Fibroids Are Common in Midlife, but You Have Options

What Are Fibroids?

Uterine fibroids are tumors that consist of smooth muscle and fibrous connective tissue. Fibroids are almost always noncancerous, and though they can develop earlier in the childbearing years, the chance of diagnosis increases with age.

Types of Uterine Fibroids

There are three types of fibroids:

• Intramural fibroids. These grow inside the muscular wall of the uterus. Intramural fibroids are the most common type of fibroids.
• Subserosal fibroids. These grow on the outside of the uterus. They can be large enough to cause pelvic pressure symptoms or an unbalanced feeling in the abdomen. If the subserosal fibroid grows a stem, similar to the stalk of a skin tag, it’s called a pedunculated fibroid.
• Submucosal fibroids. These are less common and grow in the middle layer, or myometrium, of the uterus. Because this type of fibroid affects the lining of the uterus, submucosal fibroids are the most likely to cause heavy periods

It’s common for women not to know they have uterine fibroids until they’re discovered for a secondary reason, like trying to get pregnant or when they start having symptoms, says Puja Uppal, D.O., a board-certified family medicine physician in Pinckney, Michigan.

But while fibroids may not be noticeable by all who have them, for some, they can present a much bigger problem. Some women experience distressing and painful symptoms from fibroids. “Symptoms can be so severe that one’s quality of life is negatively affected,” Uppal says.

Another important part of understanding fibroids and how to treat them, Uppal points out, is the not-yet-fully-understood racial disparity with fibroids. Black women are diagnosed with the tumors at roughly three times the rate of white women. The reasons for this are still being studied, though there is certainly a genetic link.

What Do Fibroids Feel Like?

LaToya Jordan, 43, of New York City, says she believed early on that fibroids were in her future because many of her cousins had them. Her period had always been heavy since they started in her early teens, but as she got older, her period got longer. At first, it was 10 days, and then two weeks. Eventually, her period lasted an entire month.

“There was a point where I was taking ibuprofen for cramps and it did nothing,” she says. “I was in so much pain. I missed work. I’d have to set my alarm to change my tampon during the night or it would be a huge mess.”

Danelle Lejeune, 45, of Savannah, Georgia, experienced severe anemia from her fibroids and says her fibroids are so painful she’s considering a hysterectomy.

“If I move the wrong way, it feels like ovulation,” Danelle says. “I have a big hot mess in there.”

And yet other women have fibroids and barely notice them. “When a fibroid is not symptomatic, it doesn’t affect the quality of life,” says Suzanne Sarfaty, M.D., a primary care physician and medical professor at Boston University. It’s possible for fibroids to grow and shrink depending mostly on hormone levels, she says.

Uterine Fibroid Symptoms

According to both Sarfaty and Mount Sinai Hospital, symptoms of fibroids may include the following:

• Heavy periods
• Periods that last two weeks to all month
• Pelvic pain
• Painful sex
• Fatigue
• Anemia
• Frequent urination
• Bowel problems

“Fertility and pain are the biggest problems when it comes to fibroids,” Sarfaty says. “Nobody wants chronic pain, and nobody wants a painful sex life.”

What Can We Do About Fibroids?

Treatment of uterine fibroids ranges from over-the-counter painkillers to surgery, depending on their severity.

Treatment for Minor and Moderate Fibroids

For fibroids that are causing less of an issue, Uppal says she offers alternative ideas to her patients. “Supportive care, such as physical therapy and yoga, can sometimes help relieve nonspecific pelvic pressure or pelvic pain.”

There are also varied over-the-counter options to treat cramping and pain, like acetaminophen or ibuprofen, or you could take an OTC iron supplement to treat anemia caused by heavy bleeding. Additionally, there are prescription medications that can help:

• Gonadotropin-releasing hormone (GnRH) agonists, which target the fibroid symptoms by blocking the production of estrogen and progesterone
• A progesterone-releasing IUD, which tends to eliminate or shorten periods for most women and can help relieve the symptoms (heavy bleeding and pain) but won’t shrink the fibroids
• Tranexamic acid, which is a nonhormonal oral medication that stabilizes blood clots and can ease heavy bleeding

Treatment for More Severe Fibroids

“The location and size of the fibroids can make a big difference with respect to treatment,” Uppal says. “Surgery is the most common treatment for problematic uterine fibroids.”

Writer and mother Aileen Weintraub, 45, of Ulster County, New York, had an unusually severe fibroid that disrupted her pregnancy a decade ago.

Because a fibroid was sitting on top of her cervix, Aileen was put on strict bed rest during her pregnancy. She was instructed to keep her legs propped against the wall for hours at a time. Doctors were concerned the fibroid could cause a miscarriage.

Although her son was eventually born healthy and on time, the experience changed Aileen’s plans to have more children. “I was such a mess from being on bed rest for five months that I couldn’t imagine having to go through that again,” she says.

Aileen’s experience is uncommon and an example of what fibroids can do in the worst-case scenario.

Uppal says there are two main surgical options for severe fibroids:

• Hysterectomy — a complete removal of the uterus
• Myomectomy — the surgical removal of only the fibroids

The downside to myomectomy is that it doesn’t ensure that the fibroids won’t grow back. The only way to completely prevent new fibroids is by getting a hysterectomy, Uppal says. A hysterectomy would also end the ability to have children biologically and would send a woman into menopause. It’s not a small decision.

What Happens After Fibroid Surgery

LaToya opted for a laparoscopic myomectomy to remove her fibroids. It has allowed her to function again. For now, though she knows the fibroids may eventually come back, the relief she has after having the fibroids removed is worth a lot.

And even if they do come back, understanding that she has options makes her feel empowered. Fibroids don’t have to control us, Uppal says. We can find ways to control them.

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