If you’re a woman in your 30s or older, the word “fibroid” may have come up during a doctor’s appointment. Fibroids are benign (i.e., non-cancerous) muscular tumors that grow in and around the uterus. Most women will have at least one during their lives, even if they never know it. We spoke with Dr. Erika Banks, an ob-gyn and director of the Fibroid Center at the Montefiore Medical Center in New York City, to learn what women need to know about this condition.
How common are fibroids?
They’re exceedingly common. According to current data from the National Institutes of Health, about 70 percent of white women and 80 percent of African-American women have fibroids by age 50. While middle-aged and older women are more likely to develop fibroids, younger women can get them too.
Fibroids are more prevalent among African-American women, although experts don’t know why. “We suspect that there is a genetic component because we have observed that fibroids run in families,” says Banks. She also noted that, compared to white women, African-American women tend to experience larger fibroid tumors at younger ages.
What are the symptoms?
While fibroids are common, many women will never experience symptoms. However, for women with symptomatic fibroids, the clinical burden can be heavy. A 2017 study published in the International Journal of Women’s Health found that women with uterine fibroids are more likely than others to experience heavy menstrual bleeding, constipation, bloating and diarrhea, bleeding between menstrual cycles and severe pelvic pressure. Other symptoms of fibroids include frequent urination (larger fibroids can press on the bladder), lower back pain and painful intercourse. Fibroids vary in several ways that are related to whether they’re symptomatic and which symptoms they cause. Their size ranges from that of a pea to a large melon. They can appear individually or in clusters. And they can grow in a few different locations, including inside the uterine cavity, the uterine muscle or the uterine wall, as well as right outside the uterus.
According to a 2013 national survey of women with fibroids, about 25 percent of patients “have symptoms that impact activities of daily living or are severe enough to require treatment.”
If you are experiencing any of the above symptoms, Banks says it’s worth asking your primary care physician or ob-gyn if fibroids might be the cause. In 2016, researchers at the University of Chicago found that more than one-third of women with symptomatic fibroids delayed treatment because they believed their symptoms (heavy menstrual bleeding or painful intercourse) were normal.
How are fibroids diagnosed?
Fibroids can be diagnosed in several different ways by a primary care physician or an ob-gyn. If fibroids are suspected, your doctor will conduct a pelvic exam to feel for changes in the shape of the uterus. They may also conduct an ultrasound or MRI to confirm the presence of fibroids.
Do fibroids affect patients in any other way?
In addition to their physical toll, fibroids can also have a significant psychological effect on patients. Research has shown that women living with fibroids experience fear, anxiety, anger and depression; in one study, 50 percent of women living with fibroids said they felt “helpless” and that they had no control over their fibroids.
Do fibroids need to be monitored or treated?
Fibroids only need to be treated if they’re causing symptoms, Banks says: “We only discuss treatment options with a patient when the fibroid(s) is impacting her menstrual cycle or if she is experiencing some other issue, such as frequent urination or pelvic pain.”
What are the treatment options?
As a general matter, the course of treatment will depend on whether patients are experiencing problems caused by fibroids, as well as if they want to preserve their ability to have children. For those who need treatment, there are a few different options:
- Hormonal birth control: For patients who are experiencing heavy menstrual bleeding due to fibroids, Banks explained that hormonal birth control (such as the pill or a hormonal IUD) would be the first line of treatment. “Although hormonal birth control does not remove the fibroid, it does address the issue being caused by the presence of the fibroid,” she says.
- MRI-guided focused ultrasound surgery: A nonsurgical procedure that takes place inside an MRI scanner equipped with a high-energy ultrasound transducer. The ultrasound inducer is used to deliver focused sound waves to fibroids, which heat and destroy small areas of fibroid tissue until most or all of the fibroid is eliminated.
- Uterine artery embolization: A minimally invasive procedure in which a doctor uses a catheter to inject embolic agents into the uterine arteries that supply blood to fibroids. The goal of the procedure is to block the blood vessels feeding the fibroid, causing them to shrink and die. UAE is not recommended as a treatment option for women who wish to preserve fertility, since decreased blood flow to the uterus could potentially decrease blood flow to the fetus during pregnancy. It could also decrease blood flow to the ovaries, potentially triggering early menopause. The success rate of a UAE can vary depending on the number of fibroids a patient has, as well as their location and size.
- Endometrial ablation: A procedure that removes the lining of the uterus (but not the fibroids themselves). It’s a treatment option for patients who have heavy or prolonged periods and/or bleeding between menstrual cycles. It’s not recommended for patients who want to preserve fertility, as the removal of the uterine lining can make it more difficult to get pregnant.
- Myomectomy: A surgical procedure that removes fibroids while preserving the uterus (and therefore the ability to bear children). A myomectomy can be performed either abdominally or laparoscopically. However, there is a chance that new fibroids can grow after removal.
- Hysterectomy: Surgical removal of the entire uterus. “If a patient is done having children,” Banks says, “a hysterectomy is the only procedure that will guarantee that the fibroids will no longer return.” For that reason, it is the preferred treatment among women who have completed childbearing, since it eliminates recurrence.
If you find yourself with a fibroid diagnosis, remember that it’s a highly prevalent condition for which there are several treatment options, and that you may not need treatment at all. Work with your doctor to figure out the best approach for you.