and none have demonstrated any efficacy from abstaining from alcohol, changing diet, increasing exercise, and so on.
If fibroids are not symptomatic or rapidly growing, they really don’t need any treatment, Dr. Suzanne reassures us. “Watchful waiting is a reasonable strategy; as we pass through menopause, they often shrink, and symptoms disappear or diminish,” she says.
Fibroids are quite common, often problematic, rarely dangerous. If you suspect you may have fibroids, especially if you’re experiencing symptoms and you have a family history, mention it to your gynecologist. While the chances are high any fibroids discovered will be harmless, they can still cause discomfort and annoyance. Plus, you will have some peace of mind.
The information on the Gennev site is never meant to replace the care of a qualified medical professional. Hormonal shifts throughout menopause can prompt a lot of changes in your body, and simply assuming something is “just menopause” can leave you vulnerable to other possible causes. Always consult with your physician or schedule an appointment with one of Gennev's telemedicine doctors before beginning any new treatment or therapy.