Dr. Jessica Traylor is a board-certified ob-gyn and fellowship-trained minimally invasive gynecologic surgeon with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Silver Spring Medical Center.
At least half of all women will have at least one uterine fibroid by age 50. Although fibroids are so common, many women aren’t familiar with the symptoms or treatment approaches.
During this Fibroid Awareness Month, I want to educate women about fibroids and reassure them that if they have fibroids, they are not alone, and they don’t need to suffer in silence. There are treatment approaches — medications, surgeries, and procedures — that can help improve quality of life. As a board-certified ob-gyn and minimally invasive gynecologic surgeon at Kaiser Permanente, I regularly treat patients for fibroids and see firsthand how successful treatments can be.
What Are Fibroids?
Fibroids are benign, smooth muscle tumors of the uterus, or the womb. They are not cancerous and are not considered pre-cancerous.
Fibroids can be as small as a few millimeters to as big as a watermelon.
What Are the Symptoms of Fibroids? How Do I Know If I Have a Fibroid?
Many women may never know they have a fibroid because they don’t have any symptoms, and other women may have symptoms so extreme that the fibroids affect their ability to go to work, school, or engage in the activities they love.
Some symptoms of fibroids include the following:
- Pelvic pressure
- Heavy periods. Signs of heavy menstrual periods include soaking through a pad or tampon every hour for several hours, bleeding with the passage of large clots, or having anemia (low blood count).
- Painful periods
- Abnormal uterine bleeding, such as bleeding between periods
- Frequent urination
- Back pain
Oftentimes, women are diagnosed with fibroids when they are being examined to determine the cause of infertility. In some women, the location of the fibroid can impact fertility.
Who Gets Fibroids?
We don’t know why some women get fibroids and others don’t, but we do know that they are extremely common, with upward of 70 percent of women having at least one fibroid at some point in their lifetime. Genetics and family history may play a role in some patients who have multiple relatives who have been affected by fibroids.
I have diagnosed patients with fibroids at every stage of life, including women as young as in their 20s. I have also treated women for symptomatic fibroids in their 80s. Thankfully, most women with fibroids do not have severe symptoms or grow new fibroids after they have entered menopause.
Black women tend to be diagnosed with fibroids at earlier ages than women of other races. Black women also tend to have more severe symptoms and develop fibroids that are more numerous and larger in size. More research is needed to understand this phenomenon, and what impact environmental factors may have on fibroid growth and development.
Do Fibroids Need to be Treated?
Not always. If small fibroids aren’t causing any symptoms, they do not need to be treated and can be monitored. I may recommend treatment for larger fibroids that are causing symptoms, or if a woman wants to become pregnant in the future. Unfortunately, we can’t estimate how large a fibroid will grow over time. Some grow very slowly; others grow at a fast pace.
As an ob-gyn, I talk to my patients about how their fibroid symptoms impact their quality of life, and their overall goals, including whether they want to become pregnant. Some treatments for fibroids are not recommended for women who want to become pregnant.
What Non-Surgical Treatments Are Available for Fibroids?
Non-steroidal anti-inflammatory agents, or NSAIDs such as ibuprofen or naproxen, are widely available and may help to lower the production of prostaglandins, which are pro-inflammatory hormone-like substances that the body produces during menstruation. NSAIDs have been shown to reduce the severity of pain and bleeding during menstruation.
Hormonal medications, including low-dose birth control, can be effective in treating fibroid symptoms. A progestin-releasing intrauterine device, for example, can relieve heavy bleeding.
Non-hormonal medications, such as tranexamic acid can be taken each month around the time of menstruation to reduce bleeding.
Iron supplementation is key for women suffering from heavy menstrual bleeding or abnormal uterine bleeding caused by their fibroids because they are often anemic. Many over-the-counter iron supplements can be taken by mouth, but when patients have more severe anemia, I may recommend intravenous iron infusions that are administered in the medical office.
These medications will not shrink fibroids but do help relieve symptoms. For some women, these medications are helpful enough that they don’t need additional treatment for their fibroids.
There are also medications that can be used on a short-term basis that can reduce fibroid-related menstrual bleeding. For my patients planning to have surgery for fibroids, these medications can be useful to help optimize their health prior to surgery.
What is Uterine Fibroid Embolization?
A uterine fibroid embolization, also called a uterine artery embolization, is a procedure performed by an interventional radiologist. The interventional radiologist reduces the blood supply to the uterus and fibroids by introducing a solution or small particles into the blood vessels. As that blood flow slows down, the fibroid becomes smaller and softer. As a result, people have fewer symptoms. It’s important to note the fibroids don’t go away but they cause fewer problems, such as less heavy menstrual bleeding and less fibroid bulk symptoms.
This is a very effective outpatient procedure for women who want to avoid surgery. However, it is not recommended for women who want to become pregnant.
What Are Surgical Treatments for Fibroids?
We have different surgical approaches. Your doctor will discuss the best approach for you, taking into account where the fibroids are located, how many fibroids you have, the size of the fibroids, and whether you want to become pregnant in the future.
Options include the following:
- Myomectomy, which is fibroid removal. This is a good option for women who many want to become pregnant in the future. There are multiple ways to perform a myomectomy: an abdominal (open) myomectomy, laparoscopic or robotic assisted laparoscopic myomectomy, or hysteroscopic myomectomy. Sometimes we use combinations of these approaches, and tailor the surgical plan to each patient’s needs. In all but an open myomectomy, the surgeries are typically outpatient. Most patients recover in just a few weeks, with few to no incisions and little pain.
Abdominal myomectomy is more often performed on patients with large fibroids. Patients need a few days to recover in the hospital, and home recovery can take several more weeks.
With myomectomy, there is a chance of fibroid regrowth or developing new fibroids in the future.
- Hysterectomy, or removal of the uterus. This is only an option for women who do not wish to become pregnant. After a hysterectomy, it is extremely unlikely for fibroids to grow back. When people undergo hysterectomy for fibroids, we are usually able use a minimally invasive approach using laparoscopy or robotic-assisted laparoscopy. These approaches result in small incisions, less pain and shorter recovery times compared with open hysterectomy techniques.
During a hysterectomy, we remove the uterus and all of the fibroids at the same time. I want people to know that having a hysterectomy does not mean you will automatically be menopausal; that occurs only if the ovaries are removed as well.
- Other newer technologies provide the ability to treat fibroids using minimally invasive treatments without surgically removing the fibroids or the uterus. This is called radiofrequency ablation and uses energy to treat the fibroids and causes them to shrink (but not disappear).
If you are grappling with fibroids, know that there are a variety of treatment options available. Not everyone needs surgery. Not everyone needs hormonal therapy. Treatments are tailored to the individual, the symptoms, and the person’s goals. Reach out to your doctor to discuss an approach that will help you feel better and get you back to the activities you enjoy.
Feature image, stock.adobe.com
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