Fibroids

Fibroids are benign tumors of the uterus.  They are SO common.  Most estimates say that up to 75% of women have at least one fibroid.  Fibroids grow because of a smooth muscle uterine cell mutation that is influenced by the hormones estrogen and progesterone.  They can be as small as a pea or as big as your head!

Fibroid tumors can be asymptomatic and a woman may never even know she has them.  They can also wreak havoc on a woman’s body, causing heavy bleeding, anemia, a feeling of fullness or pressure, difficulty emptying the bladder or having a bowel movement and even pain.  They can impact a pregnancy in a number of ways, from causing miscarriage to requiring the need for a c-section.  One of the most difficult scenarios in pregnancy is when a fibroid grows under the influence of hormones and actually outgrows its blood supply.  The fibroid can degenerate causing horrific pain.

Fibroids can be located on the surface of the uterus.  These are called subserosal.  Fibroids can be found in the muscular wall of the uterus.  These are called intramural.  And fibroids can be found just on the inner surface of the uterus.  These are called submucosal.

Fibroids can be diagnosed most easily yet surely with an ultrasound.  There are other ways to diagnose fibroids including MRI, but we usually at least begin with an ultrasound.

Treatment for fibroids often depends on the symptoms the woman is having, as well as her age and desire for fertility.  Some women require no treatment, especially if they didn’t even know that they had fibroids.  Others may only need mild pain relief like NSAIDs .

But if a woman is experiencing heavy bleeding, she may seek treatment.  Often times the heavy bleeding can be controlled with medications like the birth control pill (or other hormonal regimens) or tranaxemic acid.  Remember from a previous blog that tranaxemic acid decreases the amount of bleeding by inhibiting the breakdown of clots.  Heavy bleeding is associated with an abnormally high rate of clot breakdown.

Other medical treatment options include GnRH agonists.  These are medications that block the production (temporarily) of estrogen and progesterone.  When the fibroids are not under the influence of these hormones, they often shrink.  This is not a permanent fix, however, because when the medication is stopped, the hormones return and the fibroids begin to grow again.  GnRH agonists are often used to shrink fibroids before attempting surgery, to make the surgery easier, safer, and less time-consuming thereby reducing loss of blood and leading to a faster recovery.

In my next blog, I will discuss both noninvasive and invasive procedures to treat uterine fibroids.

Dr. Deb Herchelroath