Uterine Fibroids. You’ve heard the term; if you’re American, you’ve probably seen a drug commercial for a medication to take to relieve your symptoms (yes, the USA has these crazy drug commercials pushing out prescription pharmaceuticals with catchy tunes and all).
But what exactly are uterine fibroids and why am I writing this article on them? Basically, I want you to be your own biggest advocate when it comes to your health and these tumors (normally non-cancerous) are extremely common in women of child-bearing age and older and can be a real pain!
According to UCLA OBGYN (http://obgyn.ucla.edu/fibroids) uterine fibroids also known as leiomyomas (pronounced ‘lie-o-my-O-muhs’) or uterine fibromas, are “firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus.” They are the most common tumors in the female reproductive system, effecting between 20-50 percent of women of reproductive age. Twenty to fifty percent! That’s huge! The thing is they can range in size from something so small as to be undetectable, to something as large as a grapefruit! They can grow inside or outside of the uterus and they can grow back! The only medical guarantee you’ll get for them not growing back is if you have a hysterectomy! But aren’t so many women too young to have hysterectomies? Obviously it’s not an option if you’re not done with having kids either!
Sometimes I feel like we are living in the dark ages. How can this be the only way to permanently get rid of fibroids? Please don’t despair though, there are other options for treatment, just know though, there is always the possibility they will come back.
First things first, what causes uterine fibroids? Guess what? No one really has a clue! There are some indicators that hormones (estrogen and progesterone) play a role, “Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells do” and fibroids tend to shrink after menopause. Other than that, it’s a bit of a guessing game!
As far as who’s likely to get them goes, unfortunately African American women seem more prone to uterine fibroids, they are also likely to be affected at a younger age. If there’s a history of them in your family, then that too is an indicator of increased risk. There could also be environmental factors that play a part, but in my opinion, there needs to be a whole lot more research done on these.
What are the signs and/or symptoms of uterine fibroids? Well, a friend of mine who had a very large uterine fibroid started with very heavy periods. These can actually be so heavy in fact, that you end up losing too much blood and in her case, needing to get a red blood cell transfusion for severe iron-deficiency anemia. Now this is extreme yes, but not as extreme as we would like it to be and if you’re anything like me, you don’t necessarily pay attention when your body goes through some minor changes like heavier periods. What other things can you be on the lookout for? Well normally fibroids aren’t painful, but if you’re experiencing any pain or pressure in that region that seems somewhat inexplicable, definitely go and get yourself checked out, you could experience pain in your back or even in your legs (could be symptoms of many other things too, I know!) What else? Periods lasting longer than a week. Peeing lots and feeling like you still need to pee after you’ve peed – that’s a lot of peeing right there! 😆 Not a laughing matter but worth a chuckle. And if that’s not enough then there’s the constipation you could also experience! Yippee! Nothing better than peeing a lot but not being able to go number two! (Definite sarcasm happening here 😉). Of course, there could be other things going on or you could be having no symptoms at all, then your doctor surprises you with the news that you’ve got uterine fibroids after your most recent lady exam! Not fun news for anyone! Basically, it’s time to start thinking about how to get rid of those suckers!
So what to do next? Well after the news has been confirmed through those wonderful pelvic exams or if that doesn’t work out, your doctor may use one of the following methods: ultrasound, or lab tests to rule out other causes of anemia, MRI, or a one of these lesser known tests –
Hysterosonography: Also called saline-infusion sonography, is basically where they inject sterile saline in the uterus cavity and use ultrasound to get a better picture of what’s happening.
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Hysterosalpingography: This is more commonly used if infertility is an issue. It’s where your doctor injects your uterus and Fallopian tubes with a dye then uses X-ray to see what’s happening.
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Hysteroscopy: This one’s a little more invasive. Your doctor will insert a small, thin, lighted tube into your vagina and go all the way into your cervix. You will be injected with a liquid or gas to expand the area so your doc can have a good look around. This might be done under a local or even a general anesthetic. Doesn’t sound like much fun at all, but if it has to be done, at least know exactly how it all works and what you might experience afterwards!
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I am by no means a medical expert, so I’m trying to write this article in layman’s/laywoman’s terms so you know what to look for and some basic options. Obviously your doc will share with you some, if not all, the options of treatment and what’s best in your situation, but I’m going to give you a list of treatment options right here and try to break each option down a little for you, so you know what questions to ask if these come up.
Watchful waiting is actually a very common option. You literally do what it sounds like and patiently wait, hoping the fibroids will go away on their own. Every woman is different and every fibroid can be different. Sometimes this works, sometimes it doesn’t. When it doesn’t, there are numerous other options:
Firstly, let’s start with medications:
Androgens: Just as it sounds, it’s like a male hormone and can give the side effects that you imagine such as weight gain, unwanted hair growth and a deeper voice, as well as a few others, so make sure you are fully versed in everything you can be about this drug.
Birth control: I’m pretty sure you’re familiar 😊
Gonadotropin-releasing hormone (Gn-RH) agonists:Basically this puts your body into a menopause-like state for the time that you take them. You can only have it for a matter of months also because it can cause bone loss. The other thing is that the fibroids may grow back the minute you stop Gn-RH.
Progestin-releasing intrauterine device (IUD): This is really used to relieve the heavy bleeding from uterine fibroids, it doesn’t shrink them, obviously it also acts as a birth control, so not an option if you’re hoping to become pregnant.
Tranexamic acid (Lysteda): This is another one taken to ease heavy bleeding. It’s non-hormonal though and only taken on heavy bleeding days.
Other options (There could be more options, especially as modern medicine embarks on new discoveries – hopefully anyway, but these are the most common as of the time of writing):
There are some non-invasive options such as MRI-guided Focused =Ultrasound Surgery. This is performed whilst you’re inside an MRI – your doc gets a precise location of the fibroids, then uses an ultrasound transducer to target sound waves to heat, thereby destroying bits of the fibroids. So far this one has got thre thumbs up as being safe and effective but again, not at stopping the fibroids from growing again.
Then we have the minimally invasive procedures such as Uterine Artery Embolization, where small particles are injected into the arteries supplying the uterus. They cut off the blood flow to the fibroids and basically shrink them, relieveing all other symptoms at the same time. the only problem with this is if your doctor gets it wrong or something happens and the blood supply to the ovaries gets screwed up somehow. This can cause major complications.
Myolysis is a laparoscopic procedure where an electric current (laser) basically destroys the fibroids and shrinks the blood supply that feeds it. Cryomyolysis works the same but freezes it instead.
Laparoscopic or Robotic Myomectomy is when your doctor makes small incisions on the abdomen and uses a camera on the end of one ot the instruments to see and therefore remove the fibroids through these incisions. The Robotic side of it is where there’s a magnified 3-D view that offers more precision and I’m sure a hell of a lot more cost.
Hysteroscopic Myomectomy seems like a rather uncomfortable procedure where the camera and instruments are inserted through the vagina rather than through the abdomen. This procedure is really for fibroids that are inside the uterus (submucosal).
Endometrial ablation is really for any abnormal bleeding rather than anything else, though can be combined with the Hysteroscopic Myomectomy to remove submucosal fibroids.
Then there are the traditional surgical procedures, of which the most well-known is the Hysterectomy, basically the removal of the uterus. This unfortunately is the only proven permanent solution for fibroids and is obviously not an option if you would like to have children. If you also have your ovaries removed at the time of your hysterectomy then the surgery will bring on menopause, and a whole new set of things to consider!
The other surgical option is an Abdominal Myomectomy for when you have very large or very deep fibroids or if you have a number of them. It is true surgery where they open you up through the abdomen and remove the fibroids, but the scarring afterwards can actually affect future fertility though is a better option (IMHO) if you are still wanting to have a baby, than a hysterectomy.
Again, be your own advocate and find out exactly what your doctor is recommending and read, read, read. Make informed decisions about your own body, remember that you have the right to decide what is best for you.
Also, please don’t ignore those warning signs!
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