Straight, No Chaser has spent quite a bit of time on conditions involving abnormalities of male and female sex hormones. We do so again today in discussing fibroids (aka fibroid tumors, leiomyomas, fibromyomas and myomas). Fibroids are noncancerous growths on the female uterus (the womb). Fibroids are extremely common. In fact, by age 50 approximately half of women will have fibroids. On the other hand, they appear to be rare under age 20. This is a condition that is most prominent during the childbearing years.

Fibroids seem to run the gamut in size, clinical signs and symptoms. Although the cause isn’t known, its effects are related to estrogen production. Here are some interesting facts about fibroids you should know.

• If a fibroid is present, it will likely continue to grow during the childbearing years and is likely to shrink after menopause (due to the relative presence of estrogen in the former circumstance and the relative lack of estrogen in the latter).
• Women tend to have multiple fibroids if and when they occur.
• Fibroids can range in size from too small to see with the naked eye to several pounds in size, causing obstruction in the pelvis.
• Fibroids are more common in African-Americans.
• During pregnancy, fibroids may grow significantly due to increasing estrogen levels. They may return to their previous size once childbirth has occurred.

Regarding symptoms, fibroids may be present without symptoms or may make a woman’s life unbearable. Any of the following symptoms may be present.

• Heavy menstrual bleeding (menorrhagia)
• Longer than normal menstrual periods
• Bleeding between menstrual periods
• Stronger than normal pain or cramping during menstrual periods
• Ongoing sensation of fullness in the pelvis
• Frequent desire to urinate
• Pain during sexual intercourse

If this complex of symptoms begins to become substantial, your physician will likely order an ultrasound, which can identify the fibroids. These ultrasounds also help to monitor the growth and possible interference or obstruction of fibroids within the uterine cavity.
Much of the management of fibroids depends on the severity of symptoms and the presence of any complications. Often nothing more than monitoring growth, treatment of pain and supplementation of iron for significant losses of blood and anemia is required. In more severe cases, other options are available, including the following:

• If you have particular difficulties with abnormal bleeding (heavy or irregular periods), you may be prescribed birth control pills.
• Short-term hormonal therapy may be given via injection to shrink the fibroids.
• IUDs (intrauterine devices) that release the hormone progestin may reduce pain and heavy bleeding.
• There are several surgical procedures that treat fibroids, including removal of the fibroids, stopping the blood supply to the fibroids and, in severe cases, removal of the uterus (hysterectomy).

All of these options are serious endeavors. Factors such as your general health and your desire to have children in the future must be considered.

Complications of fibroids are significant enough to warrant discussion. They including the following:

• Excessive bleeding may cause anemia (low red blood cell count).
• Excessive bleeding or severe pain may necessitate emergency surgery.
• Fibroids may twist, causing a blockage in blood vessels. This occurrence may make surgery necessary.
• Fibroids may block the bladder, leading to frequent UTIs (urinary tract infections) due to incomplete emptying of urine from the bladder.
• Rarely, fibroids may cause infertility.
• Rarely, in pregnant women fibroids may cramp the space of the womb. This can result in premature birth or the need for a C-section.
• Rarely, fibroids may undergo cancerous changes. These complicated fibroids are called leiomyosarcomas.

Many women who have abnormal menstrual periods, including heavy bleeding, pain, cramping, fullness of the uterine area and bleeding between periods are found to have fibroids. If you have these symptoms, and they’re causing significant distress, contact your physician.
Feel free to ask your SMA expert consultant any questions you may have on this topic.
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