Learn what uterine fibroids are and why women should know about how to control them.
“I’m so tired all the time, Doc!” Fran exclaimed at my last office visit with her. Fran is a rather healthy 42-year old, so I needed to ask her some questions to figure out what specifically was causing her fatigue.
“Are your periods heavy, Fran?”
“Nope, they are normal, same as ever.”
I sent Fran to get a blood test, and next thing I knew, I was calling her because she was severely anemic. (She had a hemoglobin level of 6—a normal level in women is over 12.) I advised her to go to the emergency room right away for a blood transfusion.
What’s a Normal Period?
I asked her again about her periods, but this time, I asked her very specific details, including how many pads/tampons she goes through in a typical day. Fran told me she changes her pads every two hours, and that sometimes she needs to use a pad and tampon together at the same time.
“But Fran, you told me that your periods weren’t heavy.”
“Well, they’re not, Doc. That’s just how they always have been ever since I can remember! Isn’t everyone like this?”
From then on, I learned to never simply ask if my patients’ periods are simply “heavy or not.” I now ask exactly how many tampons/pads they go through and how many days their periods last.
I sent Fran for an ultrasound of the pelvis, and she ended up having exactly what I suspected – a fibroid tumor of the uterus.
What Are Fibroids?
Fibroids are tumors arising from the muscle layers of the uterus, and are otherwise known as Leiomyomas. There are two types of “tumors” generally described in medicine--those that are benign, meaning they are not cancerous, and those that are malignant, which are cancerous. Fibroid tumors are benign tumors and they do not become cancerous.
About forty percent of women have fibroids on their uterus by the time they reach age forty – that is almost half of all women. So they are quite common, and many of us will have one at some point in our lives. They may occur as single or multiple tumors in the uterus. They also tend to get worse with age until menopause, when they finally go away.
What Are the Symptoms of Fibroids?
Even though some women have fibroids in their uterus, it doesn’t necessarily mean they will cause any problems. Many women have no symptoms at all. But in those who do, the most common symptoms include pelvic pressure or pain, or increased uterine bleeding. By increased uterine bleeding, I mean that it can cause heavier periods, more frequent periods, spotting in between periods, or longer duration of periods.
Rarely, fibroids can also cause problems with fertility. This depends on the location of the tumor, the number of tumors, and the size. And fibroids in pregnant women can cause first trimester bleeding and other complications during pregnancy. But again, these complications are very rare in those with fibroids.
If severe enough, the heavy bleeding caused by fibroids can be cause anemia (like in Fran), which is detected through a blood test.
How to Diagnose and Treat Fibroids?
An ultrasound of the pelvis is used to help detect the location, the number, and the size of each fibroid tumor, and is often the test that will be ordered by your physician. And depending on where they are located and how big they are, your doctor may be able to feel them in your bimanual pelvic exam as well, but not always.
Unless your symptoms are bothersome, or if they are severe enough to cause anemia, fibroids are pretty much left alone. They typically regress and resolve with menopause. So if you can hang in there until your periods stop during menopause, treatment is often not necessary.
If they are truly stealing your mojo, here are some of your most popular options:
Hormonal Contraceptives: The oral contraceptive pills, the implant, the injection, the ring, or the hormonal intrauterine device can be used to help regulate the heavy vaginal bleeding. It wouldn’t cause your fibroids to go away, but it can help control your symptoms by decreasing the bleeding, and any pain you may experience with your heavy periods.
Uterine Artery Embolization: More and more of my patients seem to opt for this newer, more advanced procedure that is a less invasive and a non-surgical way to treat fibroids. It’s an office-based procedure done under local anesthesia, where the doctor infuses a special embolizing agent through your blood vessels that feed the fibroid. Once this agent essentially “clogs” that artery, the fibroid will involute and regress. Women who opt for this do so because they wish to avoid surgery and hormonal methods.
Myomectomy: A surgical option for those women who may desire kids in the future is a procedure called a myomectomy, where the surgeon removes the part of the uterus that is affected by the fibroid. You would still have your uterus so that you could get pregnant later on if you so desire. The only down-side is that some women go on to develop further fibroids and the symptoms may return.
Hysterectomy: Surgery to remove the entire uterus is reserved for those women who no longer desire children. The major advantage is that it will prevent the symptoms from recurring later, and it gets rid of the problem once and for all. But the downside is that it’s a serious surgery and you can no longer have children, so you have to be sure about not wanting more.
It’s also important to note that in women over the age of 35 who report significant vaginal bleeding (whether it’s heavier bleeding, longer periods, more frequent periods, or spotting in between periods), an endometrial biopsy may be required to rule out more serious, although rarer, causes of vaginal bleeding, like endometrial cancer.
Fran ended up opting for the hormonal contraceptive method of bleeding control with the five year hormonal intrauterine device. This device tends to lighten or completely halt vaginal bleeding after about six months of use. Fran says she felt so much better once her periods lightened and her anemia improved.