Under The Knife

Now we're going to look at the surgical options for fibroid treatment. Women often turn to surgery if medical management hasn't worked, they are looking to correct infertility or they want to put an end to their fibroids once and for all.

Hysterectomy - This is complete removal of the uterus and the definitive (final) treatment for fibroids. Forty percent of all hysterectomies are performed because of fibroids, so this is a very common treatment. Of course this is only an option for women who don't want to have any more children. There are several different ways this surgery scan be done. With an abdominal hysterectomy the uterus is removed through a larger incision in the belly. A laparoscopic hysterectomy uses a camera through smaller incisions to complete the surgery. The procedure can also be done vaginally which results in no scars and usually a faster recovery. However, this cannot be done if the fibroids are very large. It's important to remember that a hysterectomy is a major surgery and will require a stay in the hospital no matter how it's done.

Myomectomy - This is a surgery where individual fibroids are removed while keeping the uterus intact. It's a good option for women who are trying to overcome infertility from their fibroids or those who want relief from symptoms but still want the option of having kids. Just like hysterectomies, there are many ways a myomectomy can be done including abdominally or laparoscopically. There is also the option of doing it with a hysteroscope or a camera that goes into the uterus. This is especially effective on those tricky submucosal fibroids that cause so many problems.

For any woman considering treatment for her fibroids it's important to consult a doctor. In order to make the best decision they will often need to get an ultrasound or MRI to get a better picture of the fibroids.

To Treat or Not to Treat - That is the Question

Admittedly up to this point we've talked about bad stuff - what puts you at risk, what can go wrong? Today we'll start looking at what can be done about fibroids. For most women the answer is: nothing. The majority of women have no symptoms from their fibroids and really don't need to do anything about them.  Doctors often call this "expectant management" or "watchful waiting," meaning we'll wait and see if anything happens. With fibroids this means getting a yearly gynecological exam and telling your doctor if anything changes. For those women who do have symptoms from fibroids or have concerns about getting pregnant because of the location of their fibroids there are options. Today we're going to look at the non-surgical methods.

Hormones - Hormones in a variety of forms have been shown to help with fibroid symptoms, especially heavy bleeding. They do not seem to decrease the size of fibroids. The hormones like estrogen and progesterone can be given in a lot of different ways. The most common is oral contraceptives or birth control pills but there are also IUDs, implants and injections. There are also drugs that affect the level of hormones in your body. One type of these know as gonadotropin-releasing hormone agonists (quite the mouthful!) has been shown to be the most effective at decreased the size of fibroids. Sadly, this drug is not recommended for long term use and is usually only given before surgery.

NSAIDs - Non-steroidal anti-inflammatory drugs are a fancy name for medicines we all have in our cabinet - ibuprofen, Motrin, Aleve. Since pain is one of the most common symptoms of fibroids, these drugs can be very helpful in their management.

Uterine artery embolization (UAE) - UAE is one of the newer treatments for fibroids. While it is a procedure, it's not a surgery - in fact a radiologist does it! The goal of UAE is to stop the blood flow to the fibroids. This is done by injecting little plastic particles into the arteries that send blood to the uterus. 

This procedure is very successful at shrinking the fibroids (up to 65%) and up to 85% of women report less symptoms. 

Fibroids and Pregnancy

A lot of women worry about if their fibroids will affect their pregnancy. The clearest answer is - maybe. First off, fibroids can cause some women to have trouble getting pregnant in the first place. As much as 2% of all infertility can be traced back to fibroids. The fibroids that are usually to blame are the ones that sit inside the cavity of the uterus (check out the picture from the first post.) Contrary to what you might think, bigger fibroids are not always worse.

Once a woman is pregnant there are a couple of ways her fibroids can affect her. Since fibroids have been found to respond to hormones like estrogen it's often thought that they will get bigger during pregnancy. However, this actually hasn't been shown! Most fibroids don't change at all during pregnancy and some even get smaller. Despite this, there can be complications during pregnancy. The most common is pain. There have also been some studies to show that fibroids can increase the risk of a miscarriage. Again this is only really a concern if the fibroid is what doctors call submucosal or right underneath the inner lining of the uterus. Women with fibroids may also experience some bleeding before they deliver and can be at risk for preterm labor and birth. They also tend to have more caesarean sections. So what can be done? Are women with fibroids doomed to have a difficult pregnancy? Of course not! Check back next time when we discuss treatment options!

Not as simple as Black and White

In the last post we talked about some factors that increase certain women's risk of developing fibroids. One of the most significant is race. The cumulative incidence, or the total percentage of new cases, is over 80% in black women by the age of 50. Some studies have looked at why these racial differences exist. This can partially be explained by the racial differences in the other risk factors. For example, Black women on average experience their first periods at a younger age than white women. Because we know that an early period is already a risk factor for fibroids, this can explain some of the differences between the races. However, accounting for each of the individual risk factors does not explain the wide gap between black and white women's fibroid risks.

Lots of research is currently being done to try to explain these differences. One area that has received much attention is dairy consumption. One study asked black women about their diet and then followed them to see if they developed fibroids. Women consumed more servings of dairy per day had a lower risk of developing fibroids than those who ate less dairy. This was the first study to find this kind of relationship so there is still a lot of research that needs to be done particularly to see if adding calcium to the diet could decrease the development of fibroids.

Another possible explanation for racial differences is stress or racism. Several studies have looked at this relationship and found that women who reported experiences of racism in their lifetime or discrimination in their daily life had an increased risk of developing fibroids. The risk increased even more for a higher number of life events reported. There have been other diseases associated with a stressful life so this could be an explanation for the development of fibroids.

Let's Talk About Risks

So now that we've covered the basics let's move on to some more specific topics. In this post we're going to discuss risk factors for fibroids - in other words what are characteristics make you more likely to develop them. Some of these risk factors are modifiable and others are not. While many different characteristics have been researched to see if they have a connection to fibroids, today we'll only discuss a few of the most important ones to consider when determining your own risk for fibroids.

Race - The rates of fibroids are very different between black and white women with black women 2 to 3 times the rate of developing fibroids. In fact, 50% of black women in menopause are found to have fibroids compared to only 35% of white women in the same age range. The way that fibroids progress also differs by race. Black women tend to have symptoms from their fibroids at an earlier age, as a result they also have more hysterectomies for their fibroids. The reasons why these racial differences exist is not really understood but we'll look at some possible explanations in the next post.

Menstrual history - Women who had their first period at a young age (usually considered less than 10) also have a higher risk of developing fibroids. Having multiple children decreases risks.

Myth alert!!! - Some people think that using birth control pills makes fibroids grow, but this has NOT been found to be true in several studies on the topic.

Diet - Eating lots of red meat or ham can increase risks, while green vegetables can decrease risks of developing fibroids. Drinking alcohol, particularly beer can also increase risk.

Smoking - Women who smoke usually have a lower risk of developing fibroids. The reason for this is unknown but considering all of the other increased risks of smoking you still shouldn't smoke!!

Family history - Women who have family members with fibroids are also more likely to develop them.

So to wrap up, these are some of the most common risk factors for developing fibroids. As with most medical conditions everyone's body is different so ask your doctor if you have questions about your specific risk.

What are Fibroids?

You may have heard your doctor mention them after your yearly exam. Maybe a sister, aunt or friend has asked you about them. Uterine fibroids are the most common pelvic tumor in women. Now don't be alarmed by the word tumor. Fibroids are benign which means they aren't cancerous. However, fibroids can still be a serious medical problem for many women. Fibroids can also be called leiomyomas or myomas so don't be confused if you hear those words tossed around too.

So what are they exactly?

Fibroids are basically an overgrowth of the muscle that makes up the uterus. They can be located within the wall of the uterus, inside the uterine cavity, and some even grow on stalks.

It is estimated that up to 25% of women of reproductive age have at least one fibroid but as many of 80% of surgically removed uteri are found to have fibroids.

So how do I know if I have fibroids?

Often women who have fibroids don't even know it because they don't have any symptoms. The most common symptom is heavy menstrual bleeding. Some women can experience pelvic pain. Even more rare are difficulties urinating or frequent urination. Fibroids can also cause difficulties getting pregnant (stay tuned for a future post on this topic). Fibroids can be diagnosed by a doctor in a few different ways. First is by pelvic examination. Whether the doctor can feel a fibroid on this exam depends on the location and the size. Ultrasounds are a very reliable way to diagnose them and are the most common method. Often a doctor will order an ultrasound to confirm the suspicion of fibroids. There are other modes of imaging such as MRI and hysteroscopy (camera for the uterus) that may also be used. The final and most invasive way fibroids are diagnosed is during surgery. These are often incidental findings during a procedure for another purpose.