Knowing the facts on fibroids

Years ago, I had a friend, a sister resident, whose uterus was giving her trouble. She was bleeding almost all the time, and she was bleeding a lot. Her gynecologist told her she had fibroids, but she had no time to attend to the matter because, well, she was a resident, a doctor-in-training, and busy was what she was on a good day.

Her bleeding continued at a steady pace, and then one night it got a lot worse. She wandered down the hall to the bathroom. Next thing she knew she was on the floor with her roommate standing over her, a look of startled concern on her face. “NOW will you do something about this?” her roommate demanded.

My friend was in good company. About 25 percent of women have symptoms from the fibroids that close to 75 percent of us have. Fibroids are benign (non-cancerous) tumors made up of muscle cells that grow in the muscle layer of the uterus. They resemble rubbery balls, and they range in size from tiny to enormous. No one knows what causes them, although the main female hormone, estrogen, is kind of a growth hormone for fibroids. We think this because fibroids often get bigger during pregnancy, when hormone levels are high, and shrink after the menopause.

Most of the time fibroids don’t cause any problems at all. Or sometimes the symptoms are mild, with some cramping during the menstrual cycle and a bit heavier bleeding.

But fibroids can put a real crimp in a woman’s lifestyle – just think of my friend on her hallway floor. Often the symptoms sneak up on a woman, growing gradually as the fibroids grow.

She may have a feeling of heaviness in her lower abdomen. She may need to urinate frequently as the enlarging uterus pushes on the bladder that sits right in front of it.

Or there might be an unwelcome squirt with a cough or a sneeze because of the extra pressure. If the uterus is growing in the other direction, it may press on the rectum and lead to constipation.

She may have bad cramps with her period, and she may have pain with sex.

Fibroids can lead to problems with a pregnancy. A woman may have trouble getting pregnant. Once pregnant, she risks preterm labor and delivery.

Not all women with fibroids have abnormal bleeding, but it is always on our list of possibilities when a woman comes to us with that complaint. If there is a fibroid right under the endometrium, the uterine lining that sheds monthly, then it doesn’t even need to be that large to cause problems.

Somehow the fibroid’s proximity to the lining causes it to bleed heavily and can cause bleeding or spotting even when the period is over.

Back in the dark ages when my friend was lying on the floor, she had only two choices for treatment: surgical removal of the fibroids or removal of the whole uterus. The myomectomy, or fibroid removal, is just as involved a surgery as a hysterectomy, with both generally done through an abdominal incision, and involving a six-week recovery period, but it does preserve the uterus.

We have more choices now.

Radiologists can block the blood vessels that feed the fibroids, causing the fibroids to shrink. If the uterus isn’t too large and the symptom is abnormal bleeding, doctors can do a day-surgery procedure called an ablation and destroy the uterine lining so that the bleeding lightens or even stops.

A new procedure involves precisely locating the position of the fibroids with an MRI and then using a highly focused ultrasound beam to destroy the fibroids.

While these procedures don’t involve extensive surgery, they don’t always work over the long term.

My friend opted for a hysterectomy. She was in a committed relationship, and they didn’t want children. She wanted this over and done with.

She knew that a hysterectomy was a cure: if there was no uterus, then there would be no uterine fibroids.