While there are a number of conditions that can make your monthly periods painful and potentially affect your fertility (such as PCOS and endometriosis), there’s another condition that women of childbearing age experience: uterine fibroids. Here’s everything you need to know about uterine fibroids, including what they are, the symptoms to look for, and how they can affect pregnancy.
What Are Uterine Fibroids?
Uterine fibroids are benign, or non-cancerous, muscular tumors that grow in the wall of the uterus. Uterine fibroids can grow as one single fibroid (also called a leiomyoma), or they can grow in a cluster. Uterine fibroids can range in size, and may be as small as a chocolate chip, or as large as a grapefruit in more severe cases.
There are three classifications of uterine fibroids:
- Submucosal: grow into the uterine cavity
- Intramural: grow within the wall of the uterus
- Subserosal: grow on the outside of the uterus
While the exact cause of uterine fibroids isn’t known, research indicates hormonal and genetic factors play a role. Uterine fibroids tend to grow during pregnancy when hormone levels (particularly estrogen and progesterone) are high, and shrink with the use of anti-hormone medications.
Who Is At-Risk For Experiencing Uterine Fibroids?
There are a number of risk-factors for developing uterine fibroids, including:
- Age: Fibroids are more common in women ages 30 through their menopausal years. Fibroids usually shrink after a woman goes through menopause.
- Genetics: Family history can be an indicator of your likelihood to have fibroids, with women whose mothers had fibroids being at three times higher risk than average.
- Ethnicity: African American women are more likely to develop fibroids than Caucasian women.
- Obesity: Those considered overweight have a higher chance of developing uterine fibroids.
- Diet: A diet that includes a lot of red meat is linked to a higher risk of uterine fibroids, while diets that include plenty of green vegetables present a smaller risk.
What Are the Symptoms Of Uterine Fibroids?
Symptoms can vary depending on the size and amount of fibroids present in the uterus. Some women with uterine fibroids never have any symptoms at all, while others may experience:
- Heavy bleeding and painful periods
- Enlargement or a feeling of fullness in the lower abdomen
- Lower back pain
- Pain during sex
- Frequent urination
Can Uterine Fibroids Affect Fertility Or a Pregnancy?
Uterine fibroids may impact a woman’s chances of conceiving, although infertility is rare. Uterine fibroids often have more of an impact on pregnancy and delivery once a woman is pregnant. Possible pregnancy complications due to uterine fibroids can include:
- An increased likelihood of a C-section delivery
- Baby settling in a breech position
- Labor that fails to progress
- Placental abruption, where the placenta breaks away from the uterine wall before delivery
- Preterm delivery
How Are Uterine Fibroids Treated?
Your doctor will conduct a pelvic exam or use an imaging test (ultrasound, X-ray, MRI or CT scan) to diagnose uterine fibroids. Those who experience little to no symptoms typically don’t require treatment for their fibroids. However, if you have uterine fibroids and are experiencing symptoms, it can be helpful to explore treatment options with your provider. Treatments may include:
- Medication:
- Pain relievers: If your symptoms are mild, your doctor may recommend using a pain reliever such as acetaminophen or ibuprofen to manage symptoms, especially during your period.
- Iron supplements: If you are experiencing heavy bleeding during your period, your provider might recommend an iron supplement to prevent or correct anemia.
- Birth control: Low-dose birth control pills or progesterone-containing birth control injections or IUDs can be useful for preventing fibroids from growing and helping to control heavy bleeding.
- Gonadotropin-releasing hormone agonists: Given by injection, nasal spray, or implant, these drugs can shrink uterine fibroids and may be useful prior to surgery to remove them. This medication offers temporary relief of symptoms; however, existing fibroids can grow back after use.
- Surgery:
- Myomectomy: This procedure removes fibroids while leaving the uterus intact. While new fibroids may grow, those removed surgically cannot regrow. After this procedure, it’s still possible to get pregnant.
- Uterine artery embolization (UAE): Tiny particles are injected into the blood vessels leading to the uterus, which cuts off blood flow and causes the fibroids to shrink.
- Radiofrequency ablation: Small incisions are made in the abdomen, vagina, or cervix, then specialized needles are used to heat and destroy the fibroid tissue.
- Hysterectomy: This procedure removes the entire uterus, preventing future uterine fibroids and pregnancies.
It’s important to discuss your questions and concerns about uterine fibroids with your provider or women’s health specialist. They will work with you to find the best course of treatment that helps you manage your symptoms while giving you the best chance at conceiving and carrying a pregnancy in the future.