When a woman experiences symptoms typical of uterine fibroids, such as heavy or abnormal bleeding, it is important to have a consultation with a specialist to ensure the right treatment. Often surgery is not the best option for many women with uterine fibroids, but understanding what is causing the symptoms is key to deciding a treatment plan.
What causes uterine fibroids to grow?
Uterine fibroids are benign growths of the muscle layer of the uterus. The chance that a fibroid is anything but benign is extremely low, so there is rarely a need for concern. But, even though they are benign, fibroids are fed by estrogen, which cycles each month. Estrogen causes these benign growths to enlarge and often multiply, resulting in many different types of symptoms. Despite being benign, uterine fibroids have a very rich blood supply and can therefore cause heavy bleeding, even to the point that somebody might become anemic or require a blood transfusion. In addition, because there may be multiple fibroids and the fibroids can be large, they can press on adjacent organs and cause what are called bulk symptoms. These include a need to urinate frequently or urgently, bloating or pain, and other symptoms. Even when they are benign, uterine fibroids can be symptomatic or require treatment.
Can an ultrasound show uterine fibroids?
For women who are experiencing symptoms typical of fibroids, such as heavy bleeding, a need to urinate urgently or frequently, abdominal bloating or pain, often the first test that will be ordered by the gynecologist is an ultrasound. This can either be a trans-abdominal ultrasound, the type of ultrasound you may be familiar with if you’ve had a baby, where they look at the uterus and the fibroids from the outside, or a transvaginal ultrasound, where the ultrasound probe is inserted from below to see the fibroids much more closely and in more detail. These are often the first tests that are done and can diagnose not only the presence of fibroids, but also how many there are, where they are located, and if they might be the cause of the symptoms. For patients who could be contemplating minimally invasive treatments, the best of which, uterine fibroid embolization, which we perform here at American Endovascular, an MRI is preferable to an ultrasound. An MRI provides a level of detail which is very important, to ensure a minimally invasive treatment isn’t offered to somebody who might have another reason to need surgery.
How can someone tell if they have abnormal uterine fibroid bleeding?
Fibroids are extraordinarily common. 25% of all women have fibroids, 40% of African-American women have fibroids, and they tend to be familial or hereditary. If your mother or sister or aunts have fibroids, you have an increased likelihood of also having fibroids. The normal menstrual cycle is roughly 28 days in length, with bleeding lasting three or four days. If you start to get heavier or more frequent bleeding or bleeding that is lasting for a longer period of time, you need to consult your gynecologist to find out the reason for this. Very commonly, due to the high prevalence of fibroids, fibroids would be the underlying reason for heavy bleeding. In those cases, an ultrasound will often be done as the initial test to determine that the fibroids are indeed the cause. Afterward, if you’re considering a minimally invasive treatment such as Uterine Fibroid Embolization, performed here at American Endovascular, we often recommend an MRI to get a better picture of the fibroids, so we can provide the best and the most appropriate treatment.
Can you still get pregnant if you have uterine fibroids?
Yes, particularly if they are small. Fibroids, even though they are benign, can cause problems. They tend to be multiple and can distort the uterus, causing pain and other symptoms. If you have small fibroids, they are generally not a problem and you can continue with a normal pregnancy, even carrying full-term and having a normal delivery. However, as the fibroids get larger, this prevents either implantation of the embryo or normal growth of the fetus in utero and that is where there is a problem. Women who have large fibroids often need to have a procedure done prior to a successful pregnancy. These women may have unfortunately had a failed pregnancy resulting in the fibroids being diagnosed and requiring treatment.
There are several options for this, including myomectomy, which is a surgical procedure where a few of the largest fibroids are removed. More recently, we at American Endovascular can consider performing a Uterine Fibroid Embolization. It is a minimally invasive procedure that treats fibroids without surgery and allows them to shrink. This is somewhat controversial because classically a myomectomy has been done, but certainly, if you have fibroids and you are considering treatment because of pregnancy issues, you should talk with a doctor at American Endovascular, so we can go over your options.