Uterine fibroids are more common than what you may think. At least I did not think they were that common. However, it seems every time I mentioned I have fibroids to another woman, they respond saying they have or had them too. In fact, up to 80% of all women get uterine fibroids in their 30s or 40s, while African-American women are two to five times more likely to get uterine fibroids.
Uterine fibroids are benign or noncancerous tumors (“leiomyoma”, or “myoma”) that grow inside the uterus (submucosal), within the uterine walls (myometrial or intramural), or outside of the uterus (subserosal). They are typically caught during a routine pelvic exam (enlarged uterus), but must be confirmed using an imaging test such as an ultrasound. They will grow as estrogen and progesterone increase, and shrink when they decrease, or when menopause is reached. There is no known cause, but family history, obesity and diet may increase the risk of getting uterine fibroids.
Symptoms
The most common symptoms include the following.
Heavy bleeding during menstrual period
Abdominal pain
Lower back pain
Enlarged uterus
Pain during intercourse
Frequent urination or inability to fully empty bladder
Painful bowel movements
Complications during pregnancy, labor and delivery (high risk of cesarean section
Treatment Options
If you are diagnosed with uterine fibroids, you don’t have to do anything if you are not suffering from any of the symptoms. However, if you are experiencing symptoms that are impacting your quality of life, there are treatment options. The best treatment option for you will depend on the severity of your symptoms, whether you plan to have children, if you are nearing menopause, and the risks of complications.
The treatment options range from managing uterine fibroid symptoms to removing the uterine fibroids permanently, and there are pros and cons associated with pretty much all of them. The most common treatments are discussed below.
The first stage of treatment usually begins with managing pain with over-the-counter medication. Iron supplements may be necessary if heavy bleeding causes anemia. The next stage of treatment is managing the growth of the uterine fibroids present and reducing symptoms. This can be done by taking hormones used for birth control, or another hormone called GnRHa, “gonadotropin releasing hormone agonists”. The benefit of these is temporary relief of symptoms and low cost. However, you cannot get pregnant if you are taking these hormones. Also, GnRHa cannot be taken over a long period of time.
The last stage of treatment and most costly is surgical removal of the uterine fibroids, including hysterectomy and myomectomy. Hysterectomy obviously removes the fibroids and eliminates any possibility of the fibroids growing back. However, it also eliminates the possibility to get pregnant, so this is the best option for someone who does not want to have children or do not plan to have more children. Myomectomy removes the fibroids and preserves the possibility to get pregnant. However, the fibroids can grow back. If you plan to have children, it’s best to try to conceive as soon as possible after surgery. Keep in mind that there is a risk of complications during surgery that can lead to a hysterectomy. Endometrial Ablation removes the uterine lining in order to remove the fibroids. This procedure does reduce heavy bleeding, however, pregnancy is not possible following this procedure.
There are other procedures that focus on destroying or shrinking the uterine fibroids. Myolysis destroys the fibroids using an electric current. Uterine Fibroid Embolization (UFE) cuts off blood supply of the fibroids causing them to shrink. One complication with UFE is early menopause. Also, pregnancy is not possible after having this procedure.
My Story
I first became aware of fibroid tumors when I had to have one removed from my breast as a teenager. It wasn’t until I was much older, more than a decade later, that I became aware of uterine fibroids. That’s when my sister experienced a miscarriage due to a very large uterine fibroid. She elected to have a myomectomy and was able to conceive and deliver her first child via c-section.
At 37 years old I found out that I had uterine fibroids. At the time I was diagnosed, I had several small ones that were intramural and subserosal. I didn’t have any significant symptoms, so I was not too concerned.
A few years after I was diagnosed, I had to take blood thinners for six months after experiencing a pulmonary embolism. During this time the fibroids grew significantly. I don’t have any scientific proof, but I believe it was the blood thinners that allowed the fibroids to grow at an accelerated rate. From then on I began to develop many of the symptoms listed above.
At 42 years old I was still childless, so I consulted with a fertility doctor. He told me that before he could proceed with any treatment plan, I would have to take care of the fibroids. In other words, they would have to be removed. One of the risks of having uterine fibroids is that they may interfere with a woman’s ability to conceive or maintain a pregnancy (depending on size and location). My fibroids were large, and at this point the size of my uterus was equivalent to a 24-week pregnancy. It took me a while to decide what to do but eventually I decided to have a myomectomy.
Once I scheduled my surgery, I was asked to participate in a uterine fibroid study called Compare-UF. The Compare-UF study included over a thousand women in the United States who had either a hysterectomy or myomectomy to treat their uterine fibroid symptoms. The purpose of the study was to compare how the participants “felt and functioned” up to one year after having one of these two procedures. The results of the study showed that the uterine fibroid symptoms and quality of life improved greatly for both surgical procedures. However, those who had the minimally invasive hysterectomy reported a better quality of life than those who had a minimally invasive myomectomy.
Even though I decided to have a myomectomy, the specialist recommended for the surgery was very discouraging. Because of the risk of complications (hemoragghing) during surgery and the likelihood of getting pregnant at an “advanced maternal age,” he thought it would be best that I have a hysterectomy instead. This seems to be the most common treatment and I wonder if those women were discouraged from pursuing other treatments. Other than my sister, the women I have spoken with about their uterine fibroid treatment chose to have hysterectomies. I was not discouraged so I proceeded with having a myomectomy. Fortunately for me, there were no major complications, and a total of 16 fibroids were removed. Prior to the surgery I requested that a cell saver be used to capture my blood lost during surgery, clean it, and then return it back to me. As a result, I was able to avoid having a blood transfusion after losing a significant amount of blood.
After a prescribed amount of time, I initiated fertility treatment and was able to conceive less than a year after the surgery. The result of the myomectomy though was only temporary as the fibroids returned and grew during my pregnancy. Due to the amount of incisions made to remove the fibroids from my uterus, I had to get a cesarian section (c-section) to deliver my son. As a result, I did experience excessive blood loss and had to get a blood transfusion. In this case I was told a cell saver could not be used.
My story is a success story for me. My quality of life significantly improved with my choice of treatment. Although I still have fibroids, my symptoms are mild compared to what I experienced prior to the myomectomy. Most importantly, if I did not have this procedure, I would not have my son.
If you are a woman suffering from any or all of the uterine fibroid symptoms mentioned in this article, see a gynecologist who can diagnose your problem and provide treatment options that will improve the quality of your life.
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