Uterine Fibroids

Uterine Fibroids 101

Uterine Fibroids 101

by Allison Danish, MPH

Fibroids! What are they good for? Absolutely nothin’.

The word “fibroid” may sound like a Star Wars character, but it’s actually a very common medical condition—so common that the research shows that by the age of 50 around 70% of women* will have at least one uterine fibroid.

What are fibroids anyway?

Fibroids are muscular tumors that grow in the uterine wall, either inside or outside the uterus. Thankfully, they’re usually benign (not today, cancer!). But they can lead to some nasty symptoms in about 30% of patients, including pelvic pain, pain during sex, and heavy & painful periods.

While they’re incredibly common, the experience with symptoms really depends on the individual.

“The reason it can be so variable from patient to patient is because it’s a combination of size, number, and location of the fibroids,” says Dr. Elena Wagner, a minimally invasive gynecologic surgeon from Virginia Mason Hospital and Seattle Medical Center.

It’s currently thought that the closer the fibroids are to the lining of the uterus, the more likely it is that someone will experience bleeding and fertility problems. Plus, if those muscular fibroids are getting particularly swol, people may have a noticeably larger belly as well as a feeling of pressure in their pelvis. This pressure might mean having a wild urge to pee or poop for some folks.

What causes fibroids?

More research is needed (as with most conditions that affect the uterus, vulva, etc.) but the most common medical villains are hormones and genetic factors. Research suggests that environmental chemical exposures, stress, and childhood physical & sexual abuse may be associated with the development of fibroids as well.

How can fibroids make sex painful?

Like real estate, it’s all about location, location, location. Whether fibroids cause painful sex or not usually depends on where they grow—though dyspareunia (painful sex) is not all that common with fibroids alone.

Fibroids can also cooccur with other conditions that may be the painful sex culprit, like endometriosis and adenomyosis or pelvic floor dysfunction.

Who gets fibroids?

Fibroids are estrogen- and progesterone-dependent, so they mostly show up during the reproductive years. While they’re extremely common among uterus-havers of all racial and ethnic groups, fibroids are most prevalent in Black women.

80% of Black women develop fibroids by the time they are 55 compared to 70% of white women of the same age.

Black women are also more likely to develop fibroids at younger ages, have larger and more numerous fibroids, and experience more symptoms.

How are they treated?

Many people who have fibroids don’t know it, so they won’t need treatment. Because they’re benign, the only reason to see a health care provider about fibroids is if you’re experiencing symptoms. From there, you and your provider can decide on the best course of treatment.

As with the symptoms, treating fibroids is very individual. It depends on:

  • Symptoms
  • The size, number, and location of the fibroids, & 
  • What the patient’s goals are.

“Everybody’s fibroid uterus is different… so individualized care is incredibly important as far as patients go,” Dr. Wagner tells us.

Oftentimes, providers will look to non-surgical options first. That usually means hormone treatment or tranexamic acid, which is a medication that can help control menstrual bleeding. 

However, sometimes surgery is needed if fibroids are very large and are putting pressure on the pelvis and surrounding organs. Hormonal treatment likely will not shrink the fibroids enough to resolve the symptoms, and in these cases, a myomectomy (surgical removal of individual fibroids) or a hysterectomy (removal of the uterus) may be the best course of action. Plus, if infertility is a big concern, a myomectomy may be considered sooner rather than later to make it easier to carry a pregnancy to term.

Often, menopause can also cause fibroids to regress because of the drop in estrogen and progesterone, so some patients will choose to wait for menopause as a treatment option. However, it’s not a cure—and women with fibroids tend to hit menopause later in life, meaning they have more time to be in prime fibroid-growing shape. Fibroids can still develop after menopause too, and, for Black women, fibroids are less likely to resolve themselves post-menopause. 

TLDR; fibroids are really common (but are more common among Black women), most of the time they’re asymptomatic, and treatments range from hormonal to surgical.

Artwork: © Designs by Duvet Days / All Rights Reserved 

Written in collaboration with Rachel Gelman, DPT.

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