Dear DLD, I had an ultrasound recently and my doctor told me I have fibroids. Should I be worried??
Fibroids are benign growths of the uterus. Fun fact: fibroids are the most common pelvic tumor in women. Studies have found fibroids on ultrasound in between 7-80% of women - with the higher percentages seen in women in their late 30s and 40s and in black women.
The most important thing to know about fibroids is that unless they are growing rapidly or causing any symptoms, they do not require any treatment and there's no cause for concern.
Unfortunately, fibroids can cause significant symptoms including heavy, painful periods; pelvic or abdominal pain and/or pelvic pressure.
Fibroids cause different symptoms depending on where they are in the uterus. They can be on the outer surface of the uterus, in the middle of the uterine wall or on the inside of the uterus. Fibroids in the uterine wall or inside of the uterus are more likely to cause problems with heavy, painful periods while fibroids on the outer surface of the uterus are more likely to cause pain and/pressure sensations, particularly if they are large.
To treat fibroids you can:
Treat the symptoms. For heavy, painful periods treatments are similar regardless of the cause and can include hormonal therapies such as birth control pills, shots or implants or the hormonal IUD which all work similarly to decrease the thickness of the uterine lining and therefore decrease the amount of bleeding with periods. Ibuprofen or other NSAIDs and newer prescription medications such tranexamic acid can also decrease menstrual flow and pain when taken regularly just before and/or during the period. For heavy bleeding specifically due to fibroids, there are medications that can be taken daily to decrease the bleeding for up to two years, though this treatment can cause menopausal-like side effects (like hot flashes).
Treat the fibroids. Treatment for fibroids fall in three general categories:
Surgical – removing the fibroid. Depending on where they are located that might be done hysteroscopically (camera and instruments inserted inside the uterus through the vagina), laparoscopically (camera and instruments inserted through small incisions in the abdomen) or through a larger incision in the abdomen. Fibroids can often be removed without removing the uterus but for women with many fibroids who are very symptomatic and don’t want pregnancies in the future, removing the uterus (hysterectomy) may be the best option.
Shrink the fibroid through minimally invasive procedures. The most common option is uterine artery embolization which is a minimally invasive procedure to block the blood flow to the fibroid. This works best for large single fibroids. Other options include procedures to destroy the fibroid with ultrasound. None of these options are recommended for women who want to become pregnant in the future.
Medical – unfortunately, current medical treatments can only be used for short period due to the side effects they cause. They generally work by inducing a menopause-like state (remember, fibroids tend to shrink naturally with menopause) which can cause all the symptoms you expect with menopause, including thinning of bones. These are usually used for short term prior to surgery to make the surgery easier and/or less invasive. There are other medical options for fibroids currently in development so fingers crossed we will have better options available soon!
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