Here are some common questions and answers explaining what uterine fibroids are – and aren’t – with sources from some of the top specialists out there referenced for you to check out.
How Do Doctors Describe Fibroids?
Uterine fibroids are muscular tumours of the uterus and are almost always benign (less than one in 1,000 are malignant). The size and quantity present vary by individual. Fibroids could be small in size, like a pea, or larger than a grapefruit or watermelon. They may occur as a single tumour or multiple tumours and may grow rapidly or not very much over time.
Fibroids can grow in different ways, including:
- Submucosal: Fibroids growing into the uterine cavity, often causing bleeding in between periods and severe cramping.
- Intramural: Fibroids growing in the wall of the uterus; they generally don’t cause problems unless they get to be large.
- Subserosal: Fibroids growing on the outside wall of the uterus.
- Pedunculated: Fibroids growing on stalks/stems into the pelvic cavity or into the uterine cavity; the stalks can twist and cause pain, and these types of fibroids are generally the easiest to remove via laparoscopy.
It is unknown what causes fibroids, but doctors believe they develop from a stem cell in the myometrium (smooth muscular lining of the uterus) that divides repeatedly to create a firm, rubbery mass that is different (distinct) from the nearby tissue.
What Are Potential Symptoms of Fibroids?
Symptoms of uterine fibroids (also called leiomyomas or myomas) can include things like: Pelvic pressure or pain (a feeling of fullness), heavy menstrual bleeding, anemia, spotting, enlargement of the lower abdomen, constipation, difficulty emptying the bladder or frequent urination, backache and leg pain, difficulty conceiving, and pain during sex.
- Menorrhagia: Heavy, often clotty menstrual bleeding. A pad or tampon is soaked through very often, sometimes every hour.
- Hypermenorrhagia: If two or more pads or tampons are soaked through every hour.
Maya here: In my case, the symptoms I experienced were more around the digestive system and back pain (nothing related to menstrual symptoms). I was diagnosed with fibroids after visiting an emergency room for excruciating digestive pain – you can read more about that diagnosis journey here.
Who Gets Fibroids?
It’s estimated that 70–80% of womxn may develop fibroids in their lifetime, but not everyone experiences symptoms (and some people may not even know one is there until a transvaginal ultrasound). Their likelihood increases as womxn age (until menopause, when the hormonal shifts may potentially cause them to shrink).
Fibroids occur more commonly in Black womxn (up to three times more likely than in womxn of other ethnic groups), who may also experience them at earlier ages, like in their teens, and with potentially more severe symptoms such as cramping and bloating. Other risk factors may include obesity, family history, not having children, early onset of menstruation, and late age for menopause.
There is no definitive link to food or external exposure that causes a woman to develop fibroids – so, no, they’re not preventable. Here is an abstract summary of a literature review of several studies around dietary aspects:
“A protective effect has been demonstrated for consumption of fruits and green vegetables in both case-control and cohort studies. Moreover, very recent cross-sectional and case-control studies evaluating serum levels of 25-hydroxyvitamin-D3 tend to indicate that vitamin D insufficiency, which may in part be due to the diet intake, may play an important role in the development of uterine fibroids. No association was found with the intake of fibers, vitamin C and E, phytoestrogens and carotenoids, whereas association was controversial for the consumption of meat, fish, dairy products, and vitamin A.”
How Do I Know if I Have Fibroids?
- Ultrasound: Sound waves produce a picture of the area being imaged. A pelvic ultrasound involves a probe being placed on the exterior part of the lower abdomen (pelvic region). A transvaginal ultrasound involves placing a wand-like probe inside the vagina to capture images internally.
- Magnetic resonance imaging (MRI): Magnets and radio waves produce imaging
- X-rays: A form of radiation that helps to produce imaging.
- CT scan (computed tomography, CAT scan): A scan involving multiple X-rays of the body from different angles that provides a more complete image.
- Hysterosalpingogram (HSG) or sonohysterogram: An HSG involves injecting X-ray dye into the uterus and taking X-ray pictures. A sonohysterogram involves injecting saline solution into the uterus and using ultrasound for imaging to examine things like the shape of the uterus, the uterine lining, and the fallopian tubes.
Pelvic exams and/or imaging are the norm but there are also two types of surgery that can also help diagnose fibroids:
- Laparoscopy: A minimally invasive surgery where a thin, long scope is inserted into a small incision near the navel. The scope has a light and camera to allow the doctor to view the uterus and surrounding organs.
- Hysteroscopy: A thin, long scope is passed through the vagina and cervix and into the uterus (no incision). This allows the doctor to take a look inside the uterus and may help them to evaluate for other conditions, like polyps or adenomyosis.
How Can I Get Treatment for Fibroids?
Of the 70–80% of womxn who have fibroids, most don’t have symptoms – and as such, most may not need treatment.
Medications to treat the symptoms of fibroids may include over-the-counter pain killers (like ibuprofen and acetaminophen) or iron supplements if you suffer from anemia. Low-dose birth control pills or an IUD (intrauterine device) may help reduce bleeding.
Gonadotropin releasing hormone agonist (GnRH) drugs may also be prescribed as they generally cause the period to stop and may reduce the size of fibroids (potentially making them easier to remove surgically). However, be sure to read the side effects and warnings of these medications as they should only be taken for limited periods of time and may have permanent effects.
If you have fibroids with moderate or severe symptoms, surgical intervention may be something to ask your doctor about. Here are different surgeries outlined by WomensHealth.gov:
- Myomectomy: This surgery removes fibroids without taking out the healthy tissue of the uterus (in case you want to keep your uterus). New fibroids may grow after a myomectomy. Myomectomy can be performed as a major surgery (involving cutting into/across the abdomen) or minimally invasive surgery with laparoscopy or hysteroscopy. The type, size, and location of your fibroids will impact which surgery your doctor may recommend.
Maya here: When dealing with large fibroids, surgeons may use a power morcellator, a tool that literally cuts the tumour into smaller pieces (like morsels) for easier removal. The FDA re-published its communication on the use of power morcellators in myomectomy and hysterectomy. Specifically, they recommend the use of contained morcellation (placing the tumour in a “containment system” – like a special bag – inside the pelvic cavity, cutting it up in the bag, and then removing the bag containing the morcellated fibroid). Sort of like an appendectomy bag. Read below about the case of Dr. Amy Reed below to learn about how power morcellation has had lethal consequences.
- Hysterectomy: This surgery removes the uterus (definitively removing uterine fibroids, and adenomyosis if that’s a concern, as a result). WomensHealth.gov cites that fibroids are the most common reason that hysterectomy is performed, and that removable of the ovaries and cervix is usually optional (if the ovaries are not removed, womxn do not go into menopause after surgery). Recovery from hysterectomy usually takes several weeks as it is a major surgery.
- Endometrial ablation: This procedure removes or destroys the lining of the uterus in an effort to control very heavy bleeding. Complications can occur but are uncommon with most of the methods and most people recover quickly. About half of womxn who have this procedure have no more menstrual bleeding. About three in 10 womxn have much lighter bleeding. But a woman cannot bear children after this surgery.
- Myolysis: Here a needle is inserted into the fibroid(s), usually guided by laparoscopy, and an electric current or freezing is used to destroy the fibroids.
- Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE): This involves threading a thin tube into the blood vessels that supply blood to the fibroid so that tiny plastic or gel particles can be injected into the blood vessels. This blocks the blood supply to the fibroid and can cause it to shrink. However, not all fibroids can be treated with this method. Complications, including early menopause, are uncommon but can occur. Studies suggest fibroids are not likely to grow back after UFE, but more long-term research is needed.
For more thoughts on UAE, particularly if you are interested in trying to get pregnant, check out this article from Dr. Ken Sinervo of the Center for Endometriosis Care.
Why Does Knowing About Fibroids Matter?
Fibroids are shockingly common. Similar to the costs associated with endometriosis (approximately $119 billion annually in the US), people with fibroids may experience a loss of job productivity and economic hardship due to lost wages. Whether it’s heavy bleeding, severe pain, struggling to conceive, or any of the host of symptoms associated with uterine fibroids, living with them shouldn’t be an afterthought.
Maya here: The story of Dr. Amy Reed was one that was sent to me to help explain the risks of power morcellation as I prepared for my first myomectomy (thanks, Holly!). In 2013, Dr. Reed underwent a hysterectomy for fibroids at Brigham and Women’s Hospital in Boston (affiliated with Harvard Medical School, where both she and her husband held teaching positions).
After her surgery, a biopsy revealed that Dr. Reed had a hidden leiomyosarcoma – cancer. However, surgeon had used power morcellation to cut up the uterus during the hysterectomy, which essentially sprayed the cavity with malignant cells from that leiomyosarcoma. Stage four cancer spread like blowing dandelion seeds.
Dr. Reed and her husband went head to head with the healthcare establishment as they fought to ban power morcellators, at great personal and professional cost (the NYT article I’ve linked to above describes the backlash they faced – including needing to obtain restraining orders).
While contained morcellation helps protect against the spraying of cells from the thing being cut up inside the cavity, it doesn’t protect against the exposed surface after something is removed (just as cutting the top of a lemon exposes fresh flesh).
Dr. Reed passed away at the age of 44 in 2017. She was an anesthesiologist and mother of six.
Maya here: I’m exceptionally grateful for the large fibroid that led to my diagnosis. Why? Because it showed up on an ultrasound as a solid, identifiable mass, unlike the “invisible” characteristics of endometriosis that create endless challenges for my fellow endo sisters. You can read more about Part 1 of my diagnosis journey here.
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