Understanding Fibroids: Symptoms and Management

Background Information

Fibroids are benign tumors that grow in or on the uterus. While they are generally benign, they can cause significant discomfort and complications for many women. Fibroids are composed of muscle and fibrous tissue and can vary greatly in size. Some are microscopic, while others can grow large enough to distort the uterus. They typically develop during a woman’s reproductive years and tend to shrink after menopause due to a decrease in hormone levels. The location, size, and number of fibroids are just a few factors to consider when treating and managing fibroids.

Women of color are more likely to have fibroids with black women being three times more likely, and Hispanic being two times more likely compared to white women. There appears to be a genetic link with fibroids the risk does increase if a woman in your family has had fibroids. This highlights the need for generations of women to have open and candid conversations.

Types of Fibroids

1. Intramural Fibroids: These grow within the muscular wall of the uterus.
2. Submucosal Fibroids: These develop just under the lining of the uterine cavity.
3. Subserosal Fibroids: These are located on the outer wall of the uterus.
4. Pedunculated Fibroids: These grow on a stalk either inside or outside the uterus.

Symptoms of Fibroids

The presence and severity of symptoms can vary widely. Some women with fibroids experience no symptoms, while others may face significant issues, including:

Heavy menstrual bleeding: This is the most common symptom and can lead to anemia. Heavy menstrual bleeding is defined as needing to change a menstrual product such as a pad or tampon more than every 2 hours. If a cup of disc is used and you are needing to change it several times per day, then this can be considered heavy bleeding. Many cups and discs are designed to be worn for 8-12 hours.

Prolonged periods:  Periods that last more than a week should be discussed with your medical provider. If your period is lasting more than eight days, some additional investigation is warranted.

Pelvic pain and pressure: Discomfort or a feeling of fullness in the lower abdomen. Fibroids change and alter the normal anatomy and can also add additional weight to this region. Because of this, some women may experience additional pressure within the pelvic region. This additional pressure can cause pain and discomfort within the abdominal, back, and pelvic region. It should not be thought as uncommon for women with fibroids to be at higher risk of pelvic floor related dysfunction because of these anatomical differences.

Frequent urination: Caused by pressure on the bladder. The uterus is located directly above the bladder and any increase in size or distortion of the uterus can directly place additional pressure on the bladder. Because of this, it is not uncommon for women with fibroids to have urinary urgency or increased frequency.

Constipation: The rectum is just behind the bladder and uterus. The presence of fibroids on the uterus can directly cause increased pressure on the rectum and lead to constipation.

Back, hip, or leg pain: The anatomical changes that occur with the presence of fibroids not only impacts the weight and size of the uterus, but it can also impact other structures in close proximity by altering their position, or causing additional tension on structures. This applies to muscles, soft tissue structures, and nerves local to this area.

Pain during intercourse: Pain with intercourse tends to be more associated fibroids located near the cervix. The cervix is the top of the vagina and the bridge to the uterus. Fibroids near the cervix may make the cervix more rigid and in return increase pain.

Difficulty conceiving: In some cases, fibroids can affect fertility. This is typically because fibroids located within the uterine lining may decrease the available space of implantation of a fertilized egg.

Diagnosing Fibroids

Fibroids are often discovered during a routine pelvic exam. However, additional imaging tests may be required to confirm the diagnosis and determine the size and location of the fibroids:

Ultrasound: The most common imaging technique for detecting fibroids. This typically involves a transvaginal ultrasound that is inserted into the vaginal canal.

Magnetic Resonance Imaging (MRI): Provides detailed images of fibroids and their impact on surrounding tissues. Due to the costs of MRI, this technique may be reserved for cases where surgery is being considered as main intervention.

Hysterosonography: An ultrasound combined with saline injection to enhance the uterine cavity image.

Hysterosalpingography: An X-ray technique to visualize the uterus and fallopian tubes.

Hysteroscopy: A procedure that uses a small camera to examine the inside of the uterus.

Medical Management and Treatment Options

The treatment for fibroids depends on their size, number, and location, as well as the severity of symptoms and the patient’s desire for future pregnancies. It is also important to note that each treatment option described has both risks and benefits that should be discussed with a medical provider. Here are the primary medical management strategies:

1. Watchful Waiting: If fibroids are small and asymptomatic, regular monitoring may be all that is required. The key word in this description is watchful. Be sure to ask your medical provider questions about the size, number, and location of fibroids. This will allow for you to better communicate with other medical providers in the future and help you gain understanding if there is any progression.
2. Hormonal therapies: Birth control pills, GnRH agonists, and progestin-releasing IUDs can help manage symptoms. This method can be used to help decrease and control the amount of bleeding, the length of bleeding during menstruation, and also help prepare for surgery in some cases. Hormonal based therapies may assist with shrinking fibroids and/or decreasing the progression of growth.
3. Uterine Fibroid Embolization (UFE), also known as Uterine Artery Embolization (UAE), is a minimally invasive procedure used to treat fibroids. This procedure blocks the blood supply to fibroids, causing them to shrink and eventually die. This method can preserve the uterus.
4. Radiofrequency ablation is a technique that uses electrical energy converted into heat to target and destroy abnormal tissue. For uterine fibroids, RFA is designed to shrink fibroids and alleviate related symptoms without the need for invasive surgery. This method can preserve the uterus and can be performed laparoscopically, small incisions in the abdominal region, or transcervical, entry via the cervix.
5. Myomectomy is a surgical procedure designed to remove uterine fibroids while preserving the uterus. myomectomy focuses solely on excising the fibroids and reconstructing the uterine tissue. A myomectomy can be performed several ways including: open abdominal (large cut or incision), laparoscopically (small incisions), or hysteroscopy (via vagina and cervix).
6. Hysterectomy is the removal of the uterus and can be used to treat fibroids, along with other conditions. Once the uterus is removed fertility is no longer an option. When considering a hysterectomy, it is important that women recognize and know the type of hysterectomy they are receiving as it is possible to leave the cervix or remove it. It is also possible to have additional surgeries performed to remove the fallopian tubes and the ovaries as well. In most cases a hysterectomy is usually the last option for most women and should only take place following a thorough conversation with her medical provider.

Additional Treatment Options and Management Techniques

Nutrition and Diet: Partaking in diets that promote inflammation can increase the symptoms associated with fibroids and may progress the growth of fibroids. Foods to avoid and/or minimize include processed foods, refined flours, refined sugars, red meats, pork, high consumption of saturated fats. Eating more fruits and vegetables, along with whole grains to increase fiber intake can be a great way to help combat fibroids. Studies have shown that women who have more citrus based fruits in their diets, also tend to have a lower risk of fibroids. For some women, decreasing dairy and soy-based products can impact fibroid progression and/or symptoms. Increasing vitamin D consumption can help to decrease symptoms related to fibroids. We can obtain vitamin naturally by increasing our exposure to the sun. (Please continue to wear sunblock to help protect your skin.) Vitamin D supplements can help to increase your levels. Prior to adding in a supplement, it is always wise to consult with your medical provider. There are various other nutritional and dietary considerations that may help. Because of this, it is recommended that you consider working with a dietitian familiar with this topic.

Stress management: Practices such as stretching, breathing, and relaxation techniques can alleviate symptom severity. Improving stress management can help to combat additional inflammation and chronic inflammation within the body. Inflammation can cause a cascade of events that lead to heightened pain perception. One easy way to incorporate stress management practices into your daily schedule is to focus on breathing. Check out this short video on breathing so that you can better incorporate this into your lifestyle.

Regular exercise: Participating in physical activity can help reduce fibroid growth and manage symptoms. Exercise is known to have a positive impact on stress management, and is also known to help release endorphins. Endorphins are the body’s natural pain relievers. Another important fact to discuss with exercise, is that is can increase your lean body mass, or your muscle mass. Having more muscle mass and less mass related to fat or adipose tissue can mean less levels of estrogen in the body. Adipose tissue is known to create estrogen, and this hormone can contribute to growth of fibroids. The current recommendation by the Center of Disease Control (CDC) and World Health Organization (WHO) is moderate intensity exercise for at least 150 minutes per week, and the American College of Sports Medicine (ACSM) recommends at least two days per week of strength training.

Iron supplements: Heavy bleeding is commonly associated with increased risk of iron deficiency and anemia. Taking iron supplements can be helpful with improving iron levels. It is important to discuss this with your medical provider prior to adding a supplement. Also, if an iron supplement is deemed appropriate for you, please ensure you are getting enough vitamin C in your diet and/or via supplementation to help improve absorption of iron.

Accupuncture is considered non-traditional medicine and is well-known for its pain-relieving properties. By stimulating specific points on the body, acupuncture can help reduce pelvic pain and discomfort associated with fibroids. While acupuncture cannot shrink fibroids, it may help alleviate symptoms and improve quality of life.

Physical Therapy can be helpful in managing pain related to fibroids. Like acupuncture, physical therapy cannot shrink the size of fibroids, but is can help to improve quality of life by addressing pain related to the pelvic region, abdominal region, back, hip, and legs. Physical therapy can also be helpful in addressing pain with intercourse, increased cramping, constipation, and bladder symptoms. Not every physical therapist will be familiar in addressing these concerns in relationship to fibroids, and it is encouraged that you seek out one specifically trained in treating pelvic health or pelvic floor related conditions.

Environmental Exposures: Certain toxins present in our environments may be linked to fibroids. This includes certain chemicals found in hair and skin products, plastics, foods, water, and more. It is important to note that it will likely be impossible to eliminate all environmental toxins. However, for some women it can be helpful to decrease exposure to endocrine disrupting toxins by using organic products, avoiding plastic food and drink containers, using natural skin, hair, and cleaning products.

Conclusion

Fibroids can significantly impact a woman’s quality of life, but with proper diagnosis and a personalized treatment plan, symptoms can be effectively managed. If you suspect you have fibroids or are experiencing any related symptoms, consult with a healthcare provider to explore the best treatment options for you. Early intervention can help maintain reproductive health and overall well-being.

If you are unsure if you have fibroids, simply ask your medical provider. You can also begin tracking your cycle and becoming more familiar with it so that you can best communicate. Do not assume that your cycle is normal simply because it has been a certain way. Have an open conversation with your medical provider to ensure that you are well informed and can best advocate for yourself.

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