If you\u2019ve ever heard the term \u201cuterine fibroids,\u201d it\u2019s likely because the condition runs in your family (or you work in the gynecology field). As common as these non-cancerous tumors are, they often go undetected. If uterine fibroids do run in your family, you may be wondering how to tell if you have them, or if there is a way to decrease your risk of developing them. And if you or a loved one have already been diagnosed with fibroids, you\u2019re likely considering your treatment options. You may also wonder if this diagnosis could impact your fertility.<\/p>\n\n\n\n
Uterine fibroids, also known as uterine leiomyomas<\/a>, are non-cancerous or benign tumors that grow within the myometrium<\/em> (muscle layer) of the uterus (womb). Sizes of fibroids range from the size of a pea, all the way up to the size of a grapefruit. Fibroids are different from uterine polyps, which grow in the endometrium<\/em>, the inner lining of the uterus which we\u2019ve previously referred to as the \u201cwallpaper of the womb<\/a>.\u201d <\/p>\n\n\n\n Uterine fibroids are very common in American women, affecting up to 70% of women before the age of 50, and substantial percentages of women in other countries experience them as well. While research hasn\u2019t pinpointed a specific cause of fibroids, according to Johns Hopkins Medicine<\/a>: <\/p>\n\n\n\n \u201cResearch suggests each tumor develops from an abnormal muscle cell in the uterus and multiplies rapidly when encountering the estrogen hormone, which promotes the tumor\u2019s growth.\u201d <\/p>\n<\/blockquote>\n\n\n\n Most fibroids are detected during routine pelvic exams as part of well-woman visits, or via routine ultrasounds during pregnancy. <\/p>\n\n\n\n According to the Cleveland Clinic<\/a>, there are multiple ways to diagnose fibroids, including via:<\/p>\n\n\n\n While most fibroids are asymptomatic, about 30% of women will <\/em>experience symptoms, and a percentage of those women will have severe symptoms. Signs and symptoms depend on the size and type of fibroids (there are four types, with more info on each here<\/a>), and may include:<\/p>\n\n\n\n Your risk of developing uterine fibroids increases with age, up to a point. Women in their 30s and 40s are at the highest risk of developing fibroids, and their risk tapers off and decreases as they reach menopause. Compared to white women, black women<\/a> are significantly more likely to develop fibroids. They are also more likely to develop them earlier in life, and more likely to have severe symptoms. <\/p>\n\n\n\n Fibroids also appear to have a genetic component, as a woman\u2019s risk of developing them is higher if a close female relative has had them. Women with high blood pressure and\/or obesity are also at higher risk of developing fibroids. Inflammation in the body, which is impacted in part by diet and lifestyle factors<\/a>, is also believed<\/a> to play a significant role [1]. Additionally, hormonal birth control use seems to exacerbate existing fibroids. <\/p>\n\n\n\n The sex hormones estrogen and progesterone, which are responsible for the female menstrual cycle, appear to play a significant role in the development of fibroids. Estrogen is believed to be the most influential in their growth. It makes sense then, that hormonal birth control<\/a> (especially combined oral contraceptives, which contain both synthetic estrogen and synthetic progesterone) appears to exacerbate existing fibroids. <\/p>\n\n\n\n While birth control pills may be used as a band-aid for symptoms such as heavy periods, because they cause tiny hormonal spikes every day (rather than the larger cyclical fluctuations of an actual menstrual cycle), they do not reduce or otherwise cure the fibroids themselves. <\/p>\n\n\n\n While certain risk factors are outside your control, you can take specific steps to decrease inflammation in your body. <\/p>\n\n\n\n For instance, you can eliminate or significantly reduce your intake of processed foods, refined sugar, refined carbohydrates (such as white bleached flour as found in pasta, cereals, and white bread), and alcohol. You can proactively increase your consumption of anti-inflammatory foods like green leafy vegetables, cruciferous vegetables like broccoli and bok choy, beta-carotene sources like sweet potatoes and carrots, and whole grains such as millet and oats. Some research suggests that flaxseed (which must be consumed ground in order to reap the nutritional benefits) can regulate estrogen and may even help shrink fibroids. <\/p>\n\n\n\n You can also potentially decrease<\/a> your risk of developing fibroids by reducing your exposure to endocrine-disrupting chemicals (EDCs)<\/a>, which are often found in household cleaning products, cosmetics, and more, and include \u201cphthalates, parabens, environmental phenols, alternate plasticizers, Diethylstilbestrol, organophosphate esters, and tributyltin\u201d [2].<\/p>\n\n\n\n If you\u2019re using hormonal birth control (which is an EDC itself!) for family planning, consider switching to an evidence-based method of natural family planning or a fertility awareness method. They are highly effective, and there are a variety of methods to choose from to find one that best meets your needs. <\/p>\n\n\n\n Treatment for uterine fibroids depends on the size, number, and location of the tumors, the severity of the symptoms, and whether the woman desires to preserve her fertility. <\/p>\n\n\n\n Over-the-counter painkillers are recommended for mild or occasional pain from fibroids. More powerful medications<\/a> like gonadotropin-releasing hormone (GnRH) agonists are sometimes used very short-term to prevent further growth or shrink fibroids before a surgery [3]. However, significant side effects prevent GnRH agonists from being a realistic long-term treatment option. <\/p>\n\n\n\n According to the Cleveland Clinic<\/a>, some physicians are beginning to prescribe a new endometriosis medication called Elagolix for women with fibroid-related heavy bleeding. As mentioned before, birth control pills such as progestin-only \u201cmini pills,\u201d combination birth control pills, and even the morning-after pill are sometimes prescribed for fibroid symptom relief, although none of these options will reduce or otherwise cure the fibroids themselves\u2013and all come with their own range of risks and side effects<\/a>. <\/p>\n\n\n\n Sometimes surgery is needed for women who experience chronic severe symptoms due to their uterine fibroids, but this is typically not an option during pregnancy due to the risk of bleeding and\/or preterm labor. The Mayo Clinic reviews<\/a> the full gamut of surgical treatment options, which range from noninvasive to minimally invasive, to fully invasive as with a hysterectomy, plus a discussion of which surgeries will preserve your fertility if you\u2019re hoping to get pregnant in the future. While most women who have fibroids do not require aggressive surgical treatment, a staggering one-third to half<\/a> of all hysterectomies are performed because of fibroids [4]. <\/p>\n\n\n\n Some programs, such as Gessie Thompson\u2019s<\/a> \u201cHope Beyond Fibroids Elimination Program,\u201d seek to treat severe symptoms of fibroids without surgery. In multiple interviews like this one<\/a>, Thompson states that in her personal experience with fibroids and in her work as a women\u2019s health advocate, she sees fibroids as directly related to estrogen dominance<\/a>, which in turn is the result of \u201cpollutants, diet, and stress.\u201d Thompson specified that her program\u2019s approach seeks to improve women\u2019s quality of life specifically through \u201ccoaching, a nutrition plan, herbal supplements, and exercise.\u201d <\/p>\n\n\n\n Depending on their size and location, fibroids can impair some women\u2019s ability to conceive or to maintain a pregnancy (as with the submucosal type of fibroids). And, as mentioned above, women who undergo a hysterectomy due to severe fibroid symptoms will no longer be able to conceive. For women who do become pregnant, the U.S. Department of Health and Human Services\u2019 Office on Women\u2019s Health<\/a> notes that most of the time fibroids alone do not cause a \u201chigh-risk pregnancy.\u201d In some cases, though, they do<\/em> increase the likelihood of the baby being in breech position, preterm delivery (before 37 weeks gestation), placental abruption, labor that fails to progress, and a six-fold increased risk of delivering via Cesarean section (C-section). All of these complications mean increased risk for mother and baby during childbirth and postpartum. Women whose fibroids are discovered during their pregnancy may require more frequent monitoring. <\/p>\n\n\n\n For most women, uterine fibroids go undetected or are simply an annoyance. A small percentage of women, though, experience persistent, severe symptoms, which can affect fertility and pregnancy outcomes. Given the heightened focus on maternal mortality within the United States<\/a>, and especially among black women who are disproportionately affected by fibroids, one hopes more research will be done on this and other gynecological issues\u2013for which there is currently little but the Pill offered.<\/p>\n\n\n\n References:<\/em><\/p>\n\n\n\n[1] Cetin E, Al-Hendy A, Ciebiera M. Non-hormonal mediators of uterine fibroid growth. Curr Opin Obstet Gynecol. 2020 Oct;32(5):361-370. doi: 10.1097\/GCO.0000000000000650. PMID: 32739973; PMCID: PMC8314923.<\/p>\n\n\n\n[2] Bariani MV, Rangaswamy R, Siblini H, Yang Q, Al-Hendy A, Zota AR. The role of endocrine-disrupting chemicals in uterine fibroid pathogenesis. Curr Opin Endocrinol Diabetes Obes. 2020 Dec;27(6):380-387. doi: 10.1097\/MED.0000000000000578. PMID: 33044243; PMCID: PMC8240765.<\/p>\n\n\n\n[3] InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Uterine fibroids: When is treatment with hormones considered? [Updated 2020 Mar 24]. Available from: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK279532\/<\/p>\n\n\n\n[4] Stewart EA, Laughlin-Tommaso SK, Catherino WH, Lalitkumar S, Gupta D, Vollenhoven B. Uterine fibroids. Nat Rev Dis Primers. 2016 Jun 23;2:16043. doi: 10.1038\/nrdp.2016.43. PMID: 27335259.<\/p>\n\n\n\n Addressing Our Maternal Mortality Crisis with Fertility Awareness<\/a><\/p>\n\n\n\n How an Anti-inflammatory Diet Can Help Balance Hormones<\/a><\/p>\n\n\n\n How Restorative Reproductive Medicine Helps Solve Common Gynecological Issues Better than Birth Control<\/a><\/p>\n\n\n\n \u201cThe Business of Birth Control\u201d Review<\/a><\/p>\n\n\n\n\n
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What are the symptoms of uterine fibroids?<\/span><\/h2>\n\n\n\n
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What increases your risk of developing fibroids?<\/span><\/h2>\n\n\n\n
What\u2019s the connection between uterine fibroids and hormonal birth control use? <\/span><\/h2>\n\n\n\n
How can you decrease your risk of developing fibroids?<\/span><\/h2>\n\n\n\n
What are the treatment options for uterine fibroids?<\/span><\/h2>\n\n\n\n
Should you get surgery?<\/span><\/h2>\n\n\n\n
Do uterine fibroids affect fertility or pregnancy? <\/span><\/h2>\n\n\n\n
Additional Reading:<\/h4>\n\n\n\n