When buying a house, as any good real estate agent knows, it’s all about location, location, location. The same is true when one is talking about fibroids.
Fibroids are non-cancerous tumors that grow in the uterine walls of up to 70% of women. Symptoms vary widely. The majority of women with this problem aren’t even aware they have fibroids, but other women’s lives are controlled by the three most common symptoms: bleeding, pressure or pain.
In most cases, the location of the fibroid, more than the size, predicts who is going to have problems. Fibroids that actually grow into the cavity of the uterus are in the worst location. These are the fibroids that, even if they are small, may cause the change-the-tampon-every-hour heavy periods that are not only miserable to deal with but can also result in anemia. It’s a good idea to get a blood test to check for anemia, especially if you feel tired or get short of breath easily.
But even if you know you have fibroids, don’t assume your heavy menstrual bleeding is necessarily because of fibroids. It’s always a possibility that abnormal bleeding is a result of hormonal changes or pre-cancerous or cancerous uterine cells that have nothing to do with fibroids. If there is any doubt, your gynecologist should test a sample of tissue from the lining of your uterus.
“Bulk” or pressure symptoms occur when large fibroids push on the bladder or rectum, or cause abdominal distention. It’s possible for a woman with large fibroids to look five months pregnant despite a normal weight and the 300 sit-ups she does every night. Some women can even feel their own fibroids just by resting a hand on their belly.
If the fibroid is on the front of the uterus, there may be constant pressure resulting in the urge to urinate even when the bladder is empty. And when the bladder starts to fill, there’s not a whole lot of room for it to expand. If a large fibroid is on the back of the uterus, constipation and rectal pressure are possible.
Pain from fibroids isn’t common but can result if the fibroid outgrows its blood supply and dies, a process known as fibroid degeneration. This is most likely to occur during pregnancy when fibroids grow quickly. Heavy menstrual bleeding also can cause pain when the uterus contracts (cramps) in an attempt to expel huge clots.
Virtually every treatment option for fibroids depends on knowing the precise location and size of the fibroids. An ultrasound, the first step to determine size and location, uses high-frequency sound waves to take a picture of the uterus. When I see patients with fibroids, I can measure a fibroid with a standard ultrasound, but it’s not until I squirt a little sterile water through a catheter inserted through the cervix (a process known as a saline infusion sonogram) that I can tell how much of the fibroid is inside the cavity of the uterus versus in the wall of the uterus.
If you have symptomatic fibroids, one option is to wait it out, especially if menopause is around the corner. But if your fibroids are making you miserable or anemic, there are a number of choices to alleviate or eliminate the problem. Even if you have been told you need a hysterectomy (surgical removal of the uterus), you may be a candidate for an alternative, such as uterine lining ablation, hysteroscopic myomectomy or uterine artery embolization.
While many hysterectomies are appropriate and beneficial, there are still too many women who are not offered less-invasive alternatives. My book, The Essential Guide to Hysterectomy, is a source women can turn to in order to learn about uterus-sparing and minimally invasive alternatives.