July is Fibroid Awareness Month. This month, we’re answering all your questions about this uterine and reproductive health issue, from “What are my fibroid treatment options?” to “Why are Black women more prone to get fibroids?”
“That’s not normal.”
Dr. Cook stopped typing and looked up. Leigh had just told her OB-GYN that she took four ibuprofen three times a day—and sometimes a Tylenol—during her periods.
This is what it looked like to live with fibroids. After her initial diagnosis when she was a busy 32-year-old med student, it was her unfortunate normal.
What wasn’t normal was being asked about her periods. No one had asked at her annual check ups and pap smears. And while she could read her own reports, she wasn’t an OB-GYN—so the full story of what was going on with her uterus had eluded her.
Unfortunately, we aren’t always made aware of the various options for fibroid symptom management and treatment.
Leigh carried the weight of several large, symptomatic fibroids with her—along with the grief of experiencing multiple miscarriages. Now, at 39 years old, she finally had the support of a doctor who cared enough to deeply inquire about her reproductive health. (The fact that Dr. Cook was also a Black woman wasn’t lost on her.)
After speaking to Dr. Cook and weighing her options, Leigh made the decision to have a hysterectomy without regret. For her, removing her uterus was in the best interest of her health.
Many Black women find themselves in a similar position as Leigh. In fact, “Black women are four times as likely as white women to receive a hysterectomy,” according to an op-ed written by OB-GYN Hilda Hutcherson in The New York Times.
A third of these procedures happen during our peak reproductive ages (18-44). Unfortunately, we aren’t always made aware of the various fibroid treatment options available to us.
Assessing Your Fibroids
Not all fibroids produce symptoms, and most fibroids are benign, meaning non-cancerous.
But being benign doesn’t mean fibroids should be ignored.
“Annual surveillance is the first step,” says Dr. Ruth Arumala, an OB-GYN and fibroid specialist in Mansfield, Texas. “Are the fibroids growing rapidly? If so, we do tests.”
Your OB-GYN will use an ultrasound—either abdominally or vaginally—to evaluate fibroid growth.
If you are experiencing heavy bleeding during or between periods…we definitely recommend you discuss this with your physician.
However, once fibroids become symptomatic, your doctor will move the discussion from surveillance to fibroid treatment options.
“A typical monthly cycle is 21-35 days with no more than seven day of bleeding,” says Dr. Tiffany Bogan Woodus, an obstetrician-gynecologist in Cedar Hill, Texas.
“If you are experiencing heavy bleeding during or between periods,” Dr. Woodus continues, “and having so much pain that you are having difficulty functioning and missing school or work, we definitely recommend you discuss this with your physician.”
Your doctor should walk you through which treatment options are best for you. Managing your fibroids can involve symptom management or fibroid removal or treatment to reduce their size.
Nonsurgical Fibroid Treatment Options
Black women have many of the risk factors associated with fibroids, including obesity and chronic stress.
Self-care with a healthy diet, stress management, and exercise is the foundation of overall health. It’s no surprise good fibroid symptom management starts here, too.
Diet
“Studies have shown a correlation between fibroids and low vitamin D levels. Vitamin D may safely reduce fibroid risk,” says Dr. Arumala.
The greatest source of vitamin D is sunlight. Since most of us spend the majority of our time indoors, we have to find other methods of getting it.
One way to get vitamin D is through supplements—though this should be done under the watchful eye of your doctor.
Exercising can also help alleviate stress, and has the added bonus of preventing fibroids from growing.
“Nobody should supplement vitamin D without a doctor monitoring their vitamin D levels,” Dr. Arumala cautions. “High levels of vitamin D in the body can have negative side effects.”
Another is through your diet. A “fibroid diet” is one rich in natural food sources of vitamin D, such as fatty fish, cod liver oil, egg yolks, and mushrooms. It also excludes highly processed meats and animal-based dairy that are packed with hormones.
Mental and Physical Health
Many of us are overwhelmed and navigating various “isms”, tough relationships, and job stress.
Working with a therapist can help you create a self-care plan and address sources of chronic stress in your life.
Exercising can also help alleviate stress, and has the added bonus of preventing fibroids from growing. (Fat cells secrete estrogen and higher estrogen levels can encourage fibroid growth.)
Medication
While medications can’t completely get rid of your fibroids, they can help manage symptoms like anemia and heavy bleeding. In some cases, they may even shrink.
According to Dr. Arumala, the following medications may be prescribed:
- pain relievers like Aleve or other non-steroidal anti-inflammatory drugs (NSAIDs)
- tranexamic acid (a non-hormonal drug that helps with blood loss)
- combined (estrogen and progesterone) hormonal contraception
- progesterone-only pills
- the Mirena IUD
- Lupron, a weekly injection that can produce hot flashes and other menopausal symptoms
- Oriahnn and Orilissa, newer drugs that have less severe side effects than Lupron.
Side effects can occur with any medication. It’s important to do your own research and speak with your doctor about how starting any meds may affect you or interact with anything else you may be taking.
Surgical Fibroid Removal and Reduction
When you’ve tried to manage fibroid symptoms and they persist, it’s time to talk with your doctor about your fibroid treatment options.
Let’s look at fibroid reduction and removal options from minimally to the most invasive. Fibroids can return with all treatments except for hysterectomies, but there are many options available before you have to take that route.
When looking for the best treatment for fibroids, know that everyone’s fibroids and reproductive aspirations are unique. Please consult your personal physician for a fibroid treatment plan that is right for you.
With any medical procedure, make sure you understand the potential outcomes. Your health, care, and needs matter.
Radiofrequency Ablation
Two FDA-approved, outpatient fibroid treatment options use radiofrequency ablation to reduce fibroid size and symptoms: Acessa and The Sonata System by Gynesonics.
Radiofrequency ablation is a type of controlled heat applied directly to each fibroid. Once targeted, the fibroid softens, shrinks, and breaks down over time. The body absorbs the broken-down material, and the fibroid is unable to re-form.
With Acessa, a camera called a laparoscope is used inside the abdomen. (This gives visibility without having to do open surgery.) Three small incisions are made in the abdomen for the laparoscopic ultrasound, camera, and heat tool called an array.
After the procedure, most patients go home after a few hours and are back to work in a week. Some people see symptom relief quicker than others, but it all depends on the size of the fibroids. Potential side effects of Acessa include cramping, irritation from the heat, bleeding, and abdominal discomfort. (Here is an in-depth look at the risk factors.)
When choosing any fibroid treatment, take your future pregnancy plans into consideration.
The Sonata System is done transvaginally, so there aren’t any incisions. A probe with both an ultrasound and the radio frequency tool is inserted through the cervix and into the uterus to treat fibroids individually.
Patients typically return home the same day, and many return to normal activities the next day. Side effects could include short-term spotting, cramping, and a slight risk of skin burns. (Read here for more safety information on Sonata.)
When choosing any fibroid treatment, take your future pregnancy plans into consideration. Both Acessa and Sonata have not yet been FDA cleared for women who wish to conceive. However, this doesn’t mean that women aren’t getting pregnant after getting fibroid treatment with radiofrequency ablation.
“The FDA just hasn’t received the data,” says Dr. Bruce Lee, the creator of Acessa. “I am working on collecting data and I have several patients that have gotten pregnant and had successful vaginal deliveries after Acessa.”
Uterine Artery Embolization
Another procedure used to treat fibroids is Uterine Artery Embolization (UAE).
“A substance is placed in the uterine artery to block the blood flow through the uterine artery, which is the uterus’s main blood supply,” explains Dr. Woodus. “With a limited blood supply to the uterus, the fibroids aren’t getting blood either and they shrink.”
UAE can also be done through the radial artery in the wrist and is performed at outpatient facilities and hospitals. Patients can go home the same or the very next day, and can expect cramping for the first day or two after treatment. Fatigue, spotting, and bleeding may also occur for a week or more. (More detail is provided here.)
Patients are also at risk of experiencing post-embolization syndrome, which includes fever, fatigue, nausea, vomiting, pelvic pain, and cramping. In rare cases, early-onset menopause can be triggered, especially in people closer to or over 45, due to reduced blood flow to the ovaries.
Shrinking the fibroid relieves symptoms, but uterine artery embolization for fibroids isn’t for everyone. And since it limits the blood supply to the uterus, it’s not recommended for people who want to conceive children or who have larger fibroids.
Myomectomy
A myomectomy is the process of removing fibroids by cutting them away from the uterine wall. It’s done either through open abdominal surgery or as a laparoscopic, hysteroscopic (scope through the vagina), or robotic procedure.
The recovery time can range four to six weeks. (If the myomectomy is done with the hysteroscopic method, it can be two or three days.)
While a myomectomy preserves the uterus, it’s still a highly involved surgery with risks.
“Cutting into the uterine wall could cause bleeding,” Dr. Woodus says. “There is a possibility that the bleeding could cause me to have to remove your uterus to make the procedure safe for you. If you wake up from the procedure, you have to be okay with that.”
Along with the possibility of excessive bleeding, there’s also the potential for damage to nearby organs, perforated uterus, and “scar tissue that could block your fallopian tube or lead to fertility problems,” according to Healthline.
Myomectomy is currently the only FDA cleared fibroid treatment recommended for women who want to conceive in the future. Much of this is because of limited data on pregnancy after other fibroid treatments.
What we do know is that the procedure can weaken the uterus and leave scar tissue, making labor and delivery far more complicated and possibly deadly. People who’ve had myomectomies are often advised to deliver via C-section.
Hysterectomy
Fibroids can return and grow. Unfortunately, the only 100% guaranteed way to remove all fibroids, relieve symptoms, and prevent their return is by getting a hysterectomy.
This option is reserved for extreme cases, when the relationship between the uterus and fibroids becomes too much to bear.
Hysterectomies can be performed abdominally, through the vagina, laparoscopically, or robotically. The size of the fibroids can determine which method is appropriate.
Depending on your circumstances, you may need a complete or partial hysterectomy:
- Complete hysterectomies remove the uterus and the cervix.
- A partial hysterectomy only removes the uterus.
Whether or not the ovaries and the fallopian tubes need to be removed is a discussion to have with your doctor. Ovaries are an important part of hormone production and contribute to cardiovascular health, vaginal lubrication, and libido. Removing the ovaries sends a person right into menopause, which is why many women, especially younger ones who have hysterectomies, keep their ovaries if possible.
Recovery depends on which procedure is performed. It could range from one to two weeks with a vaginal hysterectomy to six to eight weeks with an abdominal hysterectomy.
For those wanting to preserve their uterus, the thought of a hysterectomy can be disheartening. However there are times when fibroids compromise health to the point that a hysterectomy is the best option to feel fully functional and well again.
Knowing your options is part of seeking treatment for fibroids. It helps us advocate for our health from a place of understanding and have active conversations with our care providers.
Learn how one woman became her own advocate while seeking treatment for fibroids that left her bleeding for months on end in our last story in this series.
