Fibroids

Source: Adapted from Know Your Options: The Definitive Guide to Choosing The Best Medical Treatments, Reader

What are fibroids?

Fibroids are rubbery masses of muscle and fibrous tissue that develop within or along the wall of a woman’s uterus (womb). They come in multiples, vary greatly in size (from microscopic to up to 20 inches or so), and generate a range of symptoms. You may be completely unaware of their existence, or you may have the most common symptom of fibroids—a heavy or prolonged menstrual period—potentially serious, because it can lead to anaemia.

The pressure of large fibroids on nearby organs can also cause low back pain, abdominal cramping, pain during intercourse, difficult or increased urination, and constipation. By distorting your uterus, fibroids may also hamper your ability to become pregnant and increase the risk of miscarriage or heavy bleeding after giving birth. Once in a while, a stalk-like (pedunculated) fibroid develops and gets twisted, causing its tissues to die. This painful condition, known as necrosis, usually calls for immediate surgery.

Who is at risk for fibroids?

Between 20% and 40% of women over age 35 have uterine fibroids of significant size, and as many as 75% of African-American women have them. It’s not known why fibroids form (although new research suggests genetics may be responsible). Once they do, the female hormone estrogen certainly spurs their further growth. Fibroids tend to enlarge during pregnancy, when estrogen levels increase, and shrink or disappear with menopause, when estrogen falls. On the bright side: If you’ve carried at least two pregnancies to term, or are athletic, you may be less prone to them.

Treatment for fibroids

Fibroids are almost never life-threatening: They don’t develop into cancer. Nor do they increase your risk of uterine cancer, so if you have only mild symptoms, you may initially want to opt for a wait-and-see approach. You’ll still need regular pelvic exams and ultrasounds to monitor any growth, and you’ll want to relieve symptoms with medications and self-care remedies. More troublesome fibroids—those that cause particularly painful menstrual periods or related pain or that could interfere with fertility or pregnancy—should be removed. At one time, the traditional treatment for fibroids was removal of the uterus, a surgical procedure known as a hysterectomy. Today, there are a number of less radical procedures to consider first.

Medications for fibroids

If your fibroids are causing heavy, painful periods, regular doses of nonsteroidal anti-inflammatory drugs (NSAIDs) may bring relief. They reduce discomfort and curb the activity of prostaglandins, chemicals that stimulate uterine contractions. Good choices include ibuprofen (Advil, Motrin) and naproxen (Aleve). If you’re truly plagued by heavy periods, oral contraceptives (Lo/Ovral, Norinyl, Ortho-Novum, Demulen) may help control the bleeding.

Because of the direct link between estrogen and fibroids, drugs that block this hormone can reduce bleeding and shrink fibroid growth. Gonadotropin-releasing hormone (GnRH) agonists accomplish this by releasing reproductive hormones, which signal ovaries to stop producing estrogen. The drugs come in a variety of forms, including leuprolide injections (Lupron Depot), nafarelin acetate nasal spray (Synarel), and goserelin acetate implants (Zoladex). These medications are generally prescribed only for short-term use, usually to shrink fibroids by about 50% before surgery. The downside: GnRH agonists can cause unpleasant side effects that mimic menopausal symptoms (hot flashes, vaginal dryness, irritability). If taken for more than six months, they can increase osteoporosis risk (strong bones need estrogen), and fibroids usually grow back once the drug treatment ends.

Lifestyle Changes

Nutritionists recommend a low-fat, high-fibre diet to help ward off a host of health woes. It’s good advice for fighting fibroids, too. Research suggests that a steady diet of fats and red meat stimulates fibroid growth, whereas eating plenty of fruits and vegetables checks their development. Fibre-rich whole grains may also ease fibroid-related bowel difficulties. To pump up your iron stores and help prevent anaemia related to excessively heavy periods, ask your doctor about taking an iron supplement. Good food sources of iron include lean meats (the less marbling, the less fat), poultry, dried fruits, and fortified cereals.

Related Procedures for Fibroids

If you’ve been told the only surgery for fibroids is a hysterectomy, it’s time to become acquainted with other possibilities, especially because hysterectomy means you’ll no longer be able to bear children. Although fibroids remain a top reason for a hysterectomy, other options exist. Only a hysterectomy offers a sure cure. Fibroids may eventually return following other procedures.

If you hope for a future pregnancy, you might choose a myomectomy. This surgical procedure removes individual fibroids either through your cervix (hysteroscopic myomectomy), in which case no incision is needed, through your abdomen (laparoscopic myomectomy), and sometimes through both (abdominal myomectomy). All require general anesthesia. Recovery from abdominal myomectomy takes up to six weeks, but you may bounce back from the hysteroscopic and laparoscopic procedures within two.

A newer, nonsurgical technique called uterine fibroid embolization (UFE), also called uterine artery embolization, works by stopping blood flow so fibroids wither away. A specially trained interventional radiologist makes a tiny cut in your groin, then inserts a catheter through an artery to the uterus. The doctor then injects tiny plastic (or gelatin) particles to block blood supply to the fibroids. General anesthesia isn’t necessary, although an overnight hospital stay is (many women suffer cramps, nausea, and fever a few hours after the procedure). If you choose to undergo UFE, you should be able to resume your regular activities in about a week. Its effect on fertility isn’t yet known, and UFE is usually recommended only for women who are no longer fertile or aren’t planning to become pregnant.

Questions for Your Doctor

• How many fibroids do I have? Where are they located?
• How will I know if the fibroids are getting bigger?
• Will fibroids affect my sex life?
• What are the odds my fibroids will regrow after surgery?

Living with Fibroids

If you’re living with Fibroids, here are some quick tips to help you take control:

• Schedule regular checkups. An annual pelvic exam ensures early detection of fibroids; twice-yearly exams monitor existing ones.
• Seek relief with heat. If fibroids cause abdominal pain, apply a heating pad or hot-water bottle at least three times a week for an hour.
• Soothe with moves. Yoga exercises can help relieve feelings of heaviness and pressure from fibroids. Look for classes at your local Y or through a health club.
• Put it in writing. Track symptoms, noting periods and heaviness of flow or pain. Then discuss the data with your doctor.
• Ask about endometrial ablation, or removal of the uterine lining, if your chief complaint is heavy periods. Be aware: This procedure destroys fertility, and it won’t help fibroids.