This reproductive health issue affects more women than you may expect.

By Julia Malacoff
Aug 06, 2020 @ 2:13 pm
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Credit: Cinema Tigers/Stocksy

Uterine fibroids are one of the most common reproductive health issues women face. In fact, Senator Kamala Harris just introduced a bill to provide more funding for research and education on them, citing the serious health complications they can bring on.

But unfortunately, many women aren’t aware of the risk factors, symptoms, and treatment options for uterine fibroids. Here, gynecologists explain what to watch out for, as well as what to do if you have them.

What are uterine fibroids?

“Uterine fibroids, or leiomyomas, as they are known medically, are non-cancerous tumors of the uterus,” explains Nancy Jasper, M.D., an ob-gyn at University Irving Medical Center. They vary widely in size and location, and are made up of the same tissue as the walls of the uterus.

“They are most problematic in women of reproductive years — who are still getting their periods — due to the hormones estrogen and progesterone, which stimulate the tumors to grow,” Dr. Jasper adds.

Who gets fibroids?

Anyone with a uterus can get fibroids, though we don’t know exactly what causes them and how many people are at risk of getting them. Part of the reason for that, according to ob-gyn Tamika Cross, M.D., is that many people never experience symptoms. This can make it difficult to do research on how common they really are, which is one of the reasons statistics on fibroids are all over the place. Some sources say they affect between 20 and 70 percent of women. Others suggest 1 in 3 women have fibroids.

In any case, it’s safe to say a significant number of women deal with uterine fibroids, whether they know it or not. And there are some genetic and lifestyle risk factors we know of.

“Risk factors include early age of start of periods, no pregnancies, possibly early use of oral contraceptives, diets rich in excessive red meats and alcohol, vitamin D deficiency, hypertension, and obesity,” says ob-gyn Jessica Shepherd, M.D. It’s important to note, though, that these are just things that might make uterine fibroids more likely—they don’t necessarily cause them.

There’s also a genetic component, Dr. Cross says. “If your mom has fibroids, your grandma has fibroids, your aunt has fibroids, you have a high chance of having fibroids as well.”

Black women are also significantly more likely, based on epidemiological research and clinical experiences, to deal with uterine fibroids. “Black women are two to three times more likely to have fibroids than white women,” Dr. Cross says.

The reason? We don’t know, but it’s likely multifactorial. Possible factors, according to Dr. Cross, include psychosocial stressors, environmental factors (for example, being exposed to different pollutants), diet, chemicals from certain hair relaxing and perming treatments, and genetics.

How do you know if you have uterine fibroids?

The symptoms of uterine fibroids include:

  • Heavy menstrual bleeding and/or anemia: “Instead of maybe going through four or five pads in a day, sometimes people are going through a whole pack of pads in a day,” Dr. Cross says. Heavy bleeding during and/or between periods can also cause anemia.
  • Irregular periods: Your periods aren’t happening approximately once a month, or you’re getting a “period” or spotting in between periods.
  • Pelvic pain or pressure
  • Pain during sex
  • Urinary problems: “Depending on where the fibroid is, it can be pushing on the bladder,” Dr. Cross says. This could either leave you feeling like you can’t fully empty your bladder, or make it so your bladder can’t fill up completely, making you feel like you need to pee all the time.
  • Constipation: Similarly, depending on the size and location of the fibroid, it might put pressure on your intestines, resulting in constipation.
  • Unexplained infertility: In some cases, fibroids can prevent women from getting pregnant. This may be their only symptom.

As for how fibroids are diagnosed, your doctor may use a few different methods to determine whether you have them or not. “The pelvic exam is key to diagnosis, especially early diagnosis, along with ultrasound and hysteroscopy, which is where they use a scope to look inside the uterus to explain reasons for abnormal bleeding,” Dr. Jasper says. “MRIs are sometimes also used to help better define the fibroids and their positions in the uterus, but they are not always necessary.”

Do fibroids cause infertility?

“Just because you have fibroids doesn't mean you're going to be infertile,” Dr. Cross says. “But If you have fertility issues, it could be because of fibroids.”

When it comes to fertility and fibroids, it’s all about the location. “Fibroids that are inside the uterine cavity are most likely to cause infertility, because it's where the baby would implant and grow,” Dr. Cross explains. “So usually you see either the baby can’t implant, so you have a miscarriage pretty early on, or maybe it implants, but then can't grow past a certain gestational age because there's not room.”

Fibroids near the fallopian tubes may also block the tubes, meaning the egg will never meet the sperm. But because there are many treatment options for fibroids (more info on that below!), Dr. Cross emphasizes that fibroids aren’t necessarily a death sentence for your fertility.

“Fibroids are sometimes requested to be removed, even when they are small, in women who are undergoing infertility treatments to help improve their success rates,” Dr. Jasper says. During pregnancy, they might grow slightly, but most of the time they stay around the same size.  “In women who have large fibroids down near the cervix, which can block the passage of the baby at birth, occasionally a cesarean may be necessary, but that is not a given.”

What are the treatment options?

If fibroids aren’t causing any symptoms but are discovered during pregnancy or a routine screening, most doctors will take a “watch and wait” approach. Otherwise, treatment options can be divided into medical and surgical categories.

“The medical options are more conservative, so I usually start with them,” Dr. Cross says. These include:

  • Hormonal birth control: Options with progesterone such as the birth control pill, hormonal IUDs, Depo Provera injections, and Nexplanon implants can help reduce heavy bleeding and cramping, Dr. Cross says.
  • NSAIDs: Over-the-counter medications like Advil and Motrin can help with pain management.
  • GnRH agonists: In some cases, medications like Depot Lurpon and Oriahnn can help. These medications block estrogen, which helps shrink fibroids and reduces bleeding — but won’t dissolve them. These can only be used for a limited amount of time, so they’re not a long-term solution Dr. Jasper notes.

If these treatments don’t relieve symptoms, surgical and procedural options include:

  • Uterine artery embolization: This is an outpatient procedure that essentially forms a fake clot in the blood vessels that feed the fibroids, Dr. Cross says. Without blood supply, the fibroid tissue dies. This procedure can be a bit painful, but it’s a good minimally-invasive option for people who don’t want to have surgery, she adds, though it’s not usually used for women who are looking to get pregnant.
  • Radiofrequency ablation: A doctor uses ultrasound technology and radiofrequency energy to shrink the blood vessels that provide blood supply to the fibroid, in a process similar to uterine artery embolization.
  • Myomectomy: This means having surgery to take the fibroids out. This can be laparoscopically, robotically (via tiny holes in your abdomen), or hysteroscopically (via the vagina). When a woman has many fibroids or larger fibroids, they are usually removed via traditional abdominal surgery, Dr. Jasper says. For women who would like to become pregnant in the future, myomectomy is most often used. Though it’s important to note that the uterus is cut open, a c-section may be necessary during delivery.
  • Hysterectomy: For women who no longer want to preserve their reproductive organs and are having fibroid symptoms that bother them, this surgery is an option that removes the entire uterus, along with any fibroids.

The bottom line? “There are many options, all that can be mixed and matched, but early intervention is key!” Dr. Jasper says.

What should you do if you think you have fibroids?

If you think you have fibroids or are experiencing any of the symptoms mentioned above, Dr. Cross urges the importance of getting help sooner rather than later. “I have some people that come to me and they're like, ‘can you just take my uterus out?’ And it's because they've been dealing with it for 10 to 15 years.” Eventually, they get to a point where they are just over it. “But if they had come sooner, we may have been able to try some other options.”

Experts also stress the importance of regular (i.e. at least once a year) and consistent gynecological care, particularly for women of color, since they tend to develop fibroids earlier and in greater numbers, Dr. Jasper says. This consistency is important because when patients “doctor hop,” they tend to get a lower quality of care. “Find a doctor you like and trust, and see them regularly,” Dr. Jasper advises. “They will be able to detect early changes in the fibroids and offer early interventions, which are extremely important to those women who are trying to preserve their fertility.”