The Latest on Fibroid Treatments
The heavy periods and pain associated with fibroids can be debilitating. Until recently, women who had them didn’t have any options beyond suffering or having a hysterectomy. More treatment options are now available, but they have their risks. Let's take a look at what's available.
Living With Fibroids
Fibroids, or leiomyoma, are benign uterine tumors composed mainly of muscle tissue. Up to 80% of women will experience at least one fibroid by the time they’re 50. The growths can vary greatly in size, with some getting large enough to press against the bladder or rectum, causing pressure or discomfort. The good news is that only about 1 in 1,000 fibroids progress into cancer.
Fibroids usually don’t cause symptoms, but when they do, they often begin with heavy, painful periods. This may lead to anemia and require treatment with iron supplements. Depending on where the fibroids occur and how large they become, they can also cause enlargement of the lower stomach, a sense of fullness, frequent urination and painful intercourse. In rare cases, fibroids can lead to infertility.
Estrogen and progesterone levels affect fibroid growth, but how and why the tumors occur remains a mystery. Fibroids do tend to run in families, so genetics may play a role in individual risk. Because of the hormonal connection, many women find their fibroids grow out of control during pregnancy, furthering the risk of complications and increasing the possibility of having to undergo a Cesarean section.
Managing and Treating Fibroids
Many women with fibroids don’t require any treatment, opting to have their doctors monitor growth until symptoms or complications become bothersome. Others, especially women who want to get pregnant or have particularly large fibroids, might need to take less-conservative approaches.
Smaller fibroids can be managed with hormonal contraception methods, such as low-dose birth control pills or progesterone treatments like the Depo shot or progestin-releasing IUDs. These options help reduce the symptoms of fibroids, such as heavy bleeding, but they don’t reduce the fibroids themselves. Birth control and progesterone treatments can raise certain cancer risks, so they should be avoided by women who are already at risk. Women who’ve developed anemia due to severe blood loss may opt to try gonadotropin-releasing hormone agonists (GnRHa), which shrink fibroids and usually stop periods during treatment. Unfortunately, GnRHa tends to be expensive.
Larger fibroids may require more aggressive interventions, but a hysterectomy is no longer the only option. Some fibroids can be removed individually without affecting fertility. Cryomyolysis, which freezes off the fibroid, or myolysis, which burns off the fibroid with an electric current, are potential options. Women with severe bleeding may opt to have an endometrial ablation, which destroys the uterine lining to reduce menstrual bleeding, but the procedure is not recommended to anyone who wishes to become pregnant.
Fibroids can profoundly impact the lives of some sufferers, but with so many treatment options available, hopefully, there’s a solution for most. Of course, a doctor is the best place to start to determine the best way to manage or treat them. And for those who choose not to treat them, it's good to know that most fibroids reverse course at menopause, so time itself heals many cases.
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