Fibroids after menopause symptoms

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Fibroids after menopause: What you need to know

Share on PinterestA doctor will base their treatment plan for fibroids on the individual.

Treatments for fibroids range from a “watch and wait” approach for women who do not have symptoms to complete removal of the uterus (hysterectomy) in women with severe symptoms.

The doctor will consider many factors when deciding on a treatment plan. Some of these factors include:

  • size of the fibroids
  • location of the fibroids
  • a woman’s age
  • the symptoms that she is experiencing

Unless she is experiencing symptoms, a woman does not usually need treatment for fibroids after menopause unless they are very large.

“Watch and wait”

Many women choose to not have treatment for their fibroids because of their tendency to shrink or go away after menopause. However, it is still important to check in with the doctor regularly to see if they have grown.

Medication

If the fibroids are causing symptoms, doctors may recommend medications. These include:

  • Pain medicine: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen, can help relieve some of the symptoms and pain associated with fibroids.
  • Iron supplements: Women with heavy menstrual bleeding may benefit from taking an iron supplement, especially when they have their period. Iron can help prevent anemia caused by excess blood loss.
  • Birth control pills: Low-dose birth control pills and some progesterone-only contraceptives can help to control heavy bleeding.
  • Gonadotropin-releasing hormone agonists (GnRHa): The most common drug in this class is called Lupron. These GnRHa drugs can help shrink fibroids and make them easier to remove if surgery is possible. However, Lupron may cause severe side effects and is linked to bone loss, so most doctors will only prescribe it for less than 6 months.

Surgery

Share on PinterestFor large fibroids, or in cases where symptoms are particularly severe, surgery may be recommended.

For women with large fibroids or who are severely affected by their symptoms, surgery may be an option.

Hysterectomy

A hysterectomy is a surgery that involves the removal of a woman’s uterus. If the woman is in menopause or close to menopause, surgeons may also remove her ovaries.

A hysterectomy will definitively end the symptoms of uterine fibroids, which makes it a good choice for a woman with severe symptoms and who does not want or has already had children.

Surgeons perform a hysterectomy through an incision in the abdomen or through the vagina.

Endometrial ablation

Endometrial ablation is a procedure where the lining of the uterus is either removed or destroyed to control a woman’s symptoms.

A woman will be unable to get pregnant after this procedure, so it is not a good choice for women who are considering pregnancy in the future. For postmenopausal women, this will not be an issue.

Myolysis

Myolysis is a procedure where a doctor inserts a needle into the fibroid. Either an electric current or a freezing mechanism is passed through the needle to destroy the fibroid tissue.

Uterine artery embolization (UAE)

Women who have severe symptoms and do not want to have a hysterectomy may be a good candidate for UAE. This procedure involves blocking the blood vessels that bring blood to the fibroid.

This procedure causes the fibroid to shrink, but it also prevents a woman from becoming pregnant in the future.

Myomectomy

A myomectomy is an operation that involves removing the fibroids while keeping the uterus. A myomectomy is the best option for a woman who wants to have children in the future. Doctors are not likely to recommend it for women who are already in menopause.

In an abdominal myomectomy, a surgeon makes a larger incision in the lower abdomen, removes the fibroids and closes the wound.

In a laparoscopic myomectomy, a surgeon makes four small incisions and inserts medical instruments into these holes to remove the fibroids.

Known to develop in the uterine walls or inside the uterus, uterine fibroids are growths or tumors that, according to the UCSF Medical Center, can affect as much as 50 percent of women.

But it’s important to note that this medical condition does not disappear along with the reproductive years. In fact, women sometimes have issues with fibroids long after they begin menopause. Here are a few things you should know about uterine fibroids after menopause.

1. Uterine Fibroid Growth Tends to Stop After Menopause

Since there is a drop in estrogen levels in the body during this physiological change, uterine fibroid growth stops. In some cases, the fibroids will actually shrink and relieve some of the associated symptoms.

2. Symptoms of Fibroids Stay the Same After Menopause

No matter how old you are, the symptoms of fibroids can still be the same. You may experience things like:

  • Abdominal enlargement
  • Lower back pain
  • Bladder or bowel pressure
  • Pain during sexual intercourse
  • Fatigue
  • In severe cases, fibroids can even cause anemia and pain in the legs.

However, some women have fibroids and never or rarely experience symptoms.

3. Hormone Replacement Therapy Can Allow Fibroids to Continue Growing

The artificial hormones found in replacement hormones act just like estrogen in the body, which means they encourage the growth of fibroids. Speak to your doctor if you are concerned about this side effect of your menopause treatment.

Overall, fibroids after menopause can still be a problematic thing, but not always and not for all women. If you are concerned about uterine fibroids after menopause, call the Georgia Vascular Institute at 770-506-4007 or .

Summit Medical Group Web Site

Uterine Fibroids: What Every Woman Should Know

Last updated: Jul 18, 2019 By Andrea Hubschmann, MD

If you are a woman you may have had, or probably know someone who has had, uterine fibroids. Most women develop uterine fibroids at some point in their lifetime. In fact, nearly 70 percent of Caucasian women and 80 percent of African American women will have one by age 50. Sometimes these benign tumors cause symptoms and need to be treated, and other times they can be left alone. Here is what Andrea Hubschmann, MD, an OB-GYN at Summit Medical Group says you should know about this condition that commonly affects women in their childbearing years.

What are uterine fibroids?

Uterine fibroids are benign tumors that grow in the muscular wall of the uterus. They can be smaller than seeds or larger than grapefruits. Large fibroids may affect the shape of the uterus. Some women have only one fibroid, while others have several.

Why do certain women develop fibroids?

We do not know why certain women get them and others do not. What we do know is that they are more common in pre-menopausal women. The hormone estrogen feeds fibroids. After menopause, when estrogen levels begin to drop, uterine fibroids tend to shrink in size and women are less symptomatic.

I am worried about cancer. Do uterine fibroids increase my risk?

Uterine fibroids are benign however all pelvic masses need to be evaluated by your doctor.

How do I know if I have uterine fibroids? What will I feel?

Some uterine fibroids are small enough or in a location where they will not cause any symptoms. Small fibroids often go undiagnosed or are incidentally found at the time of imaging for a different problem. Others that are large or grow in sensitive areas tend to cause symptoms such as pelvic pain, heavy menstrual bleeding or bleeding between periods. Fibroids can cause frequent urination or difficulty emptying the bladder, anemia, constipation, or back pain. Very large fibroids can cause dangerous conditions like compression of important structures in the pelvis. If you have any troublesome symptoms, make an appointment with your gynecologist right away. Your doctor may recommend an ultrasound or MRI.

My doctor told me I have tiny uterine fibroids, but I feel fine! Do I have to remove them?

No. Small fibroids may not cause any problems. Most women that are not experiencing symptoms never need surgery. Your doctor will monitor your progress over time. If you begin to have symptoms or the uterine fibroid starts to grow rapidly then it may be time to intervene.

I have symptoms. What are my treatment options?

Talk to your doctor about what treatment is right for you. Your options will depend on the size and location of the uterine fibroid and whether or not you are planning to become pregnant. In some cases, hormonal therapies like birth control pills can help suppress the bleeding and medications like NSAIDs can alleviate pain. There are also numerous surgical options including minimally invasive procedures.

I have fibroids that need to be removed. What type of surgery is available to me?

There are several procedures that can be used to remove uterine fibroids. The appropriate approach is based on the location of your fibroids:

  • Some fibroids located inside the uterus can be removed through a hysteroscopic submucosal resection where part of the fibroid can be shaved down through a tiny camera inserted into the uterus through the vagina.
  • If the fibroids are on the outside of the uterus, they may need an abdominal procedure, which can still be minimally invasive or performed through an abdominal incision depending on the size and location of the fibroids.
  • For women who have completed childbearing, a hysterectomy may be appropriate as this is associated with less bleeding and prevents the risk of recurrence and need for further surgery.

I read about uterine fibroid embolization. What is it and am I a candidate?

Uterine fibroid embolization is a minimally invasive procedure that cuts off the blood supply to the fibroid. When a patient is a candidate for uterine fibroid embolization, we work closely with our partners in the interventional radiology department to develop a treatment plan. During the procedure, a thin flexible tube called a catheter is inserted into a blood vessel. An interventional radiologist uses a real-time X-ray video screen to guide the catheter to the fibroid. The blood supply to the fibroid is then cut off.

I have uterine fibroids and I want to start a family. Will they affect my fertility?

Every case is different. If you are planning to become pregnant, speak with your physician. Women who are not experiencing symptoms from uterine fibroids may not need surgery prior to trying to conceive. You should discuss with your doctor whether you may be at risk for infertility or complications during your pregnancy due to your fibroids. Individuals who are symptomatic generally will their have their fibroids removed. Talk to your doctor about what is right for you.

Fibroids, also known as leiomyomas, are estrogen-dependent. As a result, they typically grow and present symptoms during a woman’s reproductive years, when the ovaries are active. Once the ovaries stop naturally producing estradiol (estrogen)—usually in her mid-50’s— a woman is said to have entered menopause. Logically, the drop in estrogen production that occurs in menopause would cause any uterine fibroids to gradually shrink, and this is typically the case. Fibroids and their accompanying symptoms often diminish after menopause. But what if they don’t?

There are a number of reasons why a woman would continue to have difficulty with a fibroid tumor during this stage of her life: stimulation from exogenous estrogen production (i.e. hormone replacement therapy), cancerous tumors, or malignant uterine/fibroid changes are a few possible causes.

Hormone replacement is commonly prescribed for menopausal women to reduce the uncomfortable symptoms that result from estrogen-deficiency, including hot flushes, vaginal dryness, mood fluctuations, and reduced desire for sex. Estrogen deficiency can also compromise bone health, increasing the risk of fractures; adding supplemental estrogens back into the body can help maintain a woman’s bone strength after menopause.

Replacing estrogen with hormone therapy can drastically increase the quality of life for many women in menopause. However, the risks of hormone replacement can sometimes outweigh the benefits, the recurrence or worsening of fibroid symptoms being one example. Dr. Donald Galen, OB-GYN and former Surgical Director at the Reproductive Science Center of the San Francisco Bay Area explains, “if fibroids are present, the addition of estrogens will generally stimulate fibroid growth, or minimize fibroid regression which otherwise would occur during natural menopause.” A study by Lamminen et al. that compared the activity of fibroids in pre- and post-menopausal women found just that: proliferative activity was low in the post-menopausal subjects who weren’t receiving hormone replacement, whereas those women who were receiving hormones had “fibroid proliferative activity equal to premenopausal women”. Dr. Galen also advises patients of other risks related to hormone therapy, as well. He explains, “estrogen can increase health risks, such as an increased risk of blood clots, increased risk of breast hyperplasia/cancer, and increased risk of endometrial hyperplasia and/or endometrial cancer.”

Hormone replacement therapy isn’t the only reason women see a persistence in fibroid symptoms after menopause. Malignant changes in existing fibroids or the emergence of new, cancerous tumors (“neoplasia”) on the uterus or reproductive organs can produce symptoms like those of benign leiomyomas. Dr. Galen advises, “as a precaution, any woman with an increase in uterine growth/size and/or post-menopausal uterine bleeding should be evaluated to rule-out malignant uterine/fibroid changes.”

SOURCES:

Burbank, Fred. Fibroids, Menstruation, Childbirth and Evolution: The Fascinating Story of Uterine Blood Vessels. Tucson, AZ: Wheatmark, 2009. 93. Print.

Lamminen, S. et al.”Proliferative activity of human uterine leiomyomacells as measured by automatic image analysis”,Gynecologic and Obstetetric Investigation. 1992; 34:111-114

LI-00-0491

Why Menopause Won’t Cure Endometriosis, Fibroids, or PCOS

Fibroids After Menopause

Fibroids are usually noncancerous growths in the uterus that can cause abnormal bleeding, according to UCLA Health. The hormones estrogen and progesterone stimulate their growth. When fibroids are large, they can cause discomfort and pain as well.

RELATED: 10 Things Your Doctor Won’t Tell You About Hysterectomy

You might think that fibroids will shrink or disappear once you’ve gone through menopause because your hormone levels drop dramatically. But that’s not always the case, says Matthew Siedhoff, MD, director of minimally invasive gynecologic surgery at the University of North Carolina at Chapel Hill. “And if a woman chooses hormone replacement therapy (HRT) after menopause, she could still experience bleeding symptoms and even fibroid growth after menopause,” Dr. Siedhoff says.

If your fibroids aren’t causing symptoms after menopause, don’t do anything, Siedhoff advises. But if your fibroids change in size or you start bleeding and are not on hormone replacement therapy, see your doctor to explore the cause.

Symptoms include pelvic pressure similar to period cramps, urgency to urinate when fibroids press on the bladder, and abdominal bloating when fibroids grow large.

If your fibroid symptoms are bothersome after menopause, you should consider surgery options, Siedhoff says. In some cases, interventional radiologists can perform procedures known as embolization that shrink fibroids by cutting off their blood supply, according to the NYU Langone Medical Center Department of Radiology. These procedures are not recommended in menopausal women, though, “because the fibroids have already shrunk as much as they’re going to,” Siedhoff says.

The best option is often surgery because it is the most effective, he says — either a hysterectomy, which removes the uterus, or a myomectomy, which removes just the fibroids, as the University of California San Francisco Medical Center explains.

Polycystic Ovary Syndrome and Menopause

Polycystic ovary syndrome (PCOS) is a hormonal disorder in which a woman’s ovaries produce more androgens, commonly known as male hormones, than she needs. As a result, a woman can have irregular menstrual cycles (or lack them completely), body-hair growth in unwanted places, thinning scalp hair, weight gain, and insulin resistance, according to the Department of Health and Human Services (HHS).

Some of these symptoms, such as excessive body-hair growth and thinning scalp hair, may get worse after menopause.

On the other hand, after menopause you no longer need treatments to bring on your period, says Maryam Siddiqui, MD, an assistant professor of obstetrics and gynecology at University of Chicago Medicine.

However, PCOS puts women at greater risk for cardiovascular disease, diabetes, high blood pressure, and sleep apnea, notes HHS. Aging also increases your risk for these conditions. That’s why as women with PCOS grow older and go through menopause, they need to be even more vigilant about managing risk factors for these other serious health issues, Dr. Siddiqui says.

If you have PCOS, ask your doctor about screening for high cholesterol and diabetes. Also, keep tabs on your blood pressure and weight.

Facts on Fibroids

We are cracking open conversations on what matters most to women and their midlife health. In this episode, we connect with Dr. Leila Sahabi of DrLeilaSahabi.com to talk about FIBROIDS.

Conversations about fibroids come up frequently in the Menopause Chicks Private Online Community. Many women learn they have fibroids from their family doctor or gynaecologist and are eager to learn what options are available. Listen in to my conversation with Dr. Leila and find out more about:

  • what are fibroids?
  • how does a woman know she has fibroids?
  • what options are available for treating fibroids?
  • are some women more likely to get fibroids?
  • do fibroids go away after menopause?
  • and, why Dr. Leila is not surprised when a woman has fibroids?

Here is the interview + some highlights from what I learned by talking with Dr. Leila:

What are fibroids?

Fibroids are non-cancerous growths of the uterus. They are common, treatable when detected early and don’t always require medication or surgery.

How does a woman know if she has fibroids?

A common misconception is that fibroids come with pain or heavy bleeding. While that may be true in some cases, women may also have fibroids without symptoms. Fibroids are often silent growths within the uterus. Some women learn they have fibroids by accident, through a routine check-up or via ultrasound. Other women experience lower abdominal pain, abdominal pressure, constipation, irregular bleeding, heavier bleeding, spotting or breakthrough bleeding without any pattern.

Dr. Leila recommends a baseline ultrasound for women around the age of 40. This will help provide you and your health care professional with a picture of your uterus, what has always been there, and what is new. The baseline is helpful for comparison if you suddenly develop fibroids a few years down the road.

What options are available for treating fibroids?

Another common assumption is that fibroids will lead to medication and surgery. Many women seek Dr. Leila’s advice, as a doctor of naturopathic medicine, in order to weigh all their options. Dr. Leila is on a mission to inform all women that fibroids are related to declining progesterone or progesterone deficiency. When a woman doesn’t have enough progesterone, estrogen acts like a growth factor. In this interview, Dr. Leila describes a case study which revealed how her patient had signs of progesterone deficiency most of her life. Once discovered, her fibroids could be treated appropriately.

Are some women more likely to develop fibroids over others?

While it’s true that many women may have fibroids and not even know it, there are some factors that indicate whether a woman is more likely to develop fibroids over others. They are:

  • if a woman has never been pregnant
  • if she started menstruating earlier than average
  • African-American women are also more likely to develop fibroids

Will fibroids go away after menopause?

This is the question Dr. Leila gets asked the most. Often, gynaecologists will suggest a watch-and-wait approach to fibroids. This is an option if the fibroids are not disrupting the woman’s quality of life. Sometimes fibroids do shrink after menopause–it depends on their size and how/if they are embedded in the uterus.

And, finally, why is Dr. Leila not surprised when a women develops fibroids?

Fibroids are a symptom of low progesterone. Listen to our interview and find out:

  • why Dr Leila is not surprised when a woman develops fibroids (13:00 mark)
  • my “ah-ha” moment from this interview: what if fibroids are actually a gift and why we can thank fibroids (15:00 mark)

Dr. Leila Sahabi is a doctor of naturopathic medicine with practices in Richmond and West Vancouver, BC. You can view her page on the Menopause Chicks Expert Directory here, or visit Dr. Leila’s website at DrLeilaSahabi.com.

Endometriosis at midlife and beyond

Published: February, 2006

Endometriosis symptoms usually subside after menopause, but not always. And they are sometimes related to other health problems.

Crippling menstrual cramps, gastrointestinal problems, and pain during sex are among the most common and distressing symptoms of endometriosis, a gynecological disorder that affects as many as 1 in 10 women. The disease occurs when tissue similar to the lining of the uterus (the endometrium) shows up on the walls of the abdominal cavity and the outer surfaces of the uterus, ovaries, fallopian tubes, bowel, bladder, and nearby organs. Rarely, endometriosis appears in the heart, lungs, and brain.

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Can endometriosis affect the bowel?

Endometriosis may spread to the outside/inside of the bowel, causing pain and bleeding when you have sex or open your bowels. Ultrasound or MRI may help to make this diagnosis and locate the disease. There are a number of different treatment options and it is not essential that the disease is treated, even if it is found.

Can endometriosis lead to cancer?

There is no evidence that endometriosis causes cancer. The number of women with cancer (all types of cancer) is similar in a group of women with endometriosis as compared to a group of women without endometriosis. Some cancers, such as ovarian cancer and non-Hodgkin’s lymphoma, are slightly more common in women with endometriosis..

Women who have endometriosis do not need to have their ovaries removed at menopause unless there are other risk factors (such as family history of ovarian cancer or other types of cancer). If the ovaries of all women who had endometriosis at menopause were removed, with the aim of reducing the risk of ovarian cancer, more deaths would occur due to other diseases such as heart disease or complications related to bone fracture.

There is currently no screening for ovarian cancer. Discuss your risk factors with your doctor.

Long-term health issues

Recent studies suggest that women with endometriosis have increased risks of abnormal cholesterol levels and heart disease. These are highest in women who are younger than 40. Some of these risks increase after hysterectomy and removal of both ovaries for endometriosis treatment.

It is important to have regular health checks with your healthcare provider.

What happens at menopause if you have endometriosis?

Menopause for women with endometriosis is the same as for women who do not have endometriosis. However, the menopause experience is individual and ranges from no symptoms to severe symptoms.

If you had a surgical menopause – your ovaries were removed, with or without your uterus – then menopause symptoms will be experienced unless you start menopausal hormone herapy, or MHT (formerly called hormone replacement therapy, or HRT) soon after the surgery.

Usually, endometriosis does go away after menopause. However, it can come back when you are on MHT, but this is rare. Even more rarely, it can return spontaneously.

What to do if you are concerned

If you are worried about any aspect of endometriosis or are worried that endometriosis may affect a part of your body or your future health, talk to your doctor.

Last updated 13 December 2019 — Last reviewed 15 May 2019

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at May 2019.

Symptomatic endometriosis developing several years after menopause in the absence of increased circulating estrogen concentrations: a systematic review and seven case reports

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Postmenopausal bleeding: Don’t worry — but do call your doctor

Bleeding indicates cancer only in a small percentage of cases, even though endometrial cancers are on the rise in American women.

Published: December, 2018

You’ve gone through menopause and you thought your periods were a thing of the past — but suddenly, you’re bleeding again, more than a year after your last period.

Should you be concerned?

The good news, according to an analysis published in the September issue of JAMA Internal Medicine, is that most likely your bleeding is caused by a noncancerous condition, such as vaginal atrophy, uterine fibroids, or polyps. But the study also reinforces the idea that postmenopausal bleeding should always be checked out by your doctor to rule out endometrial cancer, a cancer of the uterine lining, says Dr. Ross Berkowitz, William H. Baker Professor of Gynecology at Harvard Medical School.

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Fibroids

Fibroids are round growths that develop in the uterus. They are almost always benign, or non-cancerous. Fibroids range in size from as small as a pea to as large as a melon. They are also called leiomyomas or myomas.

Fibroids are very common, affecting an estimated 20 to 50 percent of all women. They are most likely to affect women in their 30s and 40s, and for reasons we don’t understand, occur more frequently in African-Americans. Many women with fibroids have family members who also have them.

Some fibroids grow steadily during the reproductive years, while others stay the same size for many years. All fibroids should stop growing after menopause. If your fibroids grow after menopause, you should consult your doctor.

Usually, fibroids cause no symptoms and don’t require treatment. But if symptoms occur, you should seek medical attention.

Types of Fibroids

Fibroids can grow in different parts of the uterus:

  • Pedunculated fibroids are attached to the uterine wall by stalks.
  • Subserosal fibroids extend outward from the uterine wall.
  • Submucosal fibroids expand from the uterine wall into the uterine cavity.
  • Intramural fibroids develop within the uterine wall.

Different types of fibroids are associated with different symptoms. For example, submucosal fibroids typically cause heavy periods. In contrast, subserosal fibroids are more likely to push against the bladder, causing frequent urination.

Causes of Fibroids

Doctors and medical researchers do not know what causes fibroids to develop. There is evidence that the female hormones, estrogen and progesterone, can make them grow. During pregnancy, when the hormone levels are high, fibroids tend to increase in size. After menopause, when the hormone levels are low, fibroids stop growing and may become smaller.

Our Approach to Fibroids

There are many effective ways to treat uterine fibroids. UCSF offers a wide range of treatments, including innovative and minimally invasive surgical techniques. When needed, we coordinate care with other experts at UCSF, such as fertility doctors and obstetricians who specialize in high-risk pregnancy.

The best treatment choice for each woman depends on personal preference as well as the size and location of her fibroids. We believe that empowering women with knowledge is an important part of the healing process, and encourage each patient to participate in choosing the best treatment option for her.

Uterine fibroids: A common reason for irregular bleeding and pain

Like uterine polyps, uterine fibroids are a common cause of changes in bleeding and period pattern. While polyps are more likely to develop around the time of menopause, fibroids most often develop during the reproductive years. Here’s how to know if you have fibroids.

Top things to know:

  • Uterine fibroids are abnormal growths of muscle tissue that form in or on the walls of the uterus.
  • Symptoms include irregular bleeding between periods and pelvic pain.
  • Estrogen and progesterone play a role in the growth of fibroids.
  • You might not notice them, but if they become problematic, they are treatable.

What they are

Uterine fibroids are abnormal growths of muscle tissue that form in (or on) the walls of the uterus. Fibroids are benign, but can cause symptoms such as irregular vaginal bleeding and pelvic pain (1,2). Uterine fibroids are sometimes called myomas or leiomyomas in medical literature.

Uterine fibroids are very common. About 3 in 4 women may have them at some point in their lives (3). They are most common during the reproductive years (2,3), and are more likely to occur in people of African ancestry (4,5). Uterine fibroids most often cause no symptoms at all (6) and often shrink after menopause (7). In other cases, untreated fibroids may lead to problems such as heavy bleeding, anemia, pelvic pain or pressure, fertility changes, and complications during pregnancy (1,2,8). Symptoms depend on the size, location, and number of fibroids.

If you think you may have uterine fibroids, tracking your bleeding, pain, and any other symptoms with Clue can provide your healthcare provider with information that may help with diagnosis and in forming a treatment plan. Early treatment can reduce the risk of complications.

What you might notice

Some of the most common symptoms of uterine fibroids are:

  • Periods that are heavy or painful (1,9)
  • Irregular bleeding (9)
  • Pelvic pressure or pain (2,10)
  • Frequent urination and difficulty emptying the bladder (1)
  • Constipation (11)
  • Difficulty getting pregnant or carrying to term (2)

In rare cases, uterine fibroids can become very large, twisted, or infected. These situations can create intense symptoms, and may require immediate medical treatment (12,13).

Some studies show that pregnancy may cause fibroids to grow slightly bigger in up to 1 in 3 people (2,14). This might make some symptoms more noticeable. The most common complication of uterine fibroids in pregnancy is pain, usually felt in the second and third trimesters (2).

Why they happen

Uterine fibroids occur when muscle cells in the uterus multiply too many times. As cells multiply, lumps of various shapes and sizes are formed. They can be numerous or few — some people might only have one. These lumps can grow on the inner and outer surfaces of the uterus, as well as within the uterine wall.

Research shows the hormones estrogen and progesterone play a role in the growth of uterine fibroids. This is probably why fibroids tend to shrink after menopause, when production of these hormones decreases (7).

Some people are more likely than others to develop uterine fibroids, and in fact fibroids may be inherited genetically (15). This means someone is more likely to develop fibroids if a family member has had them. People of African ancestry are significantly more likely to develop them (4,5). Someone is also more likely to have uterine fibroids if they have diabetes, hypertension, or polycystic ovary syndrome (16). They are more common in people who have an earlier age at first menstruation (menarche) (17), and people who have not given birth, though this may be because women with fibroids may have difficulty conceiving (2,16). Maintaining a diet high in red meat consumption may also increase the risk of uterine fibroids (18), as may beer consumption (19).

Different types of fibroids create different symptoms (10). Fibroids embedded within the uterine wall (intramural fibroids) can change the shape of the uterus, which may cause changes in fertility (10). Fibroids that project into the inside of the uterus (submucosal fibroids) may also cause difficulty in becoming or staying pregnant (8,20).

Why get them checked out?

Uterine fibroids are generally harmless and often go away on their own. When symptoms occur, however, untreated fibroids can interfere with a person’s quality of life and may lead to complications such as anemia. Anemia is a condition when the body doesn’t have enough healthy red blood cells to function properly. This can happen when uterine fibroids cause heavy bleeding (8).

Some uterine fibroids may also interfere with the probability of becoming pregnant, and may increase the chance of miscarriage (21). In these cases, treatment can help people become and stay pregnant.

Rarely, uterine fibroids can become very large, twisted, or infected. These situations can create symptoms that are intense, and may require immediate medical treatment (12,13).

How they’re diagnosed

A healthcare provider will probably ask questions about symptoms and medical and menstrual history, and perform a simple physical exam. Some uterine fibroids are diagnosed with a physical exam. Other diagnostic methods may include:

  • A pelvic ultrasound (sonogram)
  • An MRI
  • A sonohysterogram (an ultrasound performed after the uterus is filled with fluid) (10)

What you can do about them

You and your healthcare provider may choose to leave fibroids with mild symptoms untreated. Tracking your symptoms can then help you know if your fibroids are changing, and at what point a treatment plan might be helpful. When fibroids do become problematic, there are many different options for managing and treating them, and for preventing their future formation:

  • Medications: Medications can be prescribed to help control symptoms like pain or menstrual bleeding. These include non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin, and hormonal contraceptives (22). In some cases, hormonal medications are prescribed to treat uterine fibroids. These include Selective Progesterone Receptor Modulators (SMRM) which change the effect of progesterone in the body, and Gonadotropin Releasing Hormone (GnRH) Agonists which block the body’s production of both progesterone and estrogen. These medications have been shown to lessen the size and number of uterine fibroids over time in people of reproductive age (22,23,24).
  • Lifestyle Changes: Maintaining a healthy weight may help lessen the occurrence uterine fibroids (25). Getting enough exercise and eating a balanced diet may also help with this. Specifically, a diet low in red meat and high in green vegetables may help to lessen the prevalence and severity of fibroids in some people (18).
  • Non-surgical procedures: Some symptomatic uterine fibroids may be destroyed through non-invasive procedures like uterine artery embolization and myolysis. These procedures cut off blood supply to fibroids, by way of an injection or electric current. MRI-guided focused ultrasound surgery (FUS) is an example of a newer technique that uses soundwaves to destroy fibroids (10).
  • Surgery: Uterine fibroids are sometimes treated with minimally invasive surgical procedures, via the abdomen or pelvis. Some cases of fibroids may be treated with a procedure called an abdominal myomectomy, in which problematic fibroids are surgically removed. In severe cases, a hysterectomy, or a removal of the uterus, may be performed (22).

What to track

Essential to track

  • bleeding patterns
  • pain

Helpful to track

  • blood volume
  • stool
  • sex (if trying to get pregnant)

Eight Facts About Fibroid Tumors Every Woman Should Know

1. You’re not alone if you have fibroids.

The National Institutes of Health estimates that 80% of all women will develop uterine fibroids at some point during their lives. Because many women don’t experience any symptoms, it’s possible the incidence of uterine fibroids is even higher. Fibroids are considered benign or noncancerous, but can make life painful.

2. There’s only one kind of uterine fibroid.

You may hear them referred to as:

  • Leiomyomas
  • Myomas
  • Uterine myomas
  • Fibromas

These terms are all just different names for a uterine fibroid, which is a rubbery mass of tissue that arises out of the muscular portion of your uterus.

3. Fibroids come in different shapes and sizes.

Fibroids may be tiny and described as “seedlings” or grow large enough to alter the shape and size of your uterus. Those that grow on the outer wall of your uterus, which is called the serosa, can develop on a narrow stem that supports the larger growth. We call these pedunculated fibroids.

We also classify uterine fibroids according to their location in your uterus. Those that grow within the uterine wall are called intramural fibroids. Submucosal fibroids protrude into the uterine cavity, and subserosal fibroids project outward from the uterus.

4. Your fibroids may or may not cause symptoms.

Some women have no symptoms with their fibroids and are surprised when they’re discovered during a routine gynecological exam. Depending on the location of the growth, we can sometimes feel a fibroid during a pelvic exam.

Many women, however, seek our care for relief of symptoms that they may not connect to fibroids. These symptoms can include:

  • Heavy bleeding during your menstrual period
  • Periods that last more than a week
  • Pain or pressure in the pelvic region
  • Frequent urination and difficulty emptying your bladder
  • Constipation
  • Back or leg pain

Fibroids can cause such heavy bleeding that you may be at risk for developing anemia. A large fibroid that pushes your uterus out of shape can also make it difficult to maintain a pregnancy. You may have trouble becoming pregnant when a fibroid blocks a fallopian tube or otherwise interferes with your reproductive cycle.

5. We recommend diagnostic studies to confirm the diagnosis and further evaluate your fibroids.

We may recommend an ultrasound or other advanced imaging studies, including:

  • A hysterosalpingography, during which we use a dye to highlight the uterine cavity and fallopian tubes on X-ray images
  • Magnetic resonance imaging (MRI) which can show the size and location of fibroids and identify different types of tumors
  • Hysterosonography, also called a saline infusion sonogram, during which we expand the uterine cavity with a saline solution to makes it easier to obtain images of submucosal fibroids
  • Hysteroscopy, for which we insert a small telescope (hysteroscope) through your cervix and into your uterus so we can carefully examine the walls of your uterus

6. Experts still don’t know what causes fibroids.

It’s not clear yet what causes fibroids, but we can point to a few factors that can increase your risk of developing these growths, which may include:

  • Family history of fibroids
  • Early menarche (onset of menstruation)
  • Obesity
  • A diet which includes a high amount of red meat and few green vegetables
  • Alcohol use

While they develop from the muscular tissue of your uterus, fibroids have a very different genetic profile than normal uterine muscle tissue, and they contain more estrogen and progesterone receptors. These two hormones stimulate your uterine lining to prepare for pregnancy during your menstrual cycle each month and seem to promote uterine fibroid growth.

7. Fibroid growth patterns can vary greatly, or not.

Uterine fibroids can grow very slowly or enlarge quite rapidly. They may remain the same size for years. They can also shrink on their own, and those that are present during pregnancy often disappear afterward. Your risk of developing new fibroids typically decreases with menopause and tumors already present may shrink.

8. A hysterectomy is not the only option for treating fibroids.

Fibroids were once the leading reason for performing hysterectomies. Advances in medical technology and treatment techniques allow us to choose less drastic measures for treating these benign growths these days.

We may recommend medications that manipulate your hormones enough to control excessive bleeding due to the fibroids. These medications can shrink your fibroids but won’t eliminate them. Birth control pills can also control bleeding but have little effect on the size of your fibroids.

If fibroids are interfering with your ability to become pregnant or maintain a pregnancy, we can consider surgical removal of the fibroids while leaving your uterus and other reproductive organs intact. This type of surgery can often be done laparoscopically, which requires just a few small incisions and offers a faster healing time than traditional, open surgery.

At Women’s Healthcare of Princeton, we care for all aspects of your health, including diagnosis and treatment of uterine fibroids. Call or click to set up an appointment.

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