Question: I have experienced heavy periods, cramping and lower back problems for quite some time now. I went to my physician to ask what could be the cause and she told me that I had a 3cm fibroid on my uterus. She recommends a hysterectomy, but I am unsure if that is the best possible course of treatment for me. Could you explain what fibroids are and let me know if there are alternative options available for treating them?
General Fibroid Information
Fibroids are benign (non-cancerous) tumors found within the uterine walls, often resulting in a change in the size or shape of the uterus. The cause of fibroids is unknown, but fibroids are a fairly common occurrence, with 30% of all women reporting them by the age of 35. Fibroids may increase in size or quantity and thus should be monitored by your healthcare practitioner.
Doctors are not sure what causes fibroids, but the female hormones estrogen and progesterone seem to make them grow. There is also no known reason as to why some women acquire severely symptomatic fibroids while others do not. There has been so little research on the risk factors for developing symptomatic uterine fibroids.
Risk Factors for Fibroids
- Age- fibroids do not develop until after puberty and generally not until women reach their 30s.
- Race- it seems African-American women are 2-3 times more likely to develop fibroids
- Family History- if your mother or sisters has or had fibroids your risk increases
- Obesity- heavy women are 2-3 times as likely to develop fibroids
- Eating Habits- consuming a lot of red meat and pork is linked to higher fibroid risk, while consuming green vegetables helps lower your risk
- Early Menstruation- women who got their first period before 10 are at a higher risk for fibroids
A lot of women may not even be aware that they have fibroids since often they cause no symptoms.
Women who do experience symptoms from their fibroids often experience:
- Prolonged menstrual periods (7 days or longer)
- Heavy bleeding during periods
- Bloating or fullness in the belly or pelvis
- Pain in the lower belly or pelvis
- Pain with intercourse
Where do Fibroids grow?
Submucosal (sub-myoo-KOH-zuhl) - grow into the uterine cavity
Intramural (ihn-truh-MYOOR-uhl) - within the wall of the uterus
Subserosal (sub-suh-RAH-zhul) - outside the walls of the uterus
Fibroids can sometimes also be Penducluated (pin-DUHN-kyoo-lay-ted) meaning they grow on stalks out from the surface or into the cavity of the uterus and often look like mushrooms.
Can Fibroids turn into cancer?
Less than 1 in 1,000 fibroids are cancerous. Rare cancerous fibroids are called lieomyosarcoma (leye-oh-meye-oh-sar-KOH-muh).
Having fibroids does not increase your risk of developing a cancerous fibroid.
Having fibroids does not increase your risk of developing other types of cancer.
Getting Pregnant with Fibroids
Women with fibroids are more likely to experience difficulties during pregnancy and delivery, but this does not mean that they cannot safely carry and deliver a child.
Most common issues during pregnancy and birth:
- Caesarian section: the risk of needing a c-section is nearly 6x higher for women with fibroids
- Baby in the breech position: the baby’s head does not move downwards before birth meaning that the baby is not in the ideal position for vaginal birth
- Placental abruption: the placenta breaks away from the uterine wall causing the fetus to not receive enough oxygen
- preterm delivery: the baby is born early
*You should talk to your healthcare provider about which treatment options would be best for you, the NWHN cannot provide medical advice*
If your symptoms are only mild there are few at-home care options to help.
- take ibuprofen or acetaminophen for mild pain
- If you experience heavy bleeding taking iron pills to replace the lost iron might be helpful
Some birth controls can help control symptoms
- low-dose birth controls or progesterone-like birth controls do not eliminate the fibroids but can control heavy bleeding
There are a couple of options, surgical and non-surgical, available to women who wish to have the fibroids removed.
If a woman currently takes estrogen as a daily supplement in any form, she may be able to reduce larger fibroids by discontinuing its use.
Whole grains, rich in Vitamins B and E can help lower excessive estrogen levels that stimulate fibroid growth. Soybeans and soy products are also helpful because they are rich in plant estrogens. These plant estrogens, or bioflavonoids, compete with our body’s own estrogen for binding to the estrogen receptors in our cells and are weaker, so they actually help lower our body’s estrogen levels. Soybeans have shown to reduce bleeding problems in premenopausal women. Other beans and peas help replace the nutrients lost to heavy or excessive menstrual bleeding. Green vegetables have similar benefits. Most fruits and unsalted seeds and nuts are excellent vitamin-rich sources, particularly raw flax and pumpkin seeds.
It is recommended that when eating meat; choose fish, as most fish is high in linolenic acid, which helps relax muscles through the prostaglandin pathway. This acid can help alleviate muscle cramps. You can experiment with avoiding dairy products, meats high in saturated fats, alcohol, and excess salt, all of which have been associated with menstrual cramping.
(If you are bleeding often and between periods, your doctor might want to perform an endometrial biopsy to rule out endometrial cancer before performing any surgery.)
Uterine Artery Embolization (UAE)
Uterine Fibroid Embolization is surgery that shrinks fibroids by cutting off blood supply to the fibroids. This procedure can affect how the ovaries function, but if you are not planning on having more children, this may be a viable option. Recovery time for this procedure is relatively short. A doctor would perform an ultrasound or MRI to determine whether or not your fibroids would respond to this option. It is most effective in treating fibroids that cause heavy bleeding and best for women who do not want more children. It is also more effective in treating submucosal and intramural fibroids, but not as effective in treating subserosal fibroids, because they can draw blood supply from elsewhere in the pelvis. Make sure you are aware of the exact location of your fibroids if you consider this option.
This is a surgical treatment that requires first shrinking fibroids with GnRH agonists for 3 months, and subsequently piercing the fibroids with a laser that destroys the blood vessels that supply the fibroid. If you are interested in removing the fibroid all together, this is not the best option, because the GnRH agonist treatment can make future surgery more difficult. Cryomyolysis is a similar procedure that also requires 2-3 months of supplemental GnRH agonists. Instead of applying heat, however, this process involves a needle that freezes the fibroid.
This removes only the fibroids, while leaving all the healthy areas of the uterus intact. Many doctors fail to mention this option because they would rather recommend hysterectomies. The doctor’s logic is commonly that if an organ is removed (the uterus, in the case of hysterectomy) it can’t cause any further problems. This logic is flawed, because hysterectomies are notorious for causing a host of other issues! This is a personal decision, but not to be taken lightly.
Fibroids can reappear after myomectomy surgery, but 4 out of 5 women (80%) see their bleeding issues as a result of fibroids improve. So it is not 100% effective, yet preferable to a hysterectomy for many women. This surgery ranges in invasiveness from minor to major surgery, depending on the size and location of your fibroids. There is a risk of uterine infection post-myomectomy that can usually be treated with antibiotics. To read more about the different kinds of myomectomy procedures available follow this link to our website: http://nwhn.dev.web.confluencecorp.com/fibroid-treatment-options.
Many reasons doctors give for not performing myomectomies are unfounded. Some doctors may say that hysterectomies are safer than myomectomies, which is simply not true. The surgical procedures are equally safe, and hysterectomies can have more dangerous after effects. Some doctors insist that fibroids are more likely to reoccur after myomectomy procedures, but that reoccurrence rate is lower the closer a woman is to menopause. Doctors also like to claim that women who have myomectomies are more likely to require hysterectomies in the future anyway (like I mentioned before). No studies have proven this to be true. If your doctor implies this, you can ask him or her to provide a medical text supporting the statement. One does not exist.
A hysterectomy is a surgical procedure that removes the uterus entirely. Although hysterectomies can abolish current and future fibroids entirely, they can cause more serious problems. Hysterectomies have been strongly associated with urinary problems, such as increased frequency and urgency of urination, incontinence, frequent urinary tract infections, sexual function problems, and hormone deficiencies. Immediate post-surgical risks include infection, hemorrhage during or after surgery, and damage to internal organs such as the urinary tract or bowel.
Fibroid removal accounts for about 30% of all hysterectomies. This makes them the most common reason for hysterectomy, although it has been proven that other options can be just as effective in treating heavy bleeding and lengthy periods. Doctors often refer to fibroids as “fibroid tumors” in order to make them sound more serious and to make hysterectomies sound more appealing. Fibroids are tumors, but they are benign and do not metastasize, so they cannot spread and are generally not harmful.
Hysterectomies can be medically necessary for fibroid treatment, but usually only in severe cases. You should seek a second (or third) opinion from another doctor who has experience with myomectomies and other fibroid treatments. Hysterectomy should not be the first consideration. You should find a doctor who supports your goals. The NWHN promotes alternatives to hysterectomies whenever possible because they are very serious, irreversible procedures, and there are other options to be considered first.
If you would like to learn more about the surgical removal of fibroids, here are some links that give more detail about some procedures.
Myomectomy - https://www.virginiamason.org/service.cfm?id=735
Uterine Artery Embolization - https://www.virginiamason.org/service.cfm?id=733
There are also several organizations on uterine fibroids and hysterectomy alternatives which you may find helpful:
National Uterine Fibroids Foundation - http://www.nuff.org/
Fibroid Relief - http://www.fibroidrelief.org/
Hope for Fibroids - http://www.hopeforfibroids.org/
Hysterectomy Alternatives & After Effects - http://www.hersfoundation.com/ (a website which provides information about alternatives to hysterectomy and the aftereffects of the surgery.)
Make sure to discuss each option thoroughly with a doctor who has experience treating fibroids. If your doctor automatically recommends hysterectomy, you should seek a second opinion. You should find a doctor who supports your goals.
The NWHN promotes alternatives to hysterectomies whenever possible because they are very serious, irreversible procedures, and there are other options to be considered first. There is no “right way” for all women; as individuals our bodies are unique. Some methods may work for you while others may not.