Uterine fibroids are the most common benign tumors of the female genital tract and are often found in women of reproductive age. By the age of 50, it’s estimated that 70 percent of Caucasian women and 80 percent of African American women will have fibroids.
Not all fibroids are symptomatic, but the complications they cause lead many women to seek fibroid treatment. Fibroids often cause severe menstrual cramping, unpredictable menstrual cycles, heavy bleeding, pelvic pain, weak bladder control, constipation, pain during intercourse, and issues related to infertility. For this reason, they are the leading cause of hysterectomy in the U.S., despite other effective treatment options.
Uterine fibroids develop from the smooth muscle tissue of the uterus. It's not uncommon for one woman to have multiple fibroids of differing sizes, and some women are more susceptible to fibroids than others. While it’s unknown exactly what causes fibroids, it's believed that hormones and genetics play a role in their growth.
Fibroids grow under the influence of hormones such as estrogen and progesterone, which increase during a woman’s reproductive years. These hormones are responsible for stimulating the development of the lining of the uterus each menstrual cycle in preparation for pregnancy. Evidence suggests that fibroid cells may be affected similarly.
Following menopause, when estrogen levels are low, fibroids shrink. While the underlying mechanisms for why this occurs aren’t fully understood, in simulated studies, fibroid size increased when exposed to hormone replacement therapy (specifically injectable estrogen replacement therapy and synthetic progesterones) and decreased when treated with anti-hormone therapy.
Clinical studies have revealed that hundreds of genes within fibroids are dysregulated, including those responsible for cell proliferation, which may be linked to uncontrolled cell growth. When compared to the normal myometrium, it was also discovered that fibroids contain heightened concentrations of both estrogen receptors and progesterone receptors.
Risk Factors Associated with Fibroids
There are a number of risk factors that make a woman more likely to develop fibroids, including race, genetics, age, and obesity.
Race - Evidence suggests that uterine fibroids have a disproportionate effect on African-American women. African-American women are more likely to have fibroids than other racial groups, are significantly more likely to experience severe or very severe symptoms. They also experience an earlier age of onset menstruation, another risk factor tied to uterine fibroids.
Genetics/Family History - Women who have a family history of uterine fibroids are three times more likely to develop uterine fibroids.
Diet and obesity - Women who are overweight are at greater risk for developing fibroids. Very heavy women are two to three times more likely to develop uterine fibroids. Dietary habits can also influence fibroid risk, specifically the intake of food additives and soybeans, which make a woman two and-a-half times likelier to develop fibroids.
Age - Most of the time fibroids grow in women of childbearing age, such as their 30s and 40s. They are more common among premenopausal women, who are three to five times likelier to have it than postmenopausal women. Fibroid risk is reduced with age.
Starting period at a young age - Women who started their period at a young age are more likely to have fibroids.
Diagnosis at a Fibroid Clinic
When fibroids are suspected, in order to confirm the diagnosis, a fibroid specialist or gynecologist usually orders a round of testing, also referred to as a fibroid screening.
A thorough fibroid screening includes:
- Sonogram: A sonogram is performed to confirm the presence of fibroids.
- MRI: An MRI allows the doctor to determine the number of fibroids present, the size of the fibroids, and the position of each fibroid.
- Pap Smear: A pap smear taken from the cervix is used to detect cell abnormalities.
- Diagnostic Biopsy: A diagnostic biopsy procedure is used to rule out cancer.
Treatment at a Fibroid Clinic
Physicians know more about fibroids than ever before, and as a result, women have a wider range of fibroid treatment options to choose from. Studies show that hysterectomy is an overutilized procedure that may not always be necessary to treat benign gynecologic conditions such as fibroids. Minimally invasive alternatives with high success rates offer women looking to preserve their fertility with choices that better fit their priorities.
Here is an overview of widely accepted, evidence-supported medical treatments:
Hormone treatments: Hormone treatments reduce bleeding and decrease fibroid tumor size while preserving the uterus. However, symptoms return when treatment stops.
MR-guided focused ultrasound (MRgFUS): Focused ultrasound procedures cause fibroid tumors to shrink by penetrating the abdominal wall with ultrasound waves which heat fibroid tissue. However, this procedure takes several hours and is usually only appropriate for small fibroids near the surface of the uterus. Fibroids may recur, and additional treatments may be needed.
Uterine Fibroid Embolization (UFE): UFE is a minimally invasive procedure that shrinks fibroids by blooding blood flow to the tumors. Performed by an interventional radiologist, this outpatient procedure does not require general anesthesia and has a recovery period of less than one week. It preserves the uterus and has a 90 percent success rate.
Endometrial ablation: Endometrial ablation is the removal of the lining of the uterus to reduce bleeding. It can only be used in the presence of submucosal fibroids less than 1 inch in diameter. It does not reduce symptoms related to fibroid bulk, but can effectively control bleeding.
- Myomectomy: A myomectomy is the surgical removal of fibroid tumors. This procedure relieves symptoms and preserves the uterus. However, the recovery period may be lengthy -up to six weeks- and fibroids can recur. For this reason, this procedure may not be recommended depending on location, size, and number of fibroids.
- Hysterectomy: A hysterectomy is surgical removal of the uterus, which permanently relieves symptoms but causes loss of fertility. There are risks associated with surgery and general anesthesia, with a recovery period of up to six weeks. Hormonal changes if ovaries are removed. Longer-term side effects, both physical and psychological have been reported.
Your Uterine Fibroid Specialist in NYC Has Answers
VIVA EVE’s team of board-certified physicians and fibroid specialists can help guide you through diagnosis and fibroid treatment options, including minimally invasive alternatives, such as UFE. Working together, your physician will provide you with all the facts you need to select the treatment path that's right for you.
Founded on the principles that every woman deserves to know all the facts, their fibroid clinic is home to some of the best fibroid doctors in NYC. To schedule a complimentary consultation, please visit the VIVA EVE consultation page.