10 Things to Know About Uterine Fibroids
Uterine fibroids, also called leiomyomas, are tumors commonly found in women during the reproductive years. They are benign, but they can still cause uncomfortable symptoms like abdominal pain, heavy menstrual bleeding, and pain during sex, and they may also impact fertility in women trying to conceive. Up to 50% of women develop fibroids by the time they turn 50—but not everyone ever receives a diagnosis or requires treatment. You could have fibroids right now without even realizing it.
A large percentage of fibroids are totally asymptomatic—and if they don’t bother you, there’s no need to get treatment. But for those who do notice symptoms, here’s what to expect: “The biggest issues that patients will usually present with are abnormal bleeding associated with anemia, issues with infertility, recurring pregnancy losses, or problems with bulk-related symptoms … causing urinary urgency and frequency,” says Karen Wang, M.D., assistant professor of gynecology and obstetrics at the Johns Hopkins University School of Medicine in Baltimore. Fibroids can also cause GI issues like bloating or constipation.
Causes of Fibroids
Experts aren’t completely sure why some women get fibroids and others don’t. “Like everything in medicine, it’s not fully understood,” says Dr. Wang. “There could be a combination of genetics as well as environmental factors.” They are thought to be associated with estrogen because they can grow rapidly during pregnancy when estrogen production is high, and once estrogen production stops in menopause, the fibroids often shrink. There’s also a genetic component—if your mom or sister has fibroids, you’re also considered at higher risk.
Black women are more likely to get symptomatic fibroids and report debilitating symptoms compared to their white counterparts. And due to the prevalence of implicit bias in the healthcare system, women of color also face greater barriers to getting the care they need. “When a woman talks about her pain or bleeding, it’s not always heard by the physician,” says Kathy Huang, M.D., OB/GYN and assistant professor of obstetrics and gynecology at NYU Langone Health in New York City. “[Doctors] need to be asking very specific questions so the patient feels safe to answer them.”
Fibroids and Cancer Risk
The word “tumor” sounds scary, but leiomyomas are by definition benign. Cancerous fibroids are called leiomyosarcoma; however, doctors do not believe these develop from non-cancerous fibroids, and they are most often found in postmenopausal women. Plus, cancerous fibroids are extremely rare. You are not at a higher risk of developing other types of uterine cancers if you have fibroids. So, if you do want to get treatment for uterine fibroids, your doctor will focus on relieving your symptoms and preserving fertility (if that’s important to you).
Fibroids and Pregnancy
Most women who have fibroids during pregnancy do not experience any problems and do not require any special care. Some potential problems include needing a cesarean section, breech birth, placenta separating from the uterine wall, and preterm delivery. If fibroids are blocking your fallopian tubes, it can also make it harder to conceive. There’s no need to panic if you have fibroids and are currently pregnant or considering having kids. The best thing you can do is maintain an open dialogue with your doctor in case intervention is needed.
Most of the time, your doctor can diagnose fibroids after a routine pelvic exam or ultrasound. But if you’re having symptoms, it’s OK to ask for further testing. “At your annual exam, if you’re having some issues, it’s perhaps worthwhile to ask for a sonogram,” Dr. Huang suggests. Your doctor will want to figure out how many fibroids you have, where they are located, and the size of each one. These factors all determine what kind of procedure will be most helpful in relieving your discomfort.
Deciding on Treatment
Not everyone needs to get treatment for fibroids. Whether or not you need treatment depends on the severity of your symptoms. If you experience mild pain, an over-the-counter pain medicine usually works, or your doctor might prescribe an oral contraceptive to lighten your bleeding. A newer medication called Oriahnn is also used to treat heavy menses due to uterine fibroids. In more severe cases, surgical alternatives might be best. Still, you’ve got options—and hysterectomy is not the only course of action. “There are a variety [of treatment options] depending on symptoms and the patient’s preferences and desires,” Dr. Wang says.
Ideally, you can opt for a procedure that won’t require significant discomfort or recovery time. These options include a myomectomy, myolysis, endometrial ablation, or uterine fibroid embolization. Each is slightly different—some are done by a gynecologist and some by a radiologist—but all can be performed laparoscopically, meaning they’re done with a tiny tube and no major incisions. “We always try to [opt for] minimally invasive,” Dr. Huang says of her robotic surgery practice at NYU. “What can we do that’s least disruptive to the body?”
“If someone has fibroids and is wanting to maintain fertility specifically, there really is only one option, which is a myomectomy,” Dr. Wang says. “That is a surgical procedure to remove fibroids.” A myomectomy keeps your uterus intact, so pregnancy is still an option down the road. If your fibroid was hampering your fertility, myomectomy can actually make it easier for you to conceive and carry a pregnancy to term. It can be done laparoscopically or by open incision, depending on the severity and location of the fibroid.
When Hysterectomy Is an Option
If you know for sure that you are done having kids, you can opt for a hysterectomy to remove the uterus and eliminate the chance of fibroid recurrence. This is a great option for some women, but it’s important to know that it’s not your only choice. “I really want to encourage women to talk to their doctors about alternatives if they are getting hysterectomy as the only answer,” Dr. Huang says. (For added context, Black women are disproportionally likely to be presented with hysterectomy as their only option. And that’s just not the full story.)
Most women with fibroids live for years without any symptoms and do not require any additional care or treatment. And for those who do have symptoms, rest assured that you don’t have to suffer through your pain forever—even if you’ve been told as much by a medical provider. “I do encourage women to ask questions,” Dr. Huang urges. “It is your body, and you own it. You have the right to know.” Keep fighting to get the answers you need, and trust that there are choices out there that can help you.
Uterine Fibroids (1): U.S. Department of Health & Human Services, Office on Women’s Health. (n.d.) “Uterine fibroids.” https://www.womenshealth.gov/a-z-topics/uterine-fibroids
Uterine Fibroids (2): American College of Obstetricians and Gynecologists. (n.d.) “Uterine Fibroids.” https://www.acog.org/womens-health/faqs/uterine-fibroids
Racial Disparities: Journal of Women’s Health. (2013.) “The Burden of Uterine Fibroids for African-American Women: Results of a National Survey.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787340/