By Andrea Blackstone
(Source The Baltimore Times):
Cynthia M. Wesley, MD (“Dr. Cyn”), a board-certified OBGYN, reminded that they are usually benign overgrowths of the uterus. Fibroids, which are also called leiomyomas, are the most common benign pelvic tumor in women. The risk of a fibroid being cancerous is less than 0.8%, according to the OGBYN. However, fibroids can present challenges.
Q: Where do fibroids appear?
A: Fibroids can appear on the outside surface of the uterus (subserosal); having [attached] from a stalk on the outside of the uterus (pedunculated); in the body of the uterus (intramural); or within the internal lining of the uterus (submucosal). There are occasions when a fibroid can traverse more than one location.
Q: What causes fibroids?
A: The cause of fibroids is unknown. However, there is a genetic component to the development of fibroids.
Q: Why do they develop during a woman’s childbearing years?
A: Fibroids can be stimulated by hormones. When women reach childbearing age, there is an increase in hormones, such as estrogen and progesterone.
Q: Can fibroids lead to infertility?
A: Fibroids can lead to infertility by increasing a woman’s risk for miscarriage secondary to the location of some fibroids. We also see many women undergoing hysterectomy for the treatment of fibroids, which leaves them sterile.
Q: What can be done to help women with fibroids have successful pregnancies?
A: Preconception counseling is essential. Some women benefit from removal of fibroids prior to attempting pregnancy. For example, a fibroid in the lining of the uterus (submucosal fibroid) may hinder proper implantation of the pregnancy, which can lead to a miscarriage. Submucosal fibroids can be easily removed without cutting on the belly. We are able to slide a scope (hysteroscopy) into the vagina, through the opening of the cervix and resect the fibroid (myomectomy).
Q: Are African American women more at risk for developing fibroids?
A: African American women are three times more likely to develop fibroids than white women. Along with the increased prevalence, fibroids in Black women are more severe and less likely to regress after menopause. Fibroids are present in up to 80% of African American women by menopause.
Q: What are other risk factors for developing fibroids?
A: Other risk factors include a family history of fibroids, obesity, an early start of menses and a high fat diet (especially high intake of red meat). Recent studies have shown an association with Vitamin D deficiency and an increased fibroid tumor risk.
Q: What are signs that a woman may have fibroids?
A: Women may experience heavy periods, irregular bleeding, bleeding after sex, pelvic pain and an increased in their abdominal girth.
Q: What is the best way to deal with them?
A: Only symptomatic or very large fibroids should be treated. Even though asymptomatic fibroids do not warrant treatment, women should consider lifestyle modifications to decrease the occurrence of fibroid growth. Such measures as decreasing red meat, maintaining a healthy weight, and confirming appropriate Vitamin D levels can be beneficial. If women desire hormonal contraception, a progesterone only product, such as the progesterone IUD is ideal.
Q: When is treatment recommended?
A: Treatment of fibroids is recommended if women are symptomatic and if the fibroids are very large. Treatment may also be recommended in women desiring pregnancy and a fibroid in the endometrial lining (submucosal fibroid) is noted.
Q: If removal is recommended, are there any new procedures that are promising?
A: Other than a hysterectomy, there are other surgical options for removal. A myomectomy can be performed by opening the belly (laparotomy), inserting a camera below the belly button (laparoscopic or robotic), or by inserting a camera into the vagina, and through the cervix (hysteroscopy). There are other procedures that can also remove fibroids without any cutting. One procedure is uterine artery embolization. With this procedure, a small wire is passed through the groin, and the blood supply to the fibroids is blocked. With no blood supply, the fibroid will shrink and die. Another approach to removal is focused ultrasound surgery (FUS), which uses sound waves to heat and destroy fibroid tissue. It is important to note that fibroids are usually managed with medications such as progesterone only hormones or NsAIDs [non-steroidal anti-inflammatory drugs].
Q: Do fibroids shrink or cause less problems after menopause?
A: When women reach menopause, their estrogen level is markedly decreased. The decreased estrogen level causes the fibroids to shrink. However, African American women have an increased risk for fibroids to persist after menopause.
Learn more about Dr. Cyn’s fibroid information platform via http://www.fightthefibroids.com.
