Fibroids
What are Fibroids?
Uterine fibroids (also called leiomyomas or uterine myomas) are lumps that grow on the inside, outside and/or in the wall of your uterus. The growths can be as small as a pea or as large as a basketball. However, they are almost always benign (not cancerous), no matter how large the fibroids may get.
Fibroids are common among women in their 30s and 40s, and many women do not know they have them. African American women are 3 times more likely than white women to get uterine fibroids. Hispanic women are 2 times more likely than white women to get uterine fibroids. African American women are also more likely than white women to get larger and faster growing fibroids and at a younger age. Other risk factors for fibroids include: family history of fibroids, age, obesity, previous cesarean section, and alcohol consumption.
Unfortunately we do not know what causes fibroids. However, hormones like estrogen and progesterone that your body makes during the years you have periods seem to make them grow. Fibroids tend to shrink after menopause, when your body makes less of these hormones.
How to know if I have fibroids?
Fibroids often do not cause symptoms. However, if they do the symptoms may be mild or similar to other symptoms:
- Slightly heavier periods
- Long gushing periods and cramping
- Fullness or pressure in your belly
- Lower back pain
- Pain during sex
- Frequent urges to urinate
Heavy periods due to fibroids can cause iron deficiency anemia. And sometimes, fibroids can make it difficult to get pregnant.
How to get diagnosed?
If you have symptoms you may visit your doctor who will ask you questions about your symptoms. Diagnosing fibroids usually involves a pelvic examination to check the size of your uterus, an ultrasound to take pictures of your uterus, and blood tests.
How is it treated?
If the fibroids do not bother you, you may not need to do anything about them. You can visit your doctor regularly to check if they are getting bigger.
If your symptoms are pain and heavy bleeding, you may choose pain medicines and birth control (pills, intrauterine devices - IUDs) to improve your pain and make your periods lighter. These can also help prevent iron deficiency anemia along with taking iron supplements and iron-rich foods like meats, beans, and leafy green vegetables.
You may be prescribed drugs to lower estrogen levels to shrink or stop fibroid growth, especially if you will be having surgery.
Treatment for fibroids can include surgery to remove fibroids or remove their blood supply, especially if your symptoms are severe or very bothersome. Surgery to take out the fibroids only is called myomectomy. However, fibroids can grow back after myomectomy. Surgery to remove the blood supply to fibroids is called uterine artery embolization. Surgery to take out your uterus is called hysterectomy. Hysterectomy can make sure the fibroids do not come back, but you will no longer be able to become pregnant.
If you are on any medications or treatments to manage fibroid symptoms, you should talk to your healthcare provider about eliminating them or reducing them in preparation for pregnancy.
If I plan on getting pregnant what should I know?
If you have large fibroids, it can cause infertility or trouble becoming pregnant. The fibroids may prevent the fertilized egg from attaching to the lining of the womb or prevent the sperm from meeting the egg at all, however, this is rare. Fibroids that grow from the muscle wall into the womb (submucosal fibroid) can block a fallopian tube, and reduce your chances of becoming pregnant by preventing the egg from releasing into the uterus. Some research shows that women who have had more than 6 fibroids removed may be less likely to conceive than those with fewer fibroids taken out.
If you already know you have fibroids and plan to conceive, you should schedule a preconception appointment with your healthcare provider. Often, your provider will monitor you when you become pregnant and adjust your care plan based on how your fibroids behave.
If you have had a myomectomy, your healthcare provider will counsel you to wait 3 to 6 months after the surgery to give your uterus time to heal before becoming pregnant. There is a chance you may need to deliver via caesarean section if your uterus is weakened by myomectomy.
Pregnancy with fibroids
The majority of fibroids don’t change in size during pregnancy. However, one-third of uterine fibroids may grow in the first trimester and this growth is possibly influenced by estrogen, and estrogen levels rise during pregnancy.
If you have large or multiple fibroids, some potential concerns that your healthcare provider will regularly check for include:
- Placenta problems - placenta previa (placenta implants over cervix), placental abruption (placenta separates from the uterus)
- Fibroid growth
- Breech position - baby may be in breech position (bottom down instead of head down) if the fibroids limit space in the womb. If the baby’s position does not change closer to your due date, your healthcare provider may suggest caesarean section delivery.
- Preterm delivery - women with large or multiple fibroids can result in stress to the uterus, causing preterm contractions or premature rupture of membranes (water breaks before 37 weeks).
Potential complications that can occur during labor and delivery if you have large or multiple fibroids:
- Incomplete cervical dilation - bulky fibroids can block the birth canal and increase your risk of needing a caesarean section.
- Poor contracting - fibroids can disrupt the uterine tissue to the point it can cause weak contractions, and result in needing a caesarean delivery.
- Postpartum hemorrhage - poor contracting can cause bleeding after delivery. When the uterus does not contract, uterine blood vessels that were feeding the placenta can continue to bleed. This is an emergency condition and happens within 24 to 48 hours after delivery. If you experience heavy vaginal bleeding go to your emergency department immediately.
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