The Signs and Symptoms of Uterine Fibroids
Toya Wright (who you might know as Lil Wayne's ex-wife, a TV personality, or author of In My Own Words) walks around every day feeling like she's five months pregnant. Despite sticking to a healthy diet and busting her butt in the gym, that belly won't go away-because it's caused by uterine fibroids. Not only do they give her the feeling of being pregnant, but they also serve up severe bleeding and cramping every month when she gets her period.
And she's far from alone. A whopping 50 percent of women will have uterine fibroids, says Yvonne Bohn, M.D., ob-gyn at Los Angeles Obstetricians and Gynecologists and Cystex spokesperson. The Office on Women's Health even estimates that between 20 and 80 percent of women will develop fibroids by age 50. Despite the fact that this issue affects such a huge chunk of the female population, many women don't know the first thing about fibroids. (And, no, it's not the same as endometriosis, which stars like Lena Dunham and Julianne Hough have spoken out about.)
"I didn't know anything about fibroids at the time," says Wright. "It was so foreign to me. But once I was diagnosed with them, I started talking about it to different friends and family members and reading up about it, and I realized that it was really very common." (Seriously-even supermodels get them.)
What Are Uterine Fibroids?
Uterine fibroids are growths that develop from the muscle tissue of the uterus, according to the American Congress of Obstetricians and Gynecologists (ACOG). They can grow inside the uterine cavity (where a fetus grows), within the uterine wall, on the outside edge of the uterine wall, or even outside the uterus and attached by a stem-like structure. While they are often called tumors, it's super important to know that almost all of them are benign (non-cancerous), says Dr. Bohn.
"On very rare occasions they can become cancerous, and that's called a leiomyosarcoma," she says. In that case, it's usually extremely fast growing, and the only way to know if it's cancerous or not is to get it removed. But, really, it's super rare; only an estimated one in 1,000 fibroids is cancerous, according to the Office on Women's Health. And having fibroids does not increase the risk of developing a cancerous fibroid or of getting other forms of cancer in the uterus.
Right now, we don't know what causes fibroids-although estrogen does make them grow, says Dr. Bohn. For that reason, fibroids can grow a lot during pregnancy and usually stop growing or shrink during menopause. Because they're so common, it's weird to consider them a hereditary thing, says Dr. Bohn. But having family members with fibroids does increase your risk, according to the Office on Women's Health. In fact, if your mother had fibroids, your risk of having them is about three times higher than average. African-American women are also more likely to develop fibroids, as are women who are obese.
Uterine Fibroid Symptoms
Women can have multiple large fibroids and have zero symptoms, or they can have one tiny fibroid and have horrible symptoms-it all depends where the fibroid is, says Dr. Bohn.
The number-one symptom is abnormal and heavy bleeding, she says, which is usually accompanied by severe cramping and passing blood clots. Wright says this was the first sign that something was wrong; she'd never had cramps before in her life, but suddenly she was experiencing sharp pains and extremely heavy cycles: "I was running through pads and tampons-it was really bad," she says.
If you have a fibroid in the uterine cavity, bleeding can become super intense, because that's where the uterine lining builds up and sheds during your period each month, says Dr. Bohn. "Even if the fibroid is small, if it's in that wrong spot, you can hemorrhage to the point of having anemia and requiring blood transfusion," she says.
Larger fibroids can also cause pain during sex as well as back pain. They can put pressure on the bladder or rectum, resulting in constipation, or frequent or difficult urination, says Dr. Bohn. Many women get frustrated that they can't lose weight in their stomach-but it's actually fibroids. It's not uncommon for large fibroids to create a super-bloated feeling, like Wright experienced.
"I was able to feel them through my skin, and kind of see them and move them around," she says. "My doctor told me my uterus is the size of a five-months-pregnant woman." And this is no exaggeration; while rare, Dr. Bohn says that fibroids can grow to the size of a watermelon. (Don't believe it? Just read the personal story of a woman who had a melon-sized fibroid removed from her uterus.)
Can You Get Rid of Uterine Fibroids?
First things first: If you have fibroids that are small, aren't causing any life-altering symptoms, or aren't in any problematic positions, you may not even need treatment, according to ACOG. But, unfortunately, fibroids never go away on their own, and won't disappear no matter how many urban legend remedies you try or how many pounds of kale you eat, says Dr. Bohn.
Decades ago, the go-to fibroid treatment was a hysterectomy-the removal of your uterus, says Dr. Bohn. Luckily, that's no longer the case. Many women without super-severe symptoms live with their fibroids, and successfully get pregnant and have kids without any issues, she says. But this all depends on where your fibroids are located and how severe they are. In some cases, fibroids can block a fallopian tube, prevent implantation, or block the path of a natural birth, says Dr. Bohn. It all depends on the individual situation. (Here's everything you need to know about fertility.)
Today, most women with fibroids go on low-dose birth control pills or get a hormonal IUD-both of which thin the uterine lining, limiting menstrual bleeding and symptoms, says Dr. Bohn. (BC also decreases your risk of ovarian cancer-yay!) There are some drugs that can temporarily shrink fibroids, but because they reduce bone marrow density (basically making your bones weak), they're only ever used for a short period of time and usually to prep for surgery.
There are three different surgical approaches to dealing with fibroids, says Dr. Bohn. The first is a hysterectomy, or removal of the entire uterus (in women who aren't having children). The second is a myomectomy, or removal of the fibroid tumors from the uterus, either by opening the abdomen or laparoscopically (where they go through a small incision and break the fibroid into smaller pieces to remove it from the body). The third surgical option is a hysteroscopic myomectomy, where they can remove small fibroids in the uterine cavity by going into the uterus vaginally. Another treatment option is a procedure called embolization, where doctors go through a vessel in the groin and track the blood supply to the fibroid. They kill off the blood supply to the tumor, shrinking it by about one-third, says Dr. Bohn.
The fact that women can get their fibroids removed while keeping their uterus (and preserving their ability to have children) is a huge deal-which is why it's important for women to know their treatment options.
"A lot of women I talked to have made the mistake of getting fibroids removed with a hysterectomy," says Wright. "It kind of ruined their lives, because now they're not able to have kids anymore. That was the only way they thought they could remove them."
There's one big downside to removing the fibroids but leaving the uterus in place, though: the fibroids may reappear. "If we do a myomectomy, unfortunately, until the woman gets into menopause, there's a chance that the fibroids can come back," says Dr. Bohn.
Your Uterine Fibroid Game Plan
"If you're having these weird symptoms, the first thing is to let your gynecologist know," says Dr. Bohn. "Changes in your menstrual cycle, clots in your period, severe cramping, that's a sign that something isn't right." From there, your doc will determine whether the causes is structural (like a fibroid) or hormonal. While docs can feel some fibroids during a standard pelvic exam, you'll most likely get a pelvic ultrasound-the best imaging tool for looking at the uterus and ovaries, says Dr. Bohn.
While you can't totally control the growth of fibroids, living a healthy lifestyle can help minimize your risk; red meat might be linked to a higher fibroid risk, while leafy greens might be linked to lower risk, according to a study published in the journal Obsetrics and Gynecology. While there's still limited research on lifestyle risk factors and uterine fibroids, consuming more fruits and vegetables, exercising regularly, minimizing stress, and being at a healthy weight were all linked to lower incidence of fibroids, according to a review published in the International Journal of Fertility and Sterility.
And if you do get diagnosed with fibroids, don't freak out.
"The bottom line is that they're very common," says Dr. Bohn. "Just because you have one doesn't mean it's awful or that you have to be rushed to surgery. Just be aware of the signs and symptoms so you can seek attention if you have any of these abnormal feelings."