Awareness Month: What Are Uterine Fibroids?
July is Fibroids Awareness Month and at Lena we wanted to spread awareness of this common but often misunderstood condition. Fibroids can affect up to 80% of reproductive age women, so in this article we're hoping to give you a clearer understanding of what fibroids are, how they are diagnosed and treated and if there is anything you can do to prevent them.
What Are Fibroids?
Fibroids are common, benign (meaning they are not cancerous) growths that develop in or around the womb. They do not always need to be treated, but can be if they’re causing problems. Just because they are benign, it doesn't mean they can't cause problems for women (as we'll see below), but it's important to emphasise that many women can have fibroids for years without them causing issues and they may not even realise they have them.
Interestingly, the growth of fibroid tissue is similar to that of the growth of endometriosis and adenomyosis tissue, in fact 60% of women with fibroids are also found to have endometriosis. We know that there is an overlap in the genetic makeup of fibroid tissue and endometriosis tissue, which translates into an overlap of symptoms in both conditions.
The overlap also represents an important opportunity for researchers to find crucial trigger points, which may lead to new treatments for both conditions. If we can identify something which is causing both conditions, we can help more women. It's also important to address both problems at the same time, because if a woman undergoes surgery for her endometriosis, but fibroids are left behind, she may still suffer with pelvic pain after the endometriosis tissue has been removed.
How Do I Know If I Have Fibroids?
If you are experiencing any of the following symptoms, it could be uterine fibroids:
- Heavy or painful periods
- Pain during or after sex
- Bleeding between your periods
- Low back pain
- Abdominal pain
- Constipation
- Inability to empty your bladder fully
- Increased need to urinate
- Bloating
Many of these symptoms overlap with other conditions (as we discussed above), so it is important that you get the correct investigations so that you can be managed appropriately. Keeping a symptom diary, tracking your cycle and knowing how to advocate for yourself in these appointments is so important. If you'd like more information about the above, click on the links for in depth blog posts and advice from me (a former doctor!).
Fibroids are diagnosed using during a pelvic exam and the use of an ultrasound. Occasionally, they may be diagnosed using a CT or MRI scan, but this usually isn't necessary as they can be viewed with an ultrasound (removing the need for radiation exposure with a CT scan or a more involved process with MRI).
Who Gets Fibroids?
80% of women of reproductive age will get fibroids, which means that we all need to have better awareness and understanding of them. The cause of fibroids is poorly understood, but we know they are impacted by the hormones progesterone and oestrogen, with several other risk factors playing a part:
- A family history of fibroids (your mother, sister, auntie or grandmother had fibroids in the past)
- If you do not have any children
- If you got your first period late (after the age of 15/16)
- If you have a high Body Mass Index (BMI) or are obese
- If you had a late onset of menopause
Anyone with a womb can get fibroids, but they are more common between the age of 30 and 50, and more common in Black women. Around 80% of Black women will have fibroids by the time they reach 50 years of age (Wellbeing Of Women).
It's not clear what causes fibroids, however we know that it is a combination of genetic and environmental factors which impact hormonal levels and therefore the development of fibroids. They are particularly impacted by oestrogen - they often develop during pregnancy (a time of high hormones) and they regress after menopause (a time of low hormones).
Is There Anything I Can Do To Prevent Getting Fibroids?
We are not entirely sure why fibroids occur, but we know that they are impacted by hormonal levels. They tend to grow during pregnancy and shrink during menopause, showing a clear correlation to times of high and low hormones. Because the condition is associated with an overlap of genetic and environmental factors, it is not fully understood. There are some recommended lifestyle adaptations, including:
- Regular physical exercise to reduce levels of obesity and Body Mass Index
- A diet rich in fruit and vegetables, low in processed and red meat
- The use of hormonal contraceptives to keep hormone levels low and therefore reduce the risk of fibroid growth
How Are Fibroids Treated?
Some fibroids do not cause problems and therefore do not need treating. However, some fibroids cause debilitating pain, excessive bleeding (which can lead to problems like anaemia), bloating that is uncomfortable or disrupts your life and in very rare cases, infertility. These are situations in which the fibroids need treating - either to shrink them in size or remove them entirely.
There are several different options for treatment, including:
- Pain management through medication
- Iron tablets to support iron deficiency, caused by excess bleeding during your period and between periods
- Gonadotropin-releasing hormone (GnRH) agonists work by reducing the size of fibroids. These medications are temporary and if you stop taking them, the fibroids may grow back. They are often used prior to surgery to shrink the fibroids so that the surgery is easier
- Treatments, such as tranexamic acid, which work to stop heavy menstrual bleeding (to reduce the chances of iron deficiency)
- Surgery to remove the uterine fibroids. Depending on the size, location and severity of your fibroids, this will determine the type of surgery you will have. Sometimes just the fibroid is removed, or occasionally tissue surrounding the fibroid is also removed to reduce the chance of recurrence, as well as removing damaged tissue.
Overall, fibroids are a common and largely treatable condition which may not actually cause you any symptoms, only around 1 in 3 women with fibroids experience symptoms. However they may cause pain, discomfort, bloating and disrupt your fertility - so they need to be investigated and treated wherever possible. For more information, I recommend checking out the Cleveland Clinic.
Written and edited by Dr Rachel Denham, a trained medic and Women's Health Practitioner, who has worked across the charity and humanitarian sector and now specialises in women's health. Rachel is the creator of Bloody Nora, a women's health and wellbeing zine that fuses storytelling, art and science.
