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Things to Know When Considering Treatment for Uterine Fibroids [Dr. Shams]

Uterine fibroids affect a large number of women, with various risk factors including age and race. Many women will not experience symptoms, but for those who do, the symptoms can be debilitating and require treatment. 

Why are so many women affected by uterine fibroids? 

Estimates from the National Institute of Health state that about 80% of women will develop fibroids at some time in their lifetime. While they may develop fibroids, that doesn’t mean that they’ll be symptomatic. Between 20% and 70% of those fibroid cases will be symptomatic. That estimate corresponds to about 25 million women in the United States today who will have fibroids at some point in their lives, and about 16 million will experience symptoms.

Why do uterine fibroids cause the uterus to enlarge and what are the risk factors for an enlarged uterus? 

Fibroids are benign tumors that grow within the uterus. They can grow on the inside and on the outside of the uterus. They are benign masses that, once they start growing, can make the uterus appear very large. Some fibroids can grow to massive dimensions and cause the woman to feel a mass, heaviness, or a hard feeling in the mid portion of the pelvis, which is really just a large fibroid. Some of the factors that predispose to fibroids include age and race. Most patients become symptomatic in their 30s or 40s. As you get older, you’re more likely to get symptoms from fibroids. Certain race groups are more prone to developing fibroids. About 80% of African-American women will eventually develop fibroids, which also tend to grow more quickly and have more bleeding symptoms compared to other racial groups.

Fibroids are hormonally responsive, meaning that if you’re taking hormone replacements or if you have higher levels of estrogen and progesterone in your blood, then you’re more likely to develop fibroids. Since the levels of these hormones tend to decrease with menopause, the fibroids tend to regress at that time. Some studies have shown that family history is very important. If your mother or your grandmother had fibroids, you’re much more likely to develop fibroids over time. There have also been some studies that indicate your diet can affect fibroids. One study showed that if you have a high sugar diet, you’re more likely to develop fibroids, and then conversely if you eat a primarily plant-based or vegetarian diet, you’re less likely to develop fibroids. These are small studies, but they’re showing that if you eat a lot of meat, that tends to predispose you to the development of fibroids.

What causes uterine fibroids to flare up?

When uterine fibroids are related to age, they tend to be more symptomatic as you get older. They can be hormonally responsive, so if you’re taking hormone replacements, that can cause them to flare up. Research also suggests that certain diets can cause them to become symptomatic.

Where do you feel pain from uterine fibroids?

Usually, you will feel the pain from uterine fibroids in the mid-pelvis or to the sides of the pelvis, depending on where the fibroids are located. It’s not usually a sharp pain but more of heaviness and an ache because it’s pushing on the structures in the pelvis at that level. In addition to pelvic pain, you may also develop a frequency of urination, back pain, or sometimes constipation, depending on where the fibroids are located in the uterus.

What does fibroid pain feel like?

Fibroid pain is often an aching type of pain or a sensation of pressure or heaviness, rather than a sharp pain. In contrast, patients who have ovarian cysts or endometriosis will tend to have a different type of pain than you would see with fibroids.

Can uterine fibroids burst?

Uterine fibroids are not liquid cavities. They are actually fibrous masses, so they are hard and solid. Sometimes if you have a fibroid that is stuck to the inner lining of the uterus, it can slough, meaning it can detach from the uterine wall and actually come out through the vagina. This is an uncommon type of situation and only occurs in fibroids that are attached to the uterine wall. There is no way that the fibroid can actually burst.

Are there other treatment options for uterine fibroids other than a hysterectomy?

The treatment options really depend on the age that the symptoms of the fibroid develop. A person who has fibroids and has no symptoms doesn’t have to be treated. These are benign tumors, and will not develop into malignant tumors. You don’t have to treat them if you are not having symptoms. A lot of times, patients who present earlier in their early age group fibroid either involve massive fibroids and they can actually feel them, or they are having problems with pregnancy. In the older groups, symptoms of bleeding and heavy menstrual periods are common.

Fibroids tend to grow and push on other structures, and because of the location of the uterus, it can affect other structures in that area and cause other symptoms. The uterus is right next to the bladder, so patients may develop a frequency of urination. It’s also near the back, so they may develop back pain associated with menstruation. Sometimes patients will get constipation because it’s pushing on the colon.

Hysterectomy means that you’re removing the entire uterus, so once that happens you are not able to become pregnant again. Another surgical option, without removing the entire uterus, is called Myomectomy. This means we remove those specific fibroids or the largest fibroids and leave the rest of the uterus intact. The other option we consider would be something called endometrial ablation.

When the fibroids are in the inner lining of the uterus, the gynecologist can put a scope inside the uterus and then burn out the dead fibroid. As interventional radiologists, we perform fibroid embolization, where we try to kill the fibroids internally. Fibroids are very vascular, which means they need a lot of blood flow to live. If you can primarily attack the fibroids themselves, leaving the uterus intact, you can kill the fibroids and have a normal uterus. Fibroid embolization is performed by putting a small catheter inside the artery supplying the fibroids, then injecting tiny microscopic particles into the blood vessels supplying the fibroids. Over time, that will kill the fibroids.

Schedule a UFE Consultation with Dr. Shams

If you are experiencing painful symptoms from uterine fibroids, please schedule a consultation with Dr. Shams or one of our other affiliated vascular specialists in New York, New Jersey, or Ohio to get the treatment you need.