Between 20% and 80% of people with a uterus will develop uterine fibroids in their lifetime. And relative to white women, Black women are 2–3 times more likely to have fibroids, to develop them at younger ages, to have bigger fibroids, to have more fibroids, and to have more symptoms. This is an alarmingly high number and while uterine fibroids are most often nonthreatening, they can cause immense pain and suffering. So to get more information, we spoke with Dr. Eric Hardee, cofounder of Houston Fibroids, and board-certified by the American College of Radiology. Dr. Hardee has been treating uterine fibroids in the Houston area for over 20 years.
To start — what exactly are fibroids?
Fibroids are benign tumors that arise from smooth muscle cells of the uterus. They are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
They range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.
Do we know what causes uterine fibroids?
While the precise cause of fibroids is unknown, hormones promote their development. There are numerous factors that increase the risk of developing fibroids which may include but is not limited to early onset of menses, lack of pregnancy/childbirth, use of birth control pills before age 16, obesity, as well as specific genetic mutations.
Who is primarily impacted by uterine fibroids?
Fibroids are most common in women who are 30–40 years old, but they can occur at any age. They occur more often in Black women than in white women. In fact, the lifetime prevalence of fibroids is approximately 80% in Black women and 70% of Caucasian women. Black women are also more likely to develop larger fibroids and be more symptomatic.
What symptoms should people be on the lookout for?
The most common symptom of uterine fibroids include:
— Heavy menstrual bleeding, which can be severe enough to cause anemia and can lead to iron-replacement therapy or even blood transfusions. Dr. Hardee adds, "We have treated many women who had to endure several blood transfusions every year due to heavy bleeding. Women can suffer from such heavy menstrual cycles that they are forced to miss time from work every month."
— Severe pelvic pain or pressure
— Bulk-related symptoms related to the size of the uterus and fibroids
— Urinary frequency is one of the most common, caused by large fibroids sitting directly on top of the bladder
— Painful sexual intercourse
— Low back pain
— Leg pain, swelling, heaviness
How are uterine fibroids diagnosed?
Menopausal women and women who are spotting between menstrual cycles may also need an endometrial biopsy. But fibroids are initially diagnosed clinically based on a patient’s history and physical exam. Once suspected, the diagnosis of fibroids is usually confirmed with imaging such as pelvic ultrasound. Though, an MRI is the best way to accurately visualize fibroids and develop a treatment plan.
What treatment options are available?
"The majority of my patients are told that a hysterectomy is their only option, but there are other options available."
Dr. Hardee and his partner, Dr. William C. Fox, have over 35 years in combined experience performing Uterine Fibroid Embolization (UFE) and are very passionate about this nonsurgical, uterine-sparing therapy. In addition to UFE, Dr. Hardee outlined the various treatment options below, which include both noninvasive procedures as well as surgical options, including a hysterectomy.
Noninvasive options/Uterine-sparing therapy:
— Medical therapy is usually the first thing tried in patients and can include oral contraceptive pills or other agents that can be used temporarily to decrease fibroid symptoms or size.
— Intrauterine devices are sometimes tried, which may decrease bleeding in some patients.
— MR-guided focused ultrasounds can treat fibroids in a limited number of patients, although most do not qualify due to uterine fibroid anatomy or lack of insurance coverage.
— Uterine Fibroid Embolization (UFE) is an outpatient, minimally-invasive option that eliminates fibroid symptoms without surgery or the prolonged 4–6-week recovery period required. A tiny catheter is inserted and used to inject particles that shut down the blood flow to the fibroids forcing them to shrink, become dormant and ultimately eliminating all of their inherent symptoms. The advantages of UFE include no incision or scar, and no need to remove body parts. The procedure is done on an outpatient basis with no hospitalization required. There is a very short recovery period, with most women resuming normal activity and returning to work in 7–10 days.
— Myomectomy: This is a surgical procedure to remove uterine fibroids. The surgeon's goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike a hysterectomy, which removes your entire uterus, a myomectomy removes only the fibroids and leaves your uterus.
— Hysterectomy: The entire uterus is removed completely.
Under what circumstances and how frequently is a hysterectomy the best option?
There are many other reasons besides fibroids that may lead to hysterectomy. Disease processes such as uterine prolapse, adenomyosis, and cancer are commonly treated with hysterectomy. In patients with symptomatic fibroids who no longer desire pregnancy, uterine fibroid embolization is an option.
What type of questions should you ask your doctor if you suspect fibroids?
— Do I need treatment?
— What are my options for treatment?
— Are there options besides surgery?
— What are the risks of surgery?
— What are the chances the fibroids return after treatment?
— When can I expect to feel pain relief?
— Is there anything I can do to prevent fibroids?
— I’m considering UFE — do you work with an interventional radiologist?
— Are fibroids hurting my chances of getting pregnant?
— How will treatment affect my chances of getting pregnant?
— What treatment is the best option for me?