When to Worry About Uterine Fibroids - large

Uterine fibroids are the most common pelvic tumor in women. The good news is that they’re almost always benign (non-cancerous) and are not life-threatening. Having children is still possible for most women with fibroids.

Obstetrician/gynecologist Neil Salas, MD, of Upper Valley Women’s Center, part of Premier Health Specialists, discusses what you need to know about fibroids and infertility.

What Are Fibroids?

Fibroids occur when smooth muscles cells in the wall of the uterus multiply and form a mass. Women with fibroids usually have more than one, but it’s possible to have just a single fibroid. Most are found in or near the uterus, including in the cervix. The growths “can grow as small as an apple seed and as large as a grapefruit,” says Dr. Salas.

There are different kinds of fibroids based on their location. They can grow into the cavity of the uterus, develop in the uterine wall or appear outside of the uterus. Fibroids become more common as women age, says the U.S. Department of Health and Human Services’ Office on Women’s Health. They begin to appear in women in their 30s and are most common in women in their 40s and 50s. Fibroids usually shrink after menopause.

“Most women may never know that they have fibroids,” says Dr. Salas.

When fibroids do cause problems, symptoms can range from mild to severe. The most common symptoms include:

  • Heavy menstrual bleeding
  • Painful periods
  • A feeling of fullness in the pelvic area
  • Lower back pain
  • Pregnancy complications

If you experience these symptoms or you can feel a firm mass in the middle of the lower abdomen, you should talk with your doctor about the possibility of uterine fibroids, Dr. Salas says.

How Fibroids Impact Fertility

Fibroids can impact fertility, primarily if they change the shape of the inside of the uterus. There are several other ways uterine fibroids may reduce fertility or impact a pregnancy, including:

  • Fibroids near the opening of the fallopian tubes or near the cervix can prevent fertilization.
  • Fibroids can distort the uterine lining, preventing embryo implantation or development, and may increase the risk of miscarriage.
  • Large fibroids, by distorting the uterine cavity, may increase the risk for a breech birth (when the baby’s buttocks and/or feet are positioned to deliver first, rather than the head), labor abnormalities and an increased risk of cesarean delivery.

The American Society for Reproductive Medicine estimates that between 5 and 10 percent of infertile women have fibroids.

Fibroids that are interfering with a woman’s quality of life can be treated and managed through a variety of options.

Fibroids have also been associated with other pregnancy complications, including placental abruption, preterm labor, and infants who are smaller than average during pregnancy (also called small-for-gestational-age babies). Be sure to talk to your doctor if you have fibroids and are pregnant. All obstetricians are trained to deal with fibroids and pregnancy, says the Office on Women’s Health.

Fibroids: Causes & Risk Factors

When to Worry About Uterine Fibroids - in contentDespite the prevalence of uterine fibroids in women, Dr. Salas says the exact cause is not known.

“Thankfully, physicians have knowledge about the factors that increase a woman’s risk of developing fibroids, the symptoms that fibroids cause and how to treat them,” says Dr. Salas.

According to the Office on Women’s Health, there are several risk factors for uterine fibroids.

  • Age. Up to 80 percent of women may have fibroids by age 50.
  • Family history. If a family member had fibroids, this increases your risk. If your mother had fibroids, your risk of having them is about three times higher than average.
  • Ethnic origin. African-American women are more likely to develop fibroids than white women. 
  • Obesity. Women who are overweight are at higher risk for fibroids. For very heavy women, the risk is two to three times greater than average.
  • Eating habits. Eating a lot of red meat and ham increases the risk of fibroids. Eating lots of green vegetables may reduce your chance of developing fibroids.

If you are concerned about any of these risk factors, talk with your doctor about how to make lifestyle changes that can reduce your likelihood for developing uterine fibroids.

Diagnosing Fibroids

If you experience the symptoms of fibroids or are struggling with fertility issues, your doctor may perform a clinical or pelvic exam, blood tests and other tests to see if fibroids are present.

Some of the imaging tests your doctor may use to check for fibroids are:

Other diagnostic tests may include:

  • Hysteroscopy. This test uses a long thin tube that may be equipped with a camera. The scope passes from the vagina, through the cervix and into the uterus to look for fibroids and take pictures.
  • Laparoscopy. The doctor makes a small incision near the naval and inserts a long thin tube with a bright light and camera. This lets the doctor see the exterior of the uterus and other organs on a monitor and take pictures.

Treating Symptoms & Infertility

Treatments for women with fibroids will depend on the severity of your symptoms, your age and whether or not you want to have children in the future.

“Fibroids that are interfering with a woman’s quality of life can be treated and managed through a variety of options,” Dr. Salas says.

Available treatments range from medicines to surgery.

  • Iron supplements. Women with heavy menstrual bleeding can take iron supplements to prevent anemia.
  • Anti-inflammatory medicines. The doctor may prescribe these medicines for pelvic pain and discomfort.
  • Anti-hormonal medicines. Medicines that block estrogen or reduce estrogen levels can prevent and reduce fibroids. Anti-progestins can also be effective.
  • Surgery. Different types of surgical procedures are used to treat fibroids. These treatments can remove the entire uterus, the uterine lining or just the fibroids themselves. Available surgical treatments include:
    • Myomectomy. This is a conservative surgical approach that removes the fibroids and leaves the uterus intact. This may allow a future pregnancy.
    • Uterine fibroid embolization. [link to  ] This procedure cuts off the blood supply to the fibroids by blocking the arteries that deliver blood to the fibroid. It is unclear how this procedure may affect the ability to get pregnant in the future.
    • Hysterectomy. The entire uterus is removed. Pregnancy is not possible after hysterectomy.
     

Uterine fibroids are extremely common, but their effect on each woman’s life is unique.

“Women should know that many options are available to treat fibroids, and that these options can significantly improve their quality of life,” says Dr. Salas.

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