What are Fibroids?
Fibroids are benign nodules of smooth muscle cells and fibrous connective tissue. They develop within the wall of the uterus. They can grow as a single nodule or in groups known as clusters. They range in size from the size of a pea to the size of a cantaloupe. Because they are tumors women are often worried that the fibroids are cancerous or place them at an increased risk of uterine cancer but this is rarely the case.
What Are the Risk Factors?
Unfortunately, the cause of fibroids is basically unknown but scientists believe that genetics and being overweight may contribute. Fibroids mostly occur in women during their reproductive years and African American women are two to three times more likely to have them. Often fibroids can shrink and disappear on their own as a woman enters menopause because estrogen causes fibroids to grow. It's estimated that up to 40 percent of women older than 35 suffer from fibroids during their reproductive years.
What Are the Symptoms?
This is a difficult question because about 90 percent of them don't cause any problems. Any of the following, however, should be considered a warning sign:
- Very heavy menstrual bleeding
- Abdominal swelling
- Painful intercourse
- Frequent need to urinate
- Chronic kidney disorders
- Urinary tract infections
- Pelvic Pain
Is Hysterectomy the Only Option?
Traditionally a woman with fibroids was considered a candidate for hysterectomy, the surgical removal of the uterus. This not only took away her ability to conceive but also held the possibility of complications and unpleasant side effects including decreased sexual pleasure, constipation, bladder control problems, chronic fatigue, blood clots, hypertension, pelvic pain and unwanted weight gain. The hysterectomy remains the second most frequently performed surgery in the United States next to the Cesarean Section. Fibroids are the main reason that they are performed despite proven alternatives. But times are drastically changing. Women are reviewing their options and learning that in the majority of cases a hysterectomy is not only unnecessary but can be detrimental to overall good health and well-being.
What Are the Alternatives?
Often just the fibroid can be removed, in a procedure known as a myomectomy, instead of taking out the entire uterus. A number of surgical alternatives exist as well but many lack enough history to ensure of their effectiveness." There are people who are extremely enthusiastic about alternatives and try to convince you that they are the greatest thing since sliced bread," says Dr. Paula J. Adams Hillard, director of Women's Health at the University of Cincinnati College of Medicine, "but there are not many studies that go beyond five to 10 years." There are, however, developments in some of the surgical instruments used to remove fibroids. Depending on their size fibroids can be removed vaginally or abdominally. Unfortunately fibroids can reoccur.
Are There Non-Surgical Options?
Many doctors recommend watchful waiting. That's because in some cases no intervention is necessary. According to the National Institutes of Health (NIH), for women who experience occasional pelvic pain or discomfort, mild, over-the-counter anti-inflammatory or painkilling drugs often will be effective. Prescription drugs can treat other cases. "Women very close to menopause can buy time by taking a drug that stops the ovaries from producing estrogen and creates an artificial menopause on its own," says Dr. Lila E. Nachtigal, ob-gyn professor at New York University and author of Estrogen: The Facts Can Change Your Life. "No longer fueled by estrogen, the fibroids will shrink." Hormone replacement therapy after menopause seldom makes fibroids grow because the estrogen dose is so small.
What If They Go Untreated?
Many women live with fibroids and suffer no problems with them at all. But fibroids can interfere with the detection of cancer in the uterus and make pregnancy either difficult or impossible.
Can Fibroids be Prevented?
Maintaining a healthy weight through exercise and diet may be your best line of defense against fibroids. That's because estrogen levels increase as body weight increases, causing fibroids to grow.
Fibroids: More than one-third of all hysterectomies are done because of fibroids in or on the uterus wall. Ranging from the size of a pea to a grapefruit, fibroids can interfere with pregnancy, labor, and delivery. The growths, which are aggravated by hormones, often shrink and mostly disappear on their own with menopause.
Endometriosis: About one-quarter of hysterectomies are done because of endometriosis, a disease in which bits of tissue from the uterine lining relocate to other parts of the body resulting in inflammation and pain. Untreated, it can cause scarring, adhesions, and infertility. Endometriosis usually subsides with menopause.
Prolapse: This happens when organs sag internally due to factors such as childbirth or heredity. Prolapse accounts for 20 percent of all hysterectomies. If prolapse is advanced, the uterus may sag into or out of the vagina. Those with prolapse feel pressure in the pelvic region or may experience bladder or bowel problems.
Other reasons: The remaining reasons include abnormal uterine bleeding, chronic pelvic pain, and pelvic inflammatory disease caused by bacteria entering the vaginal cavity and making its way to the uterus and fallopian tubes. Hysterectomy is also done for adenomyosis, a disease in which the uterine lining, or endometrium, seems to grow into the muscular part of the uterus.
Hysterectomy is often recommended for cervical cancer, although other options may be sufficient for very early cancers. It may also be done if other cancers have attacked the reproductive organs. Hysterectomies are considered the only appropriate treatment for uterine cancer.