By Renaisa S. Anthony MD, MPH
Fibroids are non-cancerous tumors that grow in the uterus. They are the most common non-cancerous tumors found in reproductive-age women. They come in all sizes and can be found in various places throughout the uterus.
Some are in the uterine cavity and others in the muscle or right below the outside layer of the uterus. The size and location of the fibroids are most important because this is what determines symptoms and the severity of the condition.
Why should I care about fibroids?
Fibroids can cause many different problems. For instance, women with fibroids often report heavy bleeding that may cause anemia. Depending on the location and size of the fibroids, they can cause problems with becoming pregnant (infertility), problems holding your bladder (incontinence), problems with your personal appearance where you may look pregnant, and pain in your lower back, during menstruation, and during sexual intercourse.
What causes fibroids?
The scientific community has not discovered the cause of fibroids or how to prevent them. As women age they are more common, and they are more common among African American women. However, women of all ages and races can have fibroids.
How are fibroids diagnosed?
Fibroids can be diagnosed on an ultrasound. They have a specific appearance and texture on ultrasound. Fibroids are best diagnosed via ultrasound, but for exact location and size Magnetic Resonance Imaging (MRI) may be better.
Can fibroids be prevented?
At this time, we are not aware of ways to prevent fibroids. Some women are more susceptible than others. There may be a family history link. If your mother, sister, grandmother, or other close female relatives have fibroids, you may be at an increased risk of developing fibroids over your lifetime. Research has also shown that overweight and obese women are more likely to have fibroids.
How are fibroids treated?
There are multiple options for treating fibroids from medications to non-invasive procedures to surgical interventions. The treatment depends on how bothersome the fibroids are for you.
What is the extent of your symptoms? The more severe the symptoms, the more intervention warranted.
Another factor to consider is the desire for children. If a woman desires to have children, then options like a myomectomy (surgery: removing the fibroids and keeping the uterus) is an option. If a woman no longer desires children, there are more available options including but not limited to hysterectomy (surgery: removal of the uterus and other reproductive organs) and uterine artery embolization (procedure: destruction of the blood supply to the uterus).
Alternative options include medication management in which one can take medications like Lupron to shrink the size of the uterus and prevent menstruation, ultimately helping bleeding symptoms. The newest treatment for fibroids is MRI-focused ultrasound ablation in which an MRI is used to locate the fibroids and they are destroyed using high frequency ultrasound waves.
If you are interested in treating fibroids, partner with your doctor to devise a customized plan based on your individual case.
• Know and list your symptoms, rating how severe they are for you on a scale of 1-5 (1 is they do not bother me to 5 they are unbearable). If fibroids are not bothering you, then do not bother them.
• Confirm the diagnosis. Get an ultrasound. Know how many fibroids you have, where they are located and their size. This will determine your options and if you need intervention.
• What are your reproductive goals? Do you want children? If you still desire children, then medical management (medications) and/or a myomectomy would be the best options. MRI treatment is approved for some women who still desire children.
• How important is it to have your reproductive organs? Would you be okay if you no longer had a period? How much of your self-identity is attached to your uterus? These are important questions to consider when deciding between a hysterectomy and other options like uterine artery embolization.
How much time do you have to be out for recovery? Each treatment has a different recovery time. Medications do not require recovery time. However, MRI and UAE are procedures and require the shortest recovery time. Surgical operations including the myomectomy and hysterectomy require the longest recovery time. Surgical techniques for both can vary. Laparoscopy is the least invasive and has a shorter recovery time.
If you have fibroids and desire children, I recommend partnering with a reproductive endocrinologist and infertility specialist with expertise in treating fibroids. If you do not desire more children, then I recommend partnering with your standard gynecologist.
Develop a treatment plan based on the aforementioned questions with a timeline. For instance, if you desire children but not for the next three years, you may opt for medical management now with a myomectomy in two years. Communication is key, and remember to ask lots of questions.
Renaisa S. Anthony, MD, MPH is a physician at the Charles Drew Community Health Center in Omaha, NE and deputy director of the Center for Reducing Health Disparities at the University of Nebraska Medical Center. Dr. Anthony earned her medical degree from the University of Chicago, masters of public health from Harvard University, medical training at Vanderbilt University, and health policy training at the National Institutes of Health.