Fibroids

Fibroids are benign (not cancerous) tumors made mostly of muscle tissue. They are found in the wall of the uterus and sometimes on the cervix. They can range in size from as small as a pea to as large as a basketball! With larger fibroids, a woman’s uterus can grow to the size of a pregnancy that is more than 20 weeks along. About 20-25% of women over 35 get fibroids. A woman is more likely to get fibroids if:

• She has not been pregnant
• She has a close relative who also had or has them
• She is African American. The risk is 3 to 5 times higher than it is for Caucasian women.

Why fibroids occur is not really known. They do, however, depend on estrogen for their growth. They may shrink or even disappear after menopause.

Signs and Symptoms


Some women with uterine fibroids do not have any symptoms or problems from them. When symptoms or problems occur, they vary due to the number, size, and locations of the fibroid(s). These include:

• Abdominal swelling, especially if they are large
• Heavy menstrual bleeding
• Bleeding between periods or after intercourse
• Pain (backache, during sex, with periods)
• Bleeding after menopause
• Anemia from excessive bleeding
• Frequent urination from pressure on the bladder
• Constipation from pressure on the rectum
• Infertility (the fallopian tubes may be blocked)
• Miscarriage (if the fibroid is inside the uterus, the placenta may not implant the way it should)

You can find out if you have fibroids when your doctor takes a medical history and does a pelvic exam. The doctor can also do other tests such as an ultrasound or a D & C to confirm their presence, location, and size. The ultrasound is the most common test for diagnosing fibroids.

Treatment


Treatment for fibroids includes:

• “Watchful waiting” if fibroids are small, harmless, and painless or not causing any problems. Your doctor will “watch” for any changes and may suggest “waiting” for menopause, since fibroids often shrink or disappear after that time. If you have problems during this “waiting” period (too much pain, too much bleeding, etc.), you may decide that you do not want to “wait” for menopause, but choose to have something done to treat your fibroids.
  
• Medication. One type, gonadotropin-releasing hormone (GnRH) agonists, blocks the production of estrogen by the ovaries. This shrinks fibroids in some cases but is not a cure. The fibroids return promptly when the medicine is stopped. Shrinking the fibroids might allow a minor surgery to be done instead of a major one. (See surgical methods below.) GnRH agonists are taken for a few months, but not more than 6, because their side effects mimic menopause.
• Surgery. There are two basic surgical methods:
  • Myomectomy-The fibroids are removed, but the uterus is not. There are 3 approaches.
    • Laparascopic-A laparascope is used with a laser to remove the fibroids.
    • Hysteroscopic-The fibroids are cut out and the uterine lining is destroyed by laser (ablation). This makes a woman sterile (no lining, no bleeding). Laser ablation can also be done with a small electrocautery ball. This is known as “Rollerball.”
    • Laparotomy-Surgery in which the abdomen is opened and the fibroids are removed under direct vision. Fibroids can still be present, grow, and cause future trouble.
  • Hysterectomy-Surgery that removes the uterus and the fibroids with it. Depending on the size of the fibroids, this can be done:
    • Vaginally
    • Through abdominal surgery

A hysterectomy may be recommended when the fibroid is very large or when there is severe bleeding that can’t be stopped by other treatments. This leaves a woman sterile. It is the only way to get rid of fibroids for sure. A hysterectomy may also be done in the rare occasion that the fibroid becomes cancerous.

Questions to Ask

Do you have severe abdominal pain?
Do you have any of these problems? Heavy menstrual bleeding (you saturate a pad or tampon in less than an hour) Bleeding between periods or after intercourse Bleeding after menopause Anemia (noted by paleness, weakness, fatigue)
Do any of these things define the pain? It comes during sexual intercourse. It comes with your menstrual periods. It is in the lower back, and is not caused by strain or any other condition.
Do you have to urinate often or do you feel pressure on your bladder or rectum?

Self-Care/Prevention Tips


Maintain a healthy body weight. The more body fat you have, the more estrogen your body is likely to have, which enhances fibroid growth.

• Exercise regularly. This may reduce your body’s fat and estrogen levels.
• Follow a low-fat diet.