Uterine Fibroids …a Cause for Invisible Pain

HEALTH COLUMN

If you have moderate or severe symptoms from your fibroids, your provider may recommend medical treatment, surgery or other interventional procedures depending on your symptoms and history. Medical treatments include hormonal medical treatments such as birth control pills, vaginal contraceptive rings or intrauterine devices with hormone, which can help control heavy menstrual bleeding associated with fibroids. Newer medicines have been approved to manage heavy menstrual bleeding associated with fibroids in premenopausal women. Surgical options include removal of the fibroid(s) (myomectomy), destruction of the fibroid(s) without removal, or removal of the uterus (hysterectomy). 

Recently on a work day, my husband had planned a surprise lunch outing for the two of us. He made me take an hour long break and we headed to a place that we often visit in Guwahati. As we sat and ordered for our food, we could not help but overhear a conversation taking place next to our table between two well dressed ladies. The ladies seemed emotionally disturbed as one of them was diagnosed with a tumor of the uterus called 'Myoma'. They were anxious and petrified and were cursing their fate. I could gather from their conversations that the disease had been identified during a routine checkup. I could not help but go up to them. After a little ice breaking session (while my husband sat alone devouring his lunch) I began counseling these ladies in relation to the diagnosis.

"Myoma or Leiomyoma" are medical terms for uterine fibroids. Fibroids are the most common benign (not cancerous) tumors or growths, in women of childbearing age. They grow in and around the muscular wall of the uterus (womb). They can grow as a single tumor or there can be many. They can be as small as an apple seed or as big as a grapefruit. Fibroids can grow or stay about the same size over time.

Fibroids do not always cause symptoms. People who have symptoms may find fibroids hard to live with. Symptoms of fibroids can include changes in menstruation (your period), heavy bleeding, vaginal bleeding between periods, painful periods, anemia (low red blood cell count, resulting from excessive bleeding), fullness or pressure in the lower abdominal area, frequent urination, pain in the belly or lower back and pain during sex. Fibroids can cause other reproductive problems such as infertility, miscarriages and obstetrical problems such as early labor and/or increased likelihood of Cesarean section.

No one knows for sure what causes fibroids. Researchers think that more than one factor could play a role. These factors include age, having a family member with fibroids, race/ethnic origin, being overweight or obese, having high blood pressure and/or certain dietary factors and/or hormones.

Unless you have symptoms, you might not know if you have fibroids. In some cases, a doctor will find fibroids during a routine pelvic exam. Your doctor may also order medical imaging like a pelvic ultrasound to see a picture of the fibroids.

Imaging tests might include:

• Ultrasound

• Saline infusion sonohysterography (SIS or SHG) or saline ultrasound – using a small amount of saline (salt solution) placed in the uterus (womb) to help "see" inside of the uterus on an ultrasound

• Magnetic resonance imaging (MRI)

• Computed tomography (CT) or Computer Assisted Tomography (CAT) scan

Other tests your doctor may order include:

• Complete blood count (CBC) – a blood test to check for signs of anemia (low red blood cell count)

• Blood levels of iron – a blood test to measure the iron levels and confirm if iron-deficiency anemia exists

Surgery (i.e. hysteroscopy) can confirm the ultrasound diagnosis of fibroids and provide additional information like the location of the fibroids. If you have fibroids but do not have symptoms, you may not need medical intervention. If you have symptoms, there are medical treatments that may help.

Contact your doctor if you have any of the following symptoms:

• Heavy bleeding or bleeding between periods

• Significant cramping or pain with periods

• A full or heavy feeling in or near your belly

• Frequent urination or difficulty with urination

If you have moderate or severe symptoms from your fibroids, your provider may recommend medical treatment, surgery or other interventional procedures depending on your symptoms and history. Medical treatments include hormonal medical treatments such as birth control pills, vaginal contraceptive rings or intrauterine devices with hormone, which can help control heavy menstrual bleeding associated with fibroids. Newer medicines have been approved to manage heavy menstrual bleeding associated with fibroids in premenopausal women. Surgical options include removal of the fibroid(s) (myomectomy), destruction of the fibroid(s) without removal, or removal of the uterus (hysterectomy). These procedures can be performed using different methods, ranging from minimally invasive procedures to vaginal or open abdominal surgery. The type of surgery/procedure will depend on how many fibroids are present, where the fibroids are located and whether children are desired in the future.

Have a detailed conversation with your doctor about all your medical treatment options and their risks and benefits. They can answer all your questions and together you can decide which treatment is right for you.

Dr Rajashree Sharma

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