What are uterine fibroids?
Q: I am 27 and have heavy menstrual cycles. In the past year, I have begun to have more pelvic pain, especially during my period. A friend said I should get checked for fibroids. What are fibroids, and how do you treat them? A:
Uterine fibroids, also called leiomyomas or myomas, are benign masses that come from the muscle portion of the uterus. Fibroids are common. About 80% of people born with a uterus will develop fibroids, but not everyone has symptoms. Fibroids are most often diagnosed between 20 and 40 years old.
The cause of fibroids is unknown, although estrogen and progesterone appear to promote the growth of fibroids. Scientists are looking into other possible risk factors, such as family history, early onset of menstruation and lifestyle factors. People of African descent have a greater risk of fibroids, which can occur at an earlier age and produce more severe symptoms.
Here are the main symptoms caused by fibroids.
Heavy or prolonged menstrual bleeding: This can include changing a tampon or pad every hour, having bleeding for more than seven days or bleeding that prevents you from doing everyday activities.
Pain: Most commonly, fibroids cause pain during your period, but if they are large, they can cause a constant feeling of pressure or fullness.
Bulk symptoms: This can include seeing a bulge in your abdomen or appearing pregnant when you are not; urinary frequency; difficulty passing bowel movements; or feeling full constantly.
In some women, reproductive issues, including difficulty getting pregnant or a miscarriage, may be a sign of fibroids.
Given that excessive menstrual bleeding and pelvic pain may be signs of any number of issues, any person experiencing pain or heavy periods should visit their gynecologist.
Fibroids often can be felt on physical exam. Usually, when the uterus is enlarged or irregular, an ultrasound is ordered to diagnose fibroids.
Medical and surgical treatments are available. Treatment depends on which symptoms are most bothersome, as well as the size, number and location of the fibroids, and whether pregnancy is desired in the future.
Most medications aim to reduce the heavy bleeding common in people with fibroids. Hormonal medications — birth control and therapies unrelated to birth control — as well as nonhormonal medications can help suppress period bleeding. While medications can help shrink fibroids, these medications are not meant to be taken long term. Surgeries include the following.
Hysterectomy, in which the uterus is removed: This is a great option for people who are concerned about fibroids coming back in the future and have no desire for pregnancy. This procedure may be performed laparoscopically, with incisions no bigger than the size of your fingertip.
Myomectomy: A myomectomy aims to remove only the symptomcausing fibroids through the vagina or through small incisions.
Uterine fibroid embolization: Also known as uterine artery embolization, uterine fibroid embolization blocks the blood supply to fibroids, causing them to shrink. Pregnancy is not recommended after this procedure.
Radiofrequency fibroid ablation: This technique uses a device inserted into the fibroid and destroys the tissue with heat. Because this is a newer technique, few providers are trained in this technology, and you may need to ask your health care provider for a referral to a fibroid clinic or specialist.
Endometrial ablation, which destroys the lining of the uterus using a device inserted through the vagina: This treatment does not shrink fibroids, but it can decrease heavy periods caused by fibroids.
If you are diagnosed with fibroids, you can return to having a good quality of life.