According to the National Institutes of Health, a division of the US Department of Health and Human Services, most of the women living in the United States will develop uterine fibroids during their lifetime.
Up to 70% of women of European descent experience fibroids by age 50. The estimates rise to between 80% and 90% for African-American women. Many of them will never know they have the condition, as the small growths can settle in the uterus without interrupting its normal function. However, for some women, fibroids can cause serious complications.
The pain from this condition can be severe. It disrupts women’s lives at home and work. Every year, more than 600,000 of them undergo hysterectomies to alleviate their symptoms. In an attempt to regain control of their bodies, these women are told by their doctors that the only way to end their suffering is to give up their ability to have children.This is a devastating decision for any woman to face. Sadly, it’s also a decision they may not actually have to make.
Uterine fibroids affect many aspects of daily life. Its impact on fertility, however, is one of the most common reasons for women to seek their doctor’s advice. Cases with little to no pain are easy to ignore, and may not be detected until multiple attempts at conception have failed.
Once a diagnosis is received, those who still want to conceive can have difficulty finding doctors with the knowledge and experience to treat their symptoms without a hysterectomy.
Having fibroids does not mean you need to have a hysterectomy. Even in advanced cases, there are surgical treatments and other therapies that can shrink growths and restore health without sacrificing fertility.
While these methods are relatively new, they have been tested and shown to help women free themselves of uterine fibroids while retaining the ability to grow their families.
This white paper explains what uterine fibroids are and describes the various ways they affect women’s health.
Information on treatment options that do not involve hysterectomy are discussed, such as myomectomies.
Tips on how to talk to your doctor about these alternative methods and the value of seeking a second opinion are also explored.
Women who discover their uterine fibroids may be negatively affecting their ability to conceive have a reason for hope. This guide will prove that there are safe and effective treatments for uterine fibroids that preserve fertility.
UNDERSTANDING WHAT UTERINE FIBROIDS ARE
Understanding what fibroids are and how they affect the body is essential when evaluating treatment options. Placement and size define these growths and can give you and your doctor important clues when deciding which therapy options will work best.
What is a Fibroid?
Fibroids are benign tumors that grow in the uterus. They are not cancerous, and most are small enough to have no noticeable effect on uterine function. The majority of women with this condition will never know they have it.
Only a few will have symptoms severe enough to require medical intervention. Some doctors refer to these growths as leiomyomas, a general term for benign, muscular tumors.
Uterine fibroids that form under the membrane lining the outside of the uterus are called subserosal.
These growths either sit on the muscular membrane or attach themselves to it with a stem-like appendage called a pedicle. Subserosal growths usually have no effect on normal function. In rare cases, the pressure from large tumors can warp the shape of uterine walls and fallopian tubes. Tumors that form in the fundus or other areas of the uterus can make it impossible for fertilized eggs to attach firmly to misshapen walls and threaten the embryo’s viability.
Submucosal fibroids grow close to the inner lining of the uterus. Intramural fibroids are found between the layers of muscle that make up the uterine wall. Women who suffer fertility loss from fibroids are more likely to have one of these conditions. Large groths prevent fertilized eggs from implanting. They also rob growoing embryos of vital nutrients and contribute to miscarriage.
Even small submucosal tumors can negatively impact a women’s ability to conceive and carry a child to full term. Growths stretch the surrounding lining, causing abnormal bleeding that can disrupt fertility cycles. Beyond problems with conception, tumors also cause a variety of symptoms that burden the daily life of sufferers.
How Do Fibroids Form?
Doctors have yet to discover why fibroids form. However, it is known that genetics play a big role in a woman’s chance of getting them. The reproductive hormones estrogen and progesterone also affect the likelihood of developing growths. The vast majority of fibroids grow during a woman’s reproductive years. Girls who have not reached puberty don’t share the same risk of developing growths. Menopausal women will find their growths shrink naturally as their hormone levels decrease.
Medical researchers are still exploring the relationship between reproductive hormones and fibroid growth.
What is known is that while the presence of estrogen and progesterone promote the production of fibroid cells, women with the condition usually don’t show unusual hormone levels on standard blood tests.
However, the fibroids themselves will have elevated levels of estrogen in their cells. This is because fibroids contain a chemical enzyme that converts male hormones, called androgens, into estrogen. Women’s bodies use progesterone to prepare the uterus for pregnancy. Fibroids grow larger when progesterone levels are high.
Female progesterone levels peak during the luteal phase of the menstrual cycle. Many women first notice the pain and pressure of expanding fibroids at this time. A lot of research is being performed to understand how progesterone affects fibroid growth, and on antiprogesterone agents to decrease fibroid growth.
Other chemicals, called growth factors, are produced by the body and contribute to fibroid growth. These proteins promote blood vessel growth, allowing tumors to gather nutrients from your body. The actions of these proteins are still being studied.
Who Gets Fibroids?
The majority of US women will develop uterine fibroids by age 50. Though fibroids are the single most common type of tumor for all women of childbearing age, those who fit into certain demographics have higher risks.
- African descent.
- A family history of fibroids.
- Early menstruation.
- Late menopause.
- No pregnancies.
Lifestyle choices also contribute to fibroid growth.
- Use of hormone-based birth control.
- Vitamin D deficiency.
- A regular diet heavy in red meats and bacon and low in plant-based nutrients.
- Frequent use of alcohol.
Regardless of ethnicity and genetic history, doctors agree that a healthy diet and regular exercise reduce the likelihood and severity of benign growths.
How are Fibroids Diagnosed?
Most women are unaware of the presence of fibroids until it negatively impacts their health. When doctors suspect that uterine fibroids are the source of a patient’s complaints and symptoms, they use a combination of data and testing to confirm their diagnosis.
- Physicians begin by collecting on the length and frequency of the patient’s menstrual cycle. Any recent changes in flow, timing, and physical sensations are noted.
An internal pelvic exam allows doctors to feel the uterus’ lining for bumps and lesions. As most tumors are small in size, only larger growths will be found using this method. A Pap smear and test for common infections is usually included in the exam.
Ultrasound technology gives doctors a more accurate picture of the inside of the uterus. Transvaginal ultrasounds use a small wand inserted into the vagina. Doctors use transvaginal imagining to get a clear, close-up view of all uterine structures and to measure and assess any tumors.
Blood tests measure hormone levels, test for infections, and gather general data doctors use to track the effectiveness of any prescribed therapies.
Medical imagining is the best way to confirm uterine fibroids. However, information from lab tests can be instrumental in developing an effective treatment plan.
Many women with uterine fibroids experience no symptoms. Those who do usually feel mild to moderate sensations that don’t affect their daily lives. A few women, however, will suffer symptoms severe enough to require medical intervention.
What are the Symptoms of Uterine Fibroids?
The symptoms women experience depends on the size and location of growths.
Most tumors are too small to affect normal uterine function.
However, many women notice some changes caused by fibroids.
- Abnormal menstrual cycles are often one of the first indicators of uterine fibroids. Heavy menstrual bleeding is sometimes called menorrhagia. Menorrhagia causes severe
- bleeding that may restrict a woman’s ability to complete her normal daily tasks.
- Bleeding that lasts more than a week leads to anemia, a condition that causes weakness, fatigue, chest pain, headaches, dizziness, and shortness of breath. Anemia also causes irregular heartbeat, which contributes to heart disease.
- Women feel pressure or heaviness in the pelvic area or around the lower abdomen from larger growths. This sensation is usually not painful and has been described as an “uncomfortable fullness”. Some tumors make it difficult to bend at the waist or lie face down without pain or discomfort
- Fibroids that sit near the bladder causing urinary problems like increased frequency and the inability to completely void the bladder. Rectal pressure caused by fibroids growing near the bowel causes chronic constipation and painful movements. If left untreated, rectal pressure contributes to the development of hemorrhoids.
- Low back pain is a common symptom in many conditions. However, large fibroids situated on the back surface of the uterus can press against the nerves and muscles around the lower spine. This pressure aggravates sciatic conditions, compromises healthy blood circulation, and interrupt a woman’s ability to enjoy sports and other physical activities.
- Sexual discomfort is experienced by many women with uterine fibroids. Some women only feel pain during intimacy at specific points in their menstrual cycles. Others may feel it in certain positions. Sexual discomfort is a difficult issue for couples. The challenges it brings threatens the mutual satisfaction of both partners.
Pain is also felt when a large fibroid outgrows its blood supply. As the tumor dies, patients experience sharp pain. These sensations are frightening but don’t cause serious injury. Acute pain from fibroids is rare.
Are Fibroids Affecting My Ability to Conceive?
In some cases, fibroid growths reduce a woman’s ability to have a child. Infertility can result from fibroids when:
- The growth changes the shape of the cervix. Sperm may not be able to enter the uterus when walls are misshapen.
- Tumors block the Fallopian tubes. If mature eggs can’t make it into the uterine cavity, fertilization won’t happen.
- The uterine wall is warped. Fertilized embryos need to implant firmly on the uterine wall to ensure survival. Membranes that are stretched and bumpy from fibroids prevent embryos from attaching securely.
- Thin and weakened walls can’t provide growing embryos with a sufficient blood supply. Some women with fibroids suffer multiple miscarriages.
Since uterine fibroids only strike women of childbearing age, infertility can be the most devastating symptom of them all. These fibroids keep women from having the option to grow their families. There are, however, treatments that can restore the ability to conceive.
The majority of uterine fibroids don’t require treatment. Your doctor may suggest “watchful waiting”. This means taking no actions but continuing to note the progress of symptoms. If conditions change, a new treatment plan is developed.
When the pain, bleeding, and compromised fertility disrupt the ability to enjoy life, your doctor may suggest several ways to find relief. Home remedies like milk thistle, green tea, and castor oil alleviate symptoms by regulating the hormones that encourage tumor growth.
Your doctor may prescribe medications that temporarily disrupt your body’s ability to produce progesterone and estrogen. Like home remedies, this option does not shrink tumors. They do, however, make living with fibroids more comfortable until a more permanent solution is found.
In extreme cases, surgery is needed to remove growths. Your doctor may perform a procedure called a myomectomy to extract larger tumors.
Not all cases qualify for a myomectomy. The alternative is a partial or complete hysterectomy. While this method guarantees permanent relief, it also negatively impacts fertility.
What to Ask Your Doctor?
Ask your doctor these important questions to ensure you have the information needed to make informed decisions about your fibroid treatment.
- Where are the fibroids located? Are they in a position to affect my fertility cycle?
- What type of fibroids do I have?
- What symptoms are being caused by my fibroids?
- What are the best self-care options for my condition?
- Are there any medications that can alleviate my symptoms? Will those drugs affect my ability to conceive? What are the possible side effects of drug therapies?
- What surgical options do I have beyond a partial or full hysterectomy?
Combined with personal research, these questions help women with uterine fibroids decide on the best response to their condition.
Is a Hysterectomy Inevitable?
Rarely, the number and size of fibroids in the uterus makes non-surgical treatment impossible. In these cases, many doctors suggest a partial or full hysterectomy. While this procedure does permanently eliminate irregular bleeding, pain, and discomfort, it comes with a heavy physical and emotional toll. It can take up to 8 weeks for your body to recover from the surgery. During that time, your ability to participate in normal activities is severely restricted.
Once your surgical wounds heal, you may start to notice changes in your body. The disruption in hormone production leads to a condition called surgical menopause. Like the natural life phase, women experience hot flashes, irritability, weight gain, and other uncomfortable symptoms. Hormone replacement therapy is an effective way to reduce these effects.
Hysterectomies are not inevitable. Myomectomies, uterine artery embolization, and hysteroscopy are surgical procedures that remove fibroid growths without sacrificing fertility. These treatments are not appropriate for all cases. Women who want to preserve the ability to grow their families should speak to their doctor about which alternatives may work for them.
The Importance of a Second Opinion
The medical field is currently undergoing a transformation. The presence of healthcare management companies and stringent insurance rules have reduced the time and attention doctors have available for each patient.
Many doctors neglect to keep up with the latest developments in medical technology, or simply don’t see the value in investing in the equipment needed for newer procedures.
Seeking a second opinion gives patients multiple advantages. Having your case evaluated by another medical professional reduces the chance of mistakes and missed details. Each doctor can apply their unique experience and understanding and give you the best variety of treatment options from which to choose. You can also use your visits to evaluate potential surgeons, gather referrals, and ask the questions you may not feel comfortable asking your primary doctor.
Uterine fibroids are non-cancerous growths that form in or on the uterus. The majority of modern women have some form of this condition. Rarely, the tumors’ location, size, or number can cause pain, bleeding, and disrupt hormone production and the reproductive cycle. Doctors verify the presence of uterine fibroids with pelvic exams, ultrasounds, and blood tests.
Once a diagnosis is confirmed, women are faced with finding viable treatment options. Home remedies and prescription medications can alleviate some of the discomforts of fibroid growths. For those with more severe cases, surgery may be the only option.
If your doctor recommends a hysterectomy to treat uterine fibroids, you should know that there are other options. A second opinion could help you keep your ability to conceive.
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I believe there is no medical specialty with a closer interpersonal relationship than that between a woman and her gynecologist. That’s why I think you have a right to know what I believe and for you to understand the medical issues that are important to you. I believe we are in this together.
Gynecological care requires the active involvement of the patient. Medical education is an ongoing task.
It belongs to both of us. It is my job to bring you the most current medical care available and I pledge myself to that task.
I believe that knowledgeable patients are the best patients. That’s why you’ll find an extensive collection of health literature and medical DVDs in my office. I believe that physicians have an obligation to ease the minds of their patients as much as to heal their bodies. That’s why we allow time during each office visit for questions and I am available for telephone consultations.
I believe that a child’s coming into the world is a family event, and I have encouraged the active participation of all members of the family, particularly the father, throughout the birth experience. I believe that the birth of a child is a miracle, and feel privileged to have been a part of it.
Thank you for your interest.
Lyndon D. Taylor, M.D.