Uterine fibroids are more common than you think and often go undiagnosed. Those who experience symptoms could need everything from an over-the-counter pain medication to a hysterectomy to remove the uterus completely. Everyone’s experience is unique. Let’s explore what fibroids are, their various types, risk factors, and more. Then, we’ll discuss treatment options and how you can collaborate with your healthcare providers to create a treatment plan that works best for you.
The Statistics
Approximately 70% of individuals with a uterus will have uterine fibroids by age 50. Although uterine fibroids can be asymptomatic, 25%–50% of those with uterine fibroids experience symptoms, such as heavy bleeding, bulk symptoms, or pain, which can negatively impact quality of life according to the journal Fertility and Sterility.
It’s important to note that many cases are asymptomatic and go undiagnosed. Researchers estimate that up to 80% of us could develop fibroids by age 50, and African Americans are up to three times more likely to develop them than White people. In addition, they are seven times more likely to require surgery to treat them.
According to an editorial in the American Journal of Obstetrics and Gynecology, Black women may be at an increased biological risk because of our genetic makeup.
“Collectively, these 2 studies suggest an increased biological risk for fibroids in Black women. The distinct transcriptomic, molecular, and multiomic profiles observed in both studies inform the disparities we see in clinical presentation in daily practice. On the basis of these results, it is reasonable to suspect that fibroids in Black women may respond differently to medical therapies than White women.”
What Are Uterine Fibroids?
Fibroids grow in various locations on, in, or around the uterus. This includes the wall of the uterus, the uterine lining, near the fallopian tubes, or nearby internal organs. Some locations are more common than others.
Types of Fibroids:
- Intramural fibroids develop inside the muscular wall of the uterus and are often the most difficult to treat.
- Submucosal fibroids grow in the uterine cavity.
- Subserosal fibroids develop close to the muscular wall on the outside of the uterus.
- Pedunculated fibroids develop on the outside of the uterus but not as closely as the subserosal fibroids. They connect with a stem and sit farther away. This is the least common type of uterine fibroid.
Symptoms of Uterine Fibroids
Fibroids are quite common, but many women are unaware they have them. Those with symptoms may experience a wide range of effects, depending on the number, location, and severity of the symptoms. While very heavy bleeding and pelvic pain are the most common signs of fibroids, every person’s experience will be unique, which is why personalized attention from a knowledgeable provider is essential.
Possible Signs of Uterine Fibroids:
- Pelvic pain
- Painful periods
- Pain during sex
- Heavy menstrual bleeding
- Long menstrual cycle
- Frequent urination
- Inability to urinate or empty your bladder
- Constipation
- Low back pain
- Leg pains
Possible Complications
With very heavy menstrual bleeding or bleeding between periods comes the risk for anemia, a condition in which your body does not have enough healthy red blood cells. Symptoms of anemia include lethargy, dizziness, and shortness of breath. Close management by a physician is necessary if fibroids cause anemia to become life-threatening.
Some fibroids may twist at their stem and cause severe pain and symptoms that mimic those of an illness. They may also grow quickly, requiring surgical intervention if medication does not slow their growth. If fibroid tumors begin to break down, the body may react with symptoms such as fever or nausea. Treating the fibroids can often resolve infertility, which is one of the more common complications of uterine fibroids.
Fibroids: Causes and Risk Factors
It’s still unknown what causes uterine fibroids, but research suggests that there are several risk factors for them. One of the biggest risk factors is hormones. Those who take hormones or who have natural hormone imbalances seem to be at higher risk of developing fibroids. This is only one of many contributors, however, and those at risk of developing fibroids should discuss their concerns with their healthcare provider.
Risk Factors for Uterine Fibroids:
- Age
- Black women
- Weight
- Family history of fibroids
- High blood pressure
- Food additive consumption
- A diet high in red meat
- Vitamin D deficiency
- Never being pregnant
- Chronic stress
- Major stress events
Diagnosing Fibroids
Because many uterine fibroids are first detected through a routine pelvic exam, it may be difficult to detect them in very heavy women. However, if your provider suspects them or notices changes in the size or shape of your uterus, they may order additional diagnostic tests to determine their presence, size, and location.
Diagnostic Tests for Uterine Fibroids:
- Ultrasound: An ultrasound probe uses sound waves to view internal organs. Your provider may order a sonohysterography test in which they inject saline into the uterus during an ultrasound so that it is easier to see the uterine cavity.
- MRI: Magnetic resonance imaging (MRI) can be more effective at visualizing uterine fibroids once they’ve been detected with ultrasound.
- Hysteroscopy: A lighted scope is used to view the inside of the uterus. This is a minimally invasive procedure done in the clinic.
- Endometrial Biopsy: While nearly all fibroids are benign (non-cancerous), your provider may suggest a biopsy to confirm this with a diagnostic fibroid biopsy.
Treatment Options for Uterine Fibroids
There are many treatments available for uterine fibroids, including things you can do at home to complement your doctor’s care, making it more effective, medications, and even surgery to help manage your symptoms, depending on severity. Because there are many options, it’s essential to discuss them with your healthcare provider so you can make the most informed and best choice for your care.
Best Home Care
Many home remedies are simple and may already be part of your routine, such as using a heating pad and over-the-counter pain relievers. However, there is more you can do to help manage your pain without or in addition to the help of your medical provider.
Diet
A mostly vegetarian diet may help alleviate symptoms of uterine fibroids, although cold-water fish like salmon and tuna, which are high in omega-3 fatty acids, can also be beneficial. You may choose to supplement your diet with fish oil.
Many women with fibroids find that avoiding high-calorie foods can also help reduce symptoms, instead choosing green vegetables, apples, and citrus fruits that all contain high levels of flavonoids. You may decide to work with a dietician or nutritionist if you are overweight, as weight management is a large part of managing symptomatic uterine fibroids.
Stress
There are many ways stress levels affect the female reproductive system, and this is especially true for those with fibroids. A study by the Department of Epidemiology at the Gillings School of Global Public Health, University of North Carolina at Chapel Hill, found that significant and stressful life events appear to be a contributing factor in the presence and growth of uterine fibroids. To help manage stress, consider working with a therapist, receiving regular massages, exercising regularly, or practicing meditation. Certain types of yoga can help manage stress and offer exercise benefits to support weight loss.
Available Medications
Taking over-the-counter pain relievers may help reduce the pain and control heavy bleeding because they also act as anti-inflammatories. However, they won’t treat fibroids long-term because they don’t shrink them. Birth control pills or an intrauterine device (IUD) may work the same way. However, medications that regulate hormones could help shrink fibroids over time, so long as you continue taking the medication. Your physician may recommend medication as one of the first treatment options.
Non- or Minimally Invasive Procedures
Some procedures are minimally invasive or non-invasive and would be the next step in treating fibroids. These procedures are often very effective at treating fibroids that haven’t responded as well to medication alone or your doctor feels your fibroids need more aggressive therapy to control your symptoms.
- Forced Ultrasound Surgery: A specialized MRI machine targets high-energy, high-frequency sound waves at each fibroid to destroy them.
- Myolysis or Cryomyolysis: These procedures use either extreme heat or cold, such as water, electric current, laser, or other forms, to destroy the uterine lining.
- Uterine Fibroid Embolization (UFE): A plastic or gel material is inserted into the blood vessels of the fibroids, cutting off their blood supply and causing them to shrink.
Surgery to Treat Fibroids
It may be necessary to remove fibroids surgically through myomectomy. If uterine fibroids return frequently or no other treatments have been successful at managing symptoms, the last treatment option is usually a hysterectomy to remove the uterus completely. This is a permanent solution, and many healthcare providers will exhaust all other treatments or consider it only for those nearing menopause.
Questions to Ask Your Provider
The US Department of Health and Human Services Office on Women’s Health answers many questions that women may have about uterine fibroids, especially for those recently diagnosed. They also provide a list of questions to ask your provider that can help you better understand the condition and its impact on you, such as the number and size of your fibroids.
Other questions you may want to ask are:
- Where are the fibroids located?
- Will they grow larger, and how will you know if they do?
- What potential problems could they cause?
- Are there any future tests needed to monitor the fibroids?
- Do the fibroids require treatment immediately?
- What treatment options do you suggest?
If you feel uncomfortable with your doctor’s answers or wish to verify the results or suggested treatment, be sure to schedule a second opinion with another provider. This is another way you can take control of your health.
The Final Word On Fibroids
Although not all fibroids cause symptoms, some women may only experience inconvenient, heavy bleeding, while others require extensive treatment like surgical intervention. Those of reproductive age are at a higher risk of developing fibroids. Black women are even more susceptible. Black Health Matters is working to raise awareness about conditions affecting the Black community by sharing information and providing solutions. However, all women should know their risk of uterine fibroids and discuss the possibility and treatment options with their provider.
