While it’s never a bad time to educate women about uterine fibroids, July just happens to be Fibroids Awareness Month, which gives Rescripted a unique opportunity to delve into this common but still-infrequently discussed condition.
What are fibroids?
Fibroids are muscular, usually benign tumors that form within the walls of the uterus, and their sizes vary from tiny as a pea to as large as a melon.
According to the FDA, fibroids will affect 20%-to-80% of women by the time they reach age 50. About a third of those women will experience heavy menstrual bleeding as a result, says Tiffany Werbin-Silver, MD, an OB-GYN with Northwell Health in Mount Kisco, New York.
“Although fibroids are common, they usually get swept under the rug, unless they are very severe,” says Elizabeth King, a certified fertility coach diagnosed with fibroids during her pregnancy journey. This diagnosis only came about, however, when she started “bleeding more heavily than I ever had before,” she says, “and I was having pain during my cycle that wasn’t there prior.”
Read on to learn more about why fibroids cause heavy menstrual bleeding and why early detection of fibroids is vital for fertility and health reasons.
Can fibroids cause heavy menstrual bleeding?
The short answer is, according to Dr. Werbin-Silver, yes. The reasons why are a little more complicated. First of all, it’s important to understand that “fibroids tend to grow in high estrogenic states, like pregnancy,” says Dr. Werbin-Silver. She goes on to explain that it’s during pregnancy that “sometimes people’s fibroids get a lot bigger and worse because of the estrogen content.”
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Location, location, location
As for heavy menstrual bleeding, it depends on the location of the fibroids. “Essentially you can have fibroids anywhere in the uterus,” says Dr. Werbin-Silver. But it’s when fibroids develop just under the lining of the uterus and then “abut into the cavity of the uterus – those are the ones that tend to cause heavy bleeding.” These specific growths are called submucosal fibroids, because they appear on the lining of the uterus that sheds as part of a monthly period.
Dr. Werbin-Silver does say that heavy menstrual flow can also result from intramural fibroids, because these growths develop inside the muscular uterine wall. But the subserosal fibroids, which grow under the surface of the outer uterine wall and extend outside of the uterus, “don’t tend to cause any bleeding problems.”
It’s also important to mention that pedunculated fibroids, which “are formed on a stalk and can hang off the uterus,” aren’t the type of growths that cause heavy bleeding. “But they can cause significant pain,” says Dr. Werbin-Silver. So even if you’re not experiencing heavy periods, don’t dismiss these types of fibroids, either.
Speaking from her own experience, King advises patients to “monitor your fibroids,” because, echoing Dr. Werbin-Silver, “it’s not necessarily the size that matters, but the location as well.” King goes on to say that the locations of where the fibroids were in her uterus directly “affected my fertility,” not to mention the heavy bleeding became more than simply a nuisance: “I was so tired because I was losing so much blood.” Although King’s OB/GYN confirmed her fibroids, it was only upon the recommendation of King’s fertility doctor that she ended up having her fibroids removed because they were preventing her from getting pregnant: “He did an ultrasound and confirmed that because of [the fibroids’] location, even though they were small, they would prevent the implantation of an embryo, and therefore I would likely not get pregnant.”
Treatment options for fibroids
Naturally, heavy menstrual bleeding shouldn’t be ignored, but, according to Dr. Werbin-Silver treatment is on a case-by-case basis. As previously mentioned, “It depends on the location,” she says. “Sometimes you don’t have to do anything. Sometimes it’s just managing the blood flow and making sure somebody’s not anemic.”
But, “You can manage the bleeding,” she continues. “You can sometimes give medication injections that will help stop the bleeding. And, depending on the size and location of the fibroids, you can use progesterone or IUDs, but they’re obstructive.” If your menstrual bleeding is affecting your day-to-day life, it’s crucial to discuss these options with your OB/GYN or fertility specialist to ensure you have a treatment plan that works best for you.
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It’s Fibroids Awareness Month: What should people know?
Dr. Werbin-Silver says “early diagnosis” of fibroids is of utmost importance, “for a lot of different reasons.” Beyond fertility and heavy bleeding, “some women will have bladder issues and bowel issues.” Depending on the location and size of the growth, certain fibroids “can cause frequent urination and compression, pelvic pain, painful intercourse, as well as pressure and bloating sensations.”
Early detection is also imperative for women of childbearing age, because, as King can attest, fibroids can have a major impact on one’s fertility. “Some women will have difficulty getting pregnant because if the embryo implants on a fibroid, it will likely end in a miscarriage,” says Dr. Werbin-Silver. “If you’re studded with fibroids on the inside, in those situations, we would consider taking [the fibroids] out.”
Whether you’re suffering from heavy menstrual bleeding, dealing with fertility issues – or both – King encourages patients to “advocate for [themselves]. Listen to your body and intuition, and always get a second opinion.” Fibroids are no different than any other medical issues, which means “people need to be educated on their specific case, and what makes the most sense as it relates to their future, fertility, and getting pregnant.”
So if you’re suddenly experiencing heavy menstrual bleeding, don’t hesitate to speak to your OB/GYN or fertility specialist – especially if you’re planning to start a family. The sooner you’re aware of potential fibroids, the more quickly a treatment plan can be put into place.
Sarene Leeds holds an M.S. in Professional Writing from NYU, and is a seasoned journalist, having written and reported on subjects ranging from TV and pop culture to health, wellness, and parenting over the course of her career. Her work has appeared in Rolling Stone, The Wall Street Journal, Vulture, SheKnows, and numerous other outlets. A staunch mental health advocate, Sarene also hosts the podcast “Emotional Abuse Is Real.” Visit her website here, or follow her on Instagram or Twitter.