Uterine fibroids are a very common occurrence in women. As many as 80 percent of all women in the United States have them, according to the National Uterine Fibroid Foundation. As such, OB/GYN physicians undergo extensive training on how to diagnose them and how to subsequently manage them, both medically and surgically.
It is important to know that uterine fibroids are benign tumors. This means that they are not cancer, nor will they become cancer if left untreated. They are made out of the same type of smooth muscle cells that a woman’s uterus is comprised of. What causes fibroids is still a medical mystery. We know that getting your period at an earlier age and having fewer children increases the likelihood of developing fibroids in the future. We also know that black women are more likely than white women to develop fibroids. And, having a family history of these benign tumors can increase a woman’s risk of being diagnosed with them in the future, but no specific gene has been found to cause them yet.
Fibroids typically grow very slowly and are not usually diagnosed until a woman is in her late thirties to early fifties. Occasionally a fibroid will be located within the uterine cavity, rather than in the wall of the uterus, and this location can cause problems such as infertility and pregnancy loss earlier in a woman’s life during her reproductive years. Other symptoms that a woman might experience with fibroids include heavy and prolonged bleeding during her periods, pelvic pain or pressure, or changes in bowel movements and urination.
While the vast majority of women have uterine fibroids, less than half develop symptoms from these benign tumors. If a woman does not have symptoms, then regular pelvic exams are all that is needed for surveillance and management. However, if a woman does become symptomatic, there are multiple different therapies available for treatment. One of the most important things that an OB/GYN takes into consideration when discussing management options with a patient is whether the woman desires to have more children or not. If she wishes to have more children then more conservative therapy is attempted first.
Treating uterine fibroids can be as simple as prescribing birth control pills or having a progesterone-secreting IUD placed. While these won’t eliminate the fibroid, they can decrease the blood lost during a woman’s period. Another medication, Lupron, can be used for a relatively short period of time to stop bleeding and to help fibroids shrink in size. This medication, however, cannot be used for extended periods of time because it can cause bone loss and prematurely places a woman in a menopausal state. It is often used for three to six months prior to having surgical treatment for uterine fibroids as it can help to shrink the tumors and make additional interventions technically easier and safer with faster recovery times.
Some surgical procedures that gynecologists can perform are myomectomies, where the fibroid is removed without removing the uterus. Often times this will be performed if a woman desires future children. A hysterectomy is then often the treatment of choice for women who do not desire future children and have failed more conservative therapy. Often times a minimally invasive hysterectomy can be performed either laparoscopically or through the vagina depending on the size of the fibroids and their location.
Safety is, of course, the most important concern before considering any treatment option. Even though fibroids are benign growths, they can cause a lot of problems for women. Scheduling regular pelvic exams with your OB/GYN is the best way to help make sure they can be detected when symptoms begin to arise and your doctor can then help you make the best decision regarding further treatment.
Ellen Garvey, MD is board certified in obstetrics and gynecology. She practices at Brattleboro OB/GYN, a department of Brattleboro Memorial Hospital.