This week, we're discussing uterine fibroids and their effects on your body. Let's dive in!
What Are Uterine Fibroids?
Uterine fibroids are muscular growths in your uterus that often appear during a woman’s childbearing years. Also called leiomyomas, they are usually benign and rarely become cancerous. Fibroids can range in size from so small they can’t be seen with the naked eye to large masses that can distort or enlarge the uterus. You can have one fibroid or many.
Symptoms Of Fibroids
Most women with fibroids do not have any symptoms. For those who do, their symptoms can be influenced by the size and number of fibroids.
The most common symptoms of fibroids are:
- Heavy periods
- Long periods
- Pelvic pressure or pain
- Frequent urination
- Difficulty emptying the bladder
- Backaches or leg pain
Fibroids can become incredibly painful if they outgrow their blood supply and begin to die, although this is very rare.
Causes of Uterine Fibroids
Currently, researchers do not know the exact cause of uterine fibroids. The leading theory ties fibroid growth to hormones -- estrogen and progesterone seem to promote the growth of fibroids. The structure of fibroids contains high numbers of estrogen and progesterone receptors, seeming to confirm this theory. And, fibroids often shrink after menopause due to decreased hormone production.
While the specific cause is unclear, studies have revealed a connection between fibroid development and certain risk factors:
Fibroids are most common in women in their 40s and early 50s. NIH estimates that by age 50, 70% of women will have one or more uterine fibroids, and 30% of those women will need treatment.
While women of all races are affected, fibroids are most common in Black women. Fibroids are more likely to develop earlier in a Black woman’s life. The incidence rate for fibroids in Black women before the age of 35 is 60%, compared to 40% for white women. By age 50, that percentage increases to over 80%. Fibroids are more likely to develop earlier in a Black woman’s life, to be larger in size, and to cause more severe symptoms. The incidence rates for Hispanic and Asian women are similar to those of white women.
3. Family History
Studies also indicate that heredity may play an important role in fibroid production as well. If your mother or sister developed fibroids, you are more likely to also develop them.
Studies have linked higher BMI with increased risk of fibroids. In fact, obese women are two to three times more likely to develop fibroids.
5. Lifestyle & Eating Habits
If your diet is heavy in red meat, light on leafy greens, and involves high amounts of caffeine or alcohol, you may be more likely to develop fibroids. Your levels of physical activity can also influence your likelihood of developing fibroids. One study found an inverse relationship between physical activity and fibroids for both Black and white women. This means, the more you exercise, the less likely you are to have fibroids.
High levels of stress can also contribute to the development of fibroids. Stress is often associated with higher BMI, obesity, alcohol consumption, which can all increase your risk. Stress hormones can also send your growth factors into overdrive, potentially increasing the speed at which your fibroids grow.
Effects on Fertility
Now remember, fibroids are very common. Having fibroids does not mean you will be unable to get pregnant, but depending on their size and location, fibroids can become a factor impeding your ability to conceive. NIH estimates that fibroids are present in 5-10% of infertile patients, and they may be the cause of infertility in 1-2.4% of cases.
How do fibroids affect your fertility? Sometimes, they just get in the way of things, and block sperm from reaching your egg. In other cases, your fibroids might interfere with the implantation of an embryo in your uterine lining.
The larger the fibroid, the more problems it is liable to cause. In some cases a large fibroid can distort the shape of your uterus, potentially complicating the growth of a baby. Studies indicate that the main factor linking fibroids with infertility might be the distortion of your uterine cavity, which alters the development of your endometrium and impacts how receptive your uterus is to a pregnancy.
For women undergoing fertility treatment, the location of your fibroid will play a key role in the success of your cycle. Submucosal fibroids, or growths that develop in the inner layer of the uterus can significantly reduce implantation and pregnancy rates. As they grow, they can also block your fallopian tubes, making it impossible for sperm to reach your eggs.
Effects on Pregnancy
Again, fibroids are very normal and very common. Just because you have fibroids does not mean you will have issues with your pregnancy. That being said, the size and location of your fibroids can complicate pregnancy and delivery. For example, you are six times more likely to need a C-section. Fibroids can make your baby breech and not well positioned for delivery. Sometimes fibroids can cause placental absorption, where the placenta breaks from the wall of your uterus before delivery and your baby doesn’t get enough oxygen.
BUT, don’t worry! Your OBGYN will be able to help you navigate any complications that your fibroids might cause with your pregnancy. If you have fibroids and become pregnant, you should definitely let your obstetrician know, and he or she will be able to answer any questions you may have and monitor your pregnancy accordingly.
Identifying and Treating Fibroids
Fibroids are usually found during your regular pelvic exam. Your OBGYN might identify a (usually painless) lump or mass in the uterus. He or she may recommend imaging like an ultrasound or MRI to confirm you have a fibroid and to measure its size.
There are a range of options available to treat fibroids:
1. Watching and Waiting
Many women with fibroids experience either no symptoms or very mild ones. Fibroids aren’t cancerous and they rarely interfere with pregnancy. Your doctor may recommend just keeping an eye on the fibroid to check if it grows or shrinks, but if it doesn’t cause you discomfort there is no need to do anything else.
The medicine used to treat fibroids target estrogen and progesterone, the hormones that regulate your menstrual cycle. They are typically employed to treat symptoms like pelvic pain or heavy period, and while they won’t eliminate your fibroids, they may shrink them. One option is gonadotropin-releasing hormone (GnRH) agonists. These block your production of estrogen and progesterone, causing your body to enter a menopause-like state and your fibroids to shrink
Another common option is a progestin-releasing IUD which can relieve heavy bleeding caused by fibroids. However, this won’t shrink your fibroids or make them go away.
Your doctor can perform an MRI-guided focused ultrasound surgery (FUS). You will be put in an MRI scanner with imaging equipment that tells your doctor the precise location of your fibroid. He or she can then use sound waves to heat and destroy small areas of fibroid tissue.
Your doctor may also recommend laparoscopic surgeries like uterine artery embolization to cut off blood flow to the fibroid, causing it to shrink and die. A laparoscopic myomectomy is when your doctor removes the fibroids, leaving the uterus in place.
For very large fibroids, your doctor may do an open abdominal procedure to remove them like an abdominal myomectomy. The scarring after this surgery can affect future fertility. The other option is a hysterectomy, or the removal of the uterus. This is the only permanent solution for uterine fibroids, but it also ends your ability to bear children.
Advocating For Yourself:
Ask your doctor to make sure they check for fibroids during your yearly checkup. If you have fibroids, here are some questions you can ask your doctor to get the information you need:
- How many fibroids do I have?
- How big are they?
- Where are they located? (Outer surface, inner surface, or in the wall of the uterus)
- Will they grow larger?
- How quickly have they grown?
- How will I know if they are growing?
- What problems can they cause?
- What tests do you recommend for tracking their growth?
- What are the options for treatment if my fibroid/s become a problem?
- In your professional opinion, do I need to pursue any particular course of action to monitor or treat my fibroids?
If you are trying to get pregnant:
- Could the location/size of my fibroids affect my ability to get pregnant?
- Do my fibroids pose a risk of complicating my pregnancy?
Remember, if your doctor does not answer your questions completely, it’s always a good idea to get a second opinion. You can also reach out to us here at Binto with any questions you may have! Click here to schedule a telehealth consult with one of our healthcare professionals.