When to Treat Uterine Fibroids
By Dr. Richard Kishiue, M.D., Board-Certified OB/GYN
As many as 3 out of 4 women have uterine fibroids sometime in their life, but most aren’t aware of them because they often don’t cause symptoms. It’s when fibroids cause symptoms -- ranging from heavy and prolonged menstrual bleeding to pelvic pain and frequent urination – that women seek treatment.
What are fibroids?
They’re muscular tumors that grow in the wall of the uterus or womb. They’re almost always non-cancerous. They can grow as a single tumor as small as a seed or as big as a grapefruit and in some cases even larger. Fibroids are most common in women in their 40s and early 50s. Most fibroids are harmless, do not cause symptoms or require treatment, and shrink with menopause.What are fibroids?As many as 3 out of 4 women have uterine fibroids sometime in their life, but most aren’t aware of them because they often don’t cause symptoms. It’s when fibroids cause symptoms -- ranging from heavy and prolonged menstrual bleeding to pelvic pain and frequent urination – that women seek treatment.
No one knows for sure what causes fibroids, but they have a hereditary component and are linked to the hormones progesterone and estrogen. That’s why fibroids grow rapidly during pregnancy, when hormones are high, and they stop growing or shrink once a woman reaches menopause. If one of my patients has few or no symptoms or is nearing menopause, I often recommend watchful waiting and regular pelvic exams to check on fibroid growth or symptoms.
Sometimes, however, symptoms of fibroids are so intolerable and severe they can make daily life pretty uncomfortable. Difficulty becoming pregnant can be the first sign of fibroids. But most often women see their doctor for fibroids because of the following:
- Persistent pain or pressure in the abdomen
- Overly heavy or painful periods that can causing anemia (using one tampon or pad every hour)
- Consistent pain during sex
- Urinary problems
Treatment for fibroids can depend on many factors, including the severity of the symptoms, the size and location of the fibroid, and whether the patient wants to preserve her ability to get pregnant. Over-the-counter medications like ibuprofen and acetaminophen can be effective for mild pain. Birth control medications can help relieve heavy bleeding or painful periods, including low-dose pills, progesterone-like injections (e.g. Depo-Provera®), or an intrauterine device (IUD) that releases small amounts of a progesterone-like medication into uterus. These methods, however, do not shrink fibroids.
Gonadotropin-releasing hormone agonists, or GnRHas, are drugs that shrink fibroids for a short period of time by putting the body in a menopause-like state. These are sometimes used before surgery to make the fibroids easier to remove. GnRH-a therapy should only be used for a few months.
Uterine fibroid embolization shrinks or destroys fibroids without surgery by threading a thin tube into the blood vessels leading to the fibroid and injecting materials to block the blood supply. This method preserves the uterus, but pregnancy is not common after treatment.
Surgical fibroid removal, called a myomectomy, is the only fibroid treatment that may improve a woman’s chances of having a baby. Endometrial ablation, an outpatient procedure, removes the lining of the uterus to control very heavy bleeding. With myolosis, a needle is inserted into the fibroids, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroids.
Lastly, hysterectomy, a surgery to remove the uterus, is the only sure way to cure uterine fibroids. In fact, this is the most common reason a hysterectomy is performed. If the fibroid isn’t too large, it can often be removed laparoscopically -- reaching the uterus through the vagina -- instead of making a cut in the abdomen.
There are many treatment options to discuss with your doctor, depending on your individual health situation. Most important, getting help for your uterine fibroids can improve your health and quality of life.