According to the U.S Office on Women’s Health, uterine fibroids are typically noncancerous growths that appear on the wall of the uterus. Sometimes women can have uterine fibroids and not know, but sometimes fibroids can be apparent and difficult to live with, particularly when they are associated with pain and heavy menstrual bleeding. That being said, the topic of uterine fibroids is not well-discussed within women’s health, despite affecting between 40% and 80% of people with uteruses. In this article, we will discuss what counts as a uterine fibroid, symptoms and signs that may indicate you have uterine fibroids, whether they are related to PCOS, and treatment options available.
Let’s get started.
Defining uterine fibroids
In a nutshell, uterine fibroids are growths (consisting of muscle and connective tissue) that appear on the wall of the uterus. They can grow as a single node, or they can grow in clusters, ranging from 1 mm to over 20 cm in diameter. For most women, fibroids do not cause problems: they are noncancerous, do not trigger any unpleasant physical symptoms, and for the most part go undiagnosed. Fibroids vary in size and severity, with some fibroids being as small as a pea, while (in rare cases), they can grow to the size of a watermelon, pushing onto the ribs. Most importantly, though, cancerous fibroids are very rare and so – if a fibroid is discovered during a routine pelvic exam or an ultrasound – physicians and their patients may opt to keep an eye on the fibroid, as opposed to pursuing treatment right away.
Are there different types of fibroids?
Fibroids can grow in different places, and this affects the ‘type’ of fibroid you may be diagnosed with. For example, submucosal fibroids are those that grow inside the uterine space (this is the place a baby grows during pregnancy), while intramural fibroids are embedded into the muscular wall of the uterus itself. There are also subserosal fibroids, which are the most common type, and are located on the outside the uterus; they can push outside of the uterus and into the pelvis. Sometimes they have a “stalk” known as a pedunculated fibroid, that attaches to the uterus.
Symptoms of uterine fibroids
If you know you have fibroids but you don’t have symptoms, then you have “asymptomatic fibroids,” and these are typically small in size. On the other hand, larger fibroids can lead to the following symptoms:
- Excessive or painful bleeding on your period
- Bleeding between your periods
- Bloating and feelings of ‘fullness’ in your abdomen
- Frequent urination (as a result of the fibroid pushing on your bladder)
- Pain during sex
- Lower back pain
- Difficulty urinating or emptying your bladder
- Enlarged abdomen
How are fibroids diagnosed?
Fibroids may be diagnosed as a result of visiting your healthcare provider to discuss symptoms, or a routine pelvic exam; since you can get pregnant if you have fibroids, it’s also possible that they can be found during prenatal care. That being said, there are tests that can be conducted to fibroids, such as:
- Here sound waves are used to generate a visualization of your internal organs; depending on the size of your uterus (most women’s uteruses are about the size of a lemon) this can be performed via a transvaginal ultrasound – such as the type used to diagnose PCOS – or a transabdominal ultrasound.
- MRI scan
- Using magnets and radio waves, this test can produce images of your internal organs to see the location and size of any potential fibroids.
- CT scan
- In this case, X-ray images are used to take detailed snapshots of your internal organs from a number of different angles.
- This procedure involves the use of a thin, flexible tube with a camera attached at the end – otherwise known as a scope – to examine fibroids inside the uterus. The scope is often passed through the vagina and cervix before being moved into the uterus.
- Again using a camera, this test involves passing a scope into your lower abdomen via a small incision that allows your healthcare provider to look closely at internal organs.
What causes uterine fibroids?
As of right now, experts are unsure why some women develop uterine fibroids and others don’t. There are some risk factors that may place you at higher risk of developing fibroids, but as for the root cause, more research is needed to definitely say. The factors that may place you at higher risk for developing fibrosis include:
- Being African American
- Family history of fibroids
- High blood pressure
- Being in the overweight or obese BMI categories
- Vitamin D deficiency
- Not having children (with increasing pregnancies, your risk of fibroids decreases)
- Early onset of menstruation (getting your period before age 11)
- Late age for menopause
The factors that may lower your risk of developing fibroids include pregnancy and long-term use of hormonal contraceptives.
Are uterine fibroids related to PCOS?
Not much research has been conducted in relation to this question, but so far it seems there is not a connection between PCOS and uterine fibroids. One study that followed 1070 women, ranging from 18 to 40 years old with “gynecologic or infertility problems” were examined for uterine fibroids or polycystic ovaries via a transvaginal ultrasound. Of those women, researchers concluded that fewer women with polycystic ovaries had fibroids compared to patients with ‘normal’ ovaries, and this correlation was maintained regardless of age and ethnicity. Of course, we also know from the Rotterdam criteria that to be diagnosed with PCOS, you don’t necessarily need to have cysts on your ovaries. However, if we take the presence of cysts as a proxy for PCOS, then – from this study – there does not appear to be a connection between PCOS and uterine fibroids.
Treating uterine fibroids
If you have mild symptoms that are manageable, or you discover you have uterine fibroids from a routine pelvic exam, then the most common course of action is known as “watchful waiting.” This means your doctor will routinely check the size of your fibroids (particularly if you are hoping to get pregnant, or recently found out you are pregnant), to ensure they don’t grow too large or begin causing problems. This is because fibroids are typically noncancerous, don’t interfere with pregnancy (though they may grow more quickly during this time), and grow slowly over time, eventually shrinking after menopause as the levels of reproductive hormones decline.
But what if uterine fibroids are accompanied by painful symptoms? What avenues of treatment are available?
Typically, doctors recommend medications that regulate your menstrual cycle and help mitigate menstrual bleeding and pelvic pressure. These medications can include: gonadotropin-releasing hormone agonists (used to block the production of estrogen and progesterone, putting you in a menopause-like state), hormonal birth control (such as the progesterone-releasing IUD to help with heavy bleeding), tranexamic acid (a non-hormonal medication used to ease heavy bleeding; it is only taken on the days of your period where bleeding is heaviest), and nonsteroidal anti-inflammatory drugs (aka NSAIDS such as ibuprofen and aspirin to help with pain relief).
Finally, if you suffer from anemia or low iron as a result of heavy bleeding, then your doctor may prescribe iron and certain vitamins that can help balance levels and return your energy levels to normal.
What to do if you suspect you have uterine fibroids
First of all, know that this is completely normal. As we mentioned earlier, estimates put the commonality of uterine fibroids between the 40% and 80% mark, which means that if not almost half, then the majority of women have uterine fibroids. Also know that typically they are not a problem: they rarely turn cancerous, and your doctor can work with you to manage symptoms.
That being said, it is definitely best to book an appointment with your primary care provider. Ask for a pelvic exam, and if you have symptoms like we listed above, consider also asking for an ultrasound to get a clearer picture of the size, location, and type of fibroids you may have. If you plan on becoming pregnant soon, or you are pregnant, since uterine fibroids can grow more quickly during this time (as a result of heightened reproductive hormones and fibroids’ responsiveness to these hormones), it is well-worth keeping a close eye on your fibroids during this time. This means having open conversations with your doctor about your concerns, getting regular check ups, and making sure to consult with a physician who you feel heard by.
Finally, if your symptoms are really bothering you, definitely have a conversation with a doctor who is as invested in solving this problem as you are. (Your concerns should never be swept under the rug or made to feel ‘dramatic’). That is non-negotiable when it comes to your physical and mental wellbeing. Also make sure to choose a doctor who is interested in an open dialogue with you about treatment plans, and which ones may suit your lifestyle better than others. From there, you can decide whether NSAIDs are sufficient, whether you should explore hormonal medication, or whether watchful waiting may be the best route. No matter what though, advocate for yourself and your concerns, and choose a physician who you trust.
Allara Health provides personalized treatment that takes the guesswork out of managing PCOS, and offers a customized, holistic plan of attack that merges nutrition, medication. supplementation, and ongoing, expert support to begin healing your body.