As a practicing gynecologist in New York City, I have seen tens of thousands of patients with a condition called uterine fibroids, or noncancerous tumors of the uterus. These women come to me because fibroids affect fertility and cause heavy and unpredictable bleeding and pain. Here are the answers to some common questions about fibroids, four signs you may have them, and exactly how to handle it.
Do fibroids adversely affect pregnancy or birth?
Fibroids can adversely affect pregnancy, yes. They increase the risk of preterm birth from an average of 8 percent in women without fibroids to 16 to 18 percent. There is an increased risk of degeneration of the fibroid in pregnancy. Degeneration is partial death of the fibroids as the blood flow preferentially goes to the pregnancy and, subsequently, away from the fibroids.
The downside? This can cause significant uterine pain. Fibroids can also block natural delivery, and women with fibroids have a much higher chance of needing a cesarean section. Large fibroids can take up the baby's growing space and cause abnormalities of growth in the fetus. Finally, if the fetus' placenta has formed over a fibroid, it can increase the risk of it coming detached prematurely before delivery. This is called an abruption and requires an emergency cesarean section.
Are fibroids more common in endo patients?
Fibroids are not more common in women with endometriosis. Women with endometriosis often have a similar condition called adenomyosis, which is essentially endometriosis within the uterine wall. This condition can cause similar symptoms as fibroids: increased bleeding and pain. Since it also increases the size of the uterus, it is often mistakenly diagnosed as fibroids.
How do you know if you're more likely to get fibroids? is it genetic?
We know that there is a genetic component to the development of fibroids, but we do not understand the exact mechanism of this. African American women are more likely to develop fibroids as are daughters of women with fibroids. However, because they are so common, most women are at risk.
Roughly 50 percent of women will develop fibroids—most commonly between the ages of 30 and 50—and often undergo surgeries such as myomectomies, which remove the fibroids, or hysterectomies, which removes the entire uterus.
Here are some telltale signs and symptoms that fibroids could be affecting you and your health:
1. A change in your period: Your period has gotten significantly heavier or longer.
A common symptom of fibroids is heavier periods—even if only occasionally—as fibroids can be near the uterine lining and interfere with the blood flow. Heavier bleeding will result in the need to change a pad or tampon more often and even lead to bleeding through or around them. There will be more clotting of blood, which looks like globs of brown/purple tissue often compared to liver. Fibroids can also cause bleeding between regular periods and make the periods longer as well. Heavier periods can cause a drop in the level of blood in your body, which in turn can make you feel tired and have less energy.
2. Pelvic pain: Fibroids can cause more cramping with your period.
When large, fibroids can also cause back pain. You can also experience pain that is not clearly connected to your period or ovulation.
Occasionally, fibroid tumors can degenerate—which means they grow faster than the body can supply blood to them and parts of the fibroids begin to die—and cause pain. This pain is usually felt right along the midline above your pubic bone, the bone between your vagina and your abdomen, and it’s not necessarily associated with your period or ovulation. While small parts of the insides of the fibroids can die, the fibroids actually will continue to get larger as the outer layers continue to grow and cause further problems.
3. You feel like you need to urinate more frequently, or you feel a fullness in your lower abdomen.
Fibroids that sit on your bladder can cause the need to urinate more frequently. You might also experience a persistent feeling of fullness in the area above your pubic bone, but this differs from the occasional bloating as it is typically constant. In women with very large fibroids, the fullness can actually lead to constipation as well.
4. You can feel a mass above your pubic bone.
Most people who have fibroids have several, and often more than a dozen. Whether there is one large fibroid or 20, they can feel like a firm mass right above your pubic bone. Anytime a woman feels something that she does not believe should be there, she should be examined by a doctor as soon as possible. In this area, the most common cause of a mass is fibroids, which, although they can cause all of these problems, are seldom cancer and can almost always be removed. So don't panic, but do see a doctor to be sure of the diagnosis and learn about possible treatments.
If you suspect you might have fibroids, here's what you can do.
If any or several of these signs or symptoms lead you to think you may have fibroid tumors, schedule a visit to your gynecologist and let him/her know about your concerns. The simplest way to diagnose these tumors is through a pelvic exam. Because smaller fibroids aren’t always felt through pelvic exams, you can also expect an ultrasound or an MRI.
Many women who have fibroids do not need treatment. When they eventually get to menopause around the average age of 50, the fibroids will start to shrink. Before then, it is not possible to predict how fibroids will grow or whether they will cause problems. Birth control pills are frequently used to help control the change in menstrual bleeding, but it should be noted that the medications that we have to shrink fibroids can cause many side effects and aren't useful for most women.
While many women have tried alternative therapies such as acupuncture and Chinese herbs, there are no reliable scientific studies that support these therapies at present. Through my practice, I've found the best evidence for homeopathic treatments is in the use of vitamin D and green tea extract, which have both been shown to suppress the growth of fibroid tissue. Of course, talk to your doctor before starting a new supplement regimen.
Catching them early will give you the most treatment options and will afford you the opportunity to treat them with supplements, food, and lifestyle changes rather than surgery.