Every single woman in my family has had fibroids, including me.
Fibroids are noncancerous tumors that grow in and around the uterus. They happen to all kinds of women. But they’re especially common in Black women, who suffer from fibroids two to three times more often than white women.
Just the other day I had a patient who complained that all of a sudden her periods changed from normal to torrential to the point where she had to leave work. Whenever a woman comes in complaining about extra-heavy periods, pelvic pain throughout the month and pain during sex, fibroids are one of the first conditions I look into.
One of the frustrating things about fibroids is that we still don’t know exactly what causes them. But research projects like the Black Women’s Health Study, which has followed 59,000 Black women since 1995, is giving us clues about why Black women get some health conditions more often than others. In the recent newsletter summing up 20 years of research, uterine fibroids were the third most common condition, behind high blood pressure and obesity.
As a nurse practitioner, and a woman with a personal history of fibroids, I like educating women and helping them figure out how the best way to manage the condition.
A Problem for All Women
One in five women will have to deal with fibroids at some point. There are a few well-known risk factors, according to the National Uterine Fibroid Association:
- Being of childbearing age, especially between 30 and 40
- Being Black, especially with more African ancestry
- Having a close relative with fibroids
- Being obese
Sometimes fibroids stay small like little pebbles and women don’t know they’re there. But when they get larger, sometimes as large as a grapefruit, fibroids can cause pain during sex, heavy periods that could lead to anemia or discomfort and frequent urination because they press on the bladder. I’ve had friends and family members who didn’t know they had fibroids until they became pregnant. One of them had to have a C-section because the fibroids grew so large the baby couldn’t pass through the vaginal canal, though this is rare.
If you’re having symptoms, the first step is a transvaginal ultrasound to look at the size and shape of the uterus. Fibroids can grow outside the uterus or inside uterine cavity where they cause heavy bleeding. Others grow in between the muscles and those can distort the uterus and cause pain if they press on other organs.
The next step depends on the size of the fibroids. If they’re very small, we can just monitor them periodically. If a woman is in her late 40s or early 50s, we might wait and watch since fibroids usually shrink during menopause.
If they’re large and are causing bleeding symptoms, we usually try adjusting a patient’s hormones to decrease the bleeding. If that doesn’t work, we can explore other options.
The good news is today there are many alternatives to the hysterectomy that often was the old-school way to deal with fibroids. Many of the women in my own family had hysterectomies because of fibroids. In the past, women were told that they didn’t need their womb if they weren’t planning to have any more children. But removing the uterus leaves a space. This can allow other organs to shift and could lead to other problems, such as urinary incontinence.
I had a patient with two teenage boys who had no intention of having any more children. She opted for a hysterectomy. It was completely her choice and the only option she considered, but that’s not typical.
Beverly Johnson, the first Black model to appear on the cover of Vogue, has written about her debilitating struggle with fibroids in her 40s. She ended up having a total hysterectomy, which may involve removing the ovaries and fallopian tubes as well. She didn’t realize that she’d go into menopause as a result. Now she’s helping educate other women about the the range of other treatment options.
Modern Options for Treating Fibroids
These days, most providers want to leave the uterus and ovaries in place and find a way to shrink or remove the fibroids.
One of the most common ways to do this is with embolization — cutting off blood supply to either the individual fibroids or the entire uterus. This causes the fibroids to shrink or in some cases disappear. But uterine artery embolization is risky if you’re thinking of having a baby, because it could affect your ability to get pregnant.
The next option is surgical removal of the fibroids in a procedure called a myomectomy. In some cases, it can be done laparoscopically with robots and they remove the fibroids through small incisions. But depending on where the tumors are, doctors may have to do an open procedure to surgically remove the tumors from the uterus — this was the type of surgery I had. It takes about six weeks to recover from this major abdominal surgery.
My colleague, Alexis Atwater, MD in Washington DC sometimes uses an IUD like Mirena to help manage the heavy bleeding and pain that fibroids can cause. The IUD releases a small amount of hormone that acts directly on the uterus.
Acessa, a laparoscopic fibroid procedure that uses radiofrequency waves and heat, is one of the latest treatments approved by the FDA. Ultrasound imaging allows surgeons to pinpoint and destroy the tumors while keeping the uterus intact.
“They use heat to shrink the fibroid down,” Alexis says. “It’s the new up and coming thing and it’s even less invasive than uterine artery embolization.”
Acupuncture can be used along with traditional medicine and treatments. I received acupuncture before and after my fibroid surgery and I believe it helped me recover more quickly. Many acupuncturists use a combination of Chinese herbs and acupuncture to help restore hormonal balance so periods flows return to normal, decrease the size of fibroids and lessen the related pain and bleeding.
Cutting Your Fibroid Risk
Even after surgery, fibroids can come back, so it’s important to do what you can to prevent a recurrence. Researchers shows lifestyle choices that raise or lower your relative risk.
A 1999 Canadian study found that eating more red meat like beef and ham increased the risk for fibroids. The same study found that eating more green vegetables, fruits and fish lowered fibroid risk. And Black women who ate four or more servings of dairy a day had a 30 percent lower risk of developing fibroids, according to data from the Black Women’s Health Study reported in 2009. Researchers at Boston University School of Medicine believe that calcium may help protect against fibroids.
I eat a small container of Greek yogurt every day as a snack and I do other things to keep my mind and body healthy.
It’s been 15 years, and they haven’t come back.
The One Medical blog is published by One Medical, an innovative primary care practice with offices in Boston, Chicago, Los Angeles, New York, Phoenix, the San Francisco Bay Area, Seattle, and Washington, DC.
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