The hidden condition affecting thousands of midlife women
Almost 80 per cent of women will suffer fibroids by the age of 50 – so why don’t we know more about them, asks
When Bridget Taylor, 45, woke up to see something “protruding from my stomach”, she took herself straight to A&E. She had been complaining to her GP for two and a half years that something wasn’t right, with symptoms that included severe tiredness, heavy periods and excessive weight gain around her middle every month. “My female GP kept saying that there was nothing wrong, that it was all in my head,” Taylor says.
When the A&E nurse tried to conduct an internal examination, she quickly realised something was wrong: an ultrasound revealed two uterine fibroids outside Taylor’s womb, one pea-sized, the other the size of a six-month foetus.
Taylor had never heard of fibroids before: non-cancerous growths of the muscle lining of the womb that are surprisingly common. About 30 per cent of all women get fibroids by age 35 and almost 80 per cent of women will have fibroids by the time they are 50.
Around a third of those who develop fibroids will experience symptoms, which can range from heavy menstrual bleeding, abdominal bloating, increased urinary frequency and pelvic pain. It can lead to lower back pain and discomfort or pain during sex. For those hoping to get pregnant, fibroids can affect fertility.
Yet, despite how common they are, few of us really know or talk about them. A new campaign, Talk About U, has recently found that 61 per cent of women who suffered from fibroids don’t talk about it with their friends, and over half wouldn’t speak to a healthcare professional.
While other chronic pelvic conditions, including endometriosis, are being talked about more, with celebrities, such as Lena Dunham, revealing they have the condition, fibroids have had less coverage. Last year, however, the 31-year-old singer FKA twigs revealed that she had six fibroids removed from her uterus.
A survey, commissioned by pharmaceutical company Gedeon Richter, found that more than a third (35 per cent) thought their symptoms were just normal. “It can
Jessica Salter
be easy to rationalise and disregard symptoms like heavy periods as ‘normal’, but by not addressing the underlying problem, this can lead to further complications,” says Dr Anne Deans, a gynaecologist at Frimley Park Hospital. Another reason is that women in their 40s and 50s can be “a little bit of a neglected group”, according to Dr Pixie Mckenna, GP, host of the TV’S Embarrassing Bodies and spokesman for the campaign.
“When you’re at the end of your reproductive years, you think, ‘It’s only a few more years of periods, I’ll just put up with it’, which, of course, isn’t what we should do,” she says.
Almost one in five (19 per cent), according to the survey, felt too embarrassed to raise it with their GP. “While we are talking about periods a bit more these days, there’s still a lot of embarrassment that surrounds them,” Dr Mckenna says. “Unless someone in your friendship group breaks that circle of truth, then you don’t actually know what is normal.”
Taylor says that once she got her diagnosis and started talking about it with friends and family, others soon opened up. “Suddenly I found out this family member had had them, this friend had… I just thought, why aren’t we talking about this more?”
Whilst doctors are still unclear about the exact causes of fibroids, they are linked to the hormone oestrogen. Fibroids usually develop during a woman’s reproductive years, when oestrogen levels are at their highest.
Factors including starting menstruating at an early age and being overweight, both of which increase the amount of oestrogen in the body and can increase the risk of fibroids. In addition, according to NHS statistics, women of Africancaribbean origin are up to three times more likely to have often painful symptomatic fibroids. “We don’t know why that is,” Dr Mckenna says. “Medicine has many quirks.”
By contrast, those who have had children have a lower risk of developing fibroids, due to having fewer periods over a lifetime and thus less oestrogen exposure (although fibroids can still grow during pregnancy). One bit of good news for midlifers is that during and after the menopause, fibroids may shrink as oestrogen production falls.
Dr Mckenna says that there’s little women can do to predict who will develop fibroids (apart from family history) or prevent them. “Although there are some studies that show that women who exercise more and have a lower BMI are at a lower risk,” she says.
Added to this, a study published in 2016 found that so-called endocrinedisrupting chemicals (EDCS) could lead to the development of fibroids.
Jenya Di Pierro, a trained herbalist and founder of the health club Cloud Twelve, advises that ways to avoid EDCS include avoiding canned goods, not heating up foods in plastic containers and using eco-cleaning products around the home.
“The plastic most likely to contain BPA compounds is marked as ‘PC’ with ‘7’ in the recycling symbol and should be replaced with glass,” Di Pierro says. There are positive dietary steps women can take, too. “Studies have shown that consuming 400mg of natural folate from food appears to cancel out the effect of BPA. Natural sources of folate are broccoli, cauliflower, spinach, asparagus, avocado, kale, lentils, berries, oranges.”
Traditionally, a total abdominal hysterectomy was used to treat fibroids – and in some cases it still is. It’s the reason Dr Mckenna believes that some women fear seeing a doctor about their condition if they do suspect fibroids. But there are other options.
If a woman only has small fibroids (less than 3cm), the symptoms of heavy bleeding can be controlled in a number of ways: by taking the combined oral contraceptive pill, using a Levonorgestrel-releasing IUS (intrauterine system), such as the Mirena, or taking tranexamic acid pills. There is also medication including gonadotrophin-releasing hormone analogues (Gnrhas), which is delivered via injection and stops the ovaries producing oestrogen and so aims to shrink the size of the fibroid.
Another option is uterine fibroid embolisation (UFE), a non-surgical technique that involves blocking the blood supply to the fibroid so that it shrinks. Research presented at the Society of Interventional Radiology’s 2019 annual scientific meeting found that after a seven-year study of 950 uterine fibroid patients, UFE was just as effective as other surgical options, with fewer future complications or hospital stays required.
Taylor had a myomectomy, the surgical removal of the fibroid. During the surgery, the surgeon found 13 further fibroids behind her existing one. Her recovery took three months, with a long period in bed, unable even to walk to the bathroom. “I am still very annoyed that if my GP had picked up on my symptoms earlier, I might have been able to have a less traumatic treatment.”
But unless a woman has a full hysterectomy, there’s no guarantee the fibroids will not grow back; in at least 10 to 50 per cent of cases in which fibroids are removed, new ones grow. Jennifer Jones, 54, said that when her fibroids came back, she adopted an anti-inflammatory diet, cutting out as much processed food as she could, replacing it with lots of fruit and vegetables. “I truly believe that if I’d done that after the first surgery, they would not have returned,” she says.
Taylor says hers have come back, but they are “very small and much more manageable”. Her life post-surgery, she says, is transformed. No longer does she have heavy periods of more than eight days, nor the excessive tiredness that dogged her before. She is desperate to raise awareness of the condition, so other women do not have to endure the same level of suffering.
“I want to tell other women that if you’re having a heavier than normal cycle, that’s not something you have to put up with, you can get help. And if you need to keep asking questions, do it, don’t let anyone put you off. You need to know everything about your own body.”
For more information on uterine fibroids, visit fibroidsconnect.co.uk
‘I had a fibroid the size of a sixmonth-old foetus’