Your questions about fibroids, answered
Fibroids are very common. Here is what you need to know about fibroids, including different treatment options.
If fibroids are making your life tough from heavy periods and constant bloating, you are not alone! Seventy to 80% of women will develop uterine fibroids in their lifetime. Up to 25% of these women report fibroids as a source of major quality-of-life issues when they affect energy levels and cause physical pain and difficulty getting pregnant.
If you are one of these women or know someone who is struggling with fibroids, knowing what they are and treatment options can help. Here is what you need to know about uterine fibroids.
Fibroids, also known as uterine leiomyomas, are benign tumors that develop within or on the walls of the uterus. They are made up of muscle and connective tissue and can vary in size, ranging from small pea-sized growths to large masses that distort the shape of the uterus.
While many women may develop fibroids, some may not know that they are there. In most cases, these fibroids may shrink on their own over time and not need medical attention. Large or multiple fibroids may cause symptoms and even need to be treated or removed.
The exact cause of fibroids is unknown. However, hormonal factors, particularly estrogen and progesterone, are believed to play a role in their development. Other potential risk factors include a family history of fibroids and being overweight or obese. Being overweight or obese can elevate estrogen levels.
Types of fibroids
Fibroids are classified based on their location within the uterus. There are four different types of uterine fibroids:
Intramural fibroids are the most common type and can grow in the front, back or top of the uterus. They may lead to fertility difficulties depending on where intermural fibroids are located.
Subserosal fibroids develop on the outer wall of the uterus and can grow large, potentially putting pressure on surrounding organs. These tend to create the most pain as they put pressure on the bladder, lower back and other areas.
Pedunculated fibroids are attached to the uterus by a stem. They are not located directly in the uterus and can be either submucosal or subserosal fibroids. They generally do not cause bleeding but may cause pressure.
Submucosal fibroids grow just underneath the inner lining of the uterus and may cause more problems and bleeding than other fibroids. You may experience symptoms no matter what the size. These tend to be the rarest type of fibroids.
Symptoms of fibroids
Many women with fibroids will not experience any symptoms at all, and others may experience a variety of symptoms. Symptoms depend on the size, number and location of the fibroids. Many of these symptoms can affect everyday life.
When fibroids cause heavy or prolonged menstrual periods, try using a menstrual cup or period underwear to manage heavy bleeding. These are more absorbent than regular tampons or pads.
Also, be aware the loss of blood may lead to iron deficiency. See your primary care provider or gynecologist if you are experiencing fatigue, paleness, shortness of breath, and dry or damaged hair and skin. There are ways to manage iron deficiency through diet and possibly supplements, too.
When fibroids cause pelvic pain or pressure, use heating pads to relieve the pain in your abdomen or lower back. You may also consider an anti-inflammatory medication, including ibuprofen.
When fibroids cause abdominal bloating or swelling, stay as active as possible. Take a walk or do light exercise that is comfortable for you. Also, limit foods that cause bloating or swelling, including foods high in sodium, carbonated beverages and processed foods.
When fibroids cause frequent urination, manage your liquid consumption. Just be aware not to dehydrate yourself! You can still drink and stay adequately hydrated but consider drinking smaller amounts more frequently throughout the day rather than a lot at one time. Pelvic floor therapy may also help. Request a specialized therapy appointment
When fibroids cause constipation, increase your fiber intake and fluids. Incorporate beans, lentils, fruits and veggies into your diet and drink plenty of water to relieve constipation. Always talk with your doctor if you have questions about your diet.
While these symptoms are common, they do not necessarily mean you have fibroids. Consult with your doctor to figure out what might be going on with you.
Diagnosing uterine fibroids
Fibroids are typically diagnosed through a combination of medical history, pelvic examination and imaging tests, including ultrasound or MRI. Your doctor and these imaging tests can determine the size and location of the fibroids.
Your doctor may also recommend you have a diagnostic hysteroscopy or sonohysterography. A hysteroscopy is an exploratory surgery to see inside your uterus. A sonohysterography, also called a saline infusion sonogram (SIS), is also a procedure to see inside the uterus that can be done in the office.
Uterine fibroids treatments
You may not need any treatment for fibroids if you can manage the symptoms. Your doctor may recommend treatment options if your symptoms are unmanageable, or fibroids are affecting your ability to get pregnant.
Management and treatments for fibroids include:
Watchful waiting: If fibroids are small, not causing symptoms or you are close to or past menopause, your doctor may take a “wait and watch” approach with regular monitoring of symptoms and fibroid growth.
Medications: Hormonal medications, such as oral contraceptives, gonadotropin-releasing hormone (GnRH) agonists, and progestin-releasing intrauterine devices (IUDs) may help manage symptoms, shrink fibroids or control heavy bleeding.
Uterine fibroid embolization is a minimally invasive procedure that involves cutting off the blood supply to the fibroid so it shrinks. This is usually an outpatient procedure with a short recovery.
Myomectomy is surgery to remove the fibroid from the uterus. Gynecologic surgeons can perform a laparoscopic myomectomy through small incisions or an open procedure depending on the size and location of the fibroid. Recovery depends on the individual and whether the surgery was minimally invasive or open.
Hysterectomy is surgery to remove the entire uterus. If your symptoms are severe and fertility is no longer a concern, removing the uterus may be recommended. This definitive treatment eliminates the possibility of fibroid recurrence.
Lifestyle modifications: Certain lifestyle changes can complement medical treatments and help manage fibroid symptoms. These may include maintaining a healthy weight, exercising regularly and eating a balanced diet rich in fruits, vegetables and whole grains.
Managing stress levels is also important. Studies show that many women with fibroids struggle with increased levels of anxiety and depression. See you doctor if you need support or have questions about what diet and exercise may be right for you.
Fibroids are a common condition that can cause a range of symptoms. While the exact cause remains unknown, various treatment options are available to manage symptoms, preserve fertility and improve quality of life. Early diagnosis and regular monitoring with your doctor can help you or someone you know navigate fibroids and make informed decisions about treatment options.
Elizabeth H. Lucal, MD is a board-certified OB/GYN. She is passionate about empowering women so their voices are heard and healthcare needs are addressed. She is a strong advocate for women’s rights. Learn more about Dr. Lucal, VP of Women’s Health Services at Nuvance Health.