Uterine fibroids

Many women have no symptoms of fibroids. However, sometimes uterine fibroids can be associated with the following signs and symptoms:

• Painful periods or heavy bleeding
• Menstrual periods lasting more than a week
• Long-term vaginal discharge
• Frequent urination (this can occur when a fibroid puts pressure on the bladder)
• Inability to urinate or completely empty the bladder
• Anemia
• Constipation
• Lower back pain
• Enlargement of the lower abdomen
• Feeling of fullness in the lower abdomen
• Reproductive issues, such as infertility, multiple miscarriages, and early onset of labor during pregnancy
• Complications during pregnancy, which increase the chances of cesarean (C-section) by multiple folds

The exact causes of fibroids are not known. Research suggests that fibroids develop from abnormal muscle cells in the uterus. High estrogen levels lead to fibroid development and growth, while low progesterone levels are unable to inhibit their growth.

Fibroids usually grow in women during childbearing age, and research suggests that they may shrink after menopause. Several factors may affect a woman’s risk for having uterine fibroids, including the following:

• Age: Fibroid development becomes more common as women age, especially during their 30s and 40s.
• Family history: Women with a family history of uterine fibroids have a higher risk of developing them.
• Age of menarche (first period): Research suggests that women who start menstruation earlier are at a greater risk for uterine fibroids due to increased exposure to estrogen over the years.
• Obesity: Increased body fat, especially abdominal visceral fat, enhances the risk of uterine fibroids. Women who are overweight or obese are at higher risk.
• Vitamin D deficiency: Research has shown that vitamin D deficiency is an important risk factor for uterine fibroids.
• Diet: Certain eating habits, including consuming lots of red meat and alcohol, as well as not including fruits and green vegetables in the daily routine, can increase the risk of fibroids.
• Stress: Stress is the body’s biochemical response to life challenges. To handle stress, the body produces extra hormones, which can stimulate fibroid growth and exacerbate symptoms.
• Food additive consumption: Food preservatives like butylated hydroxytoluene (BHT), commonly found in packet cake mixes, potato chips, salted peanuts, and dehydrated mashed potatoes, may contribute to the proliferation of uterine fibroids.
• Soybean milk: Soybean milk is rich in estrogen-like substances, which may promote fibroid growth if estrogen levels are too high.
• Oral contraceptives: Long-term use of oral contraceptives may increase the risk of uterine fibroids.
• Alcohol intake: Drinking alcohol can increase the severity and duration of common fibroid symptoms. Many women report increased fibroid pain after consuming alcohol due to increased inflammation and dehydration.
• High blood pressure (Hypertension): While hypertension does not directly cause fibroids, some researchers suggest that certain anti-hypertensive medications may elevate hormone levels that promote fibroid growth. Elevated blood pressure may also contribute to the wear and tear of smooth muscle, increasing the risk of fibroid onset or growth.

Many women with uterine fibroids are often unaware of their condition until symptoms arise. Uterine fibroids are frequently discovered incidentally during routine pelvic examinations. During these exams, a medical practitioner may detect irregularities in the shape of the uterus, indicating the possible presence of fibroids.

Medical History

• During the medical history assessment, clinicians typically inquire about the patient's age and the onset of menstruation (menarche).
• The doctor will also investigate any family history of fibroids.

Laboratory Tests

• Complete Blood Count (CBC): This test may be recommended in cases of abnormal menstrual bleeding or to explore other potential causes. In cases of heavy menstrual bleeding, a CBC can assist in checking for anemia.

Note: Uterine fibroids can cause heavy menstrual bleeding, leading to anemia. A study has reported a case series of life-threatening anemia with hemoglobin levels <2.0 g/dl caused by uterine fibroids and genital bleeding.

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Imaging Tests

• Ultrasonography: A noninvasive imaging test that uses sound waves to create images of internal organs. It helps visualize the uterus and detect the presence of fibroids. Depending on the size of the uterus, the ultrasound can be performed in two ways:
  • Transvaginal: This test examines the uterus, ovaries, tubes, cervix, and pelvic area.
  • Transabdominal: This test visualizes the liver, gallbladder, kidneys, pancreas, intestine, bladder, uterus, and stomach.
• Magnetic Resonance Imaging (MRI): A noninvasive test that produces detailed images of internal organs using magnets and radio waves. It is useful for visualizing the size and location of fibroids, identifying different types of tumors, and exploring treatment options.
• Computed Tomography (CT) Scan: An imaging procedure that combines X-rays and computer technology to create images of the inside of the body.
• Hysteroscopy: A procedure that examines the inside of the uterus using a hysteroscope, a narrow telescope with a light and camera. It is inserted through the cervix into the uterus to visualize fibroids within the uterine walls and the openings of the fallopian tubes.
• Hysterosonography: Also known as sonohysterography or saline infusion sonogram, this test uses sterile salt water to expand the uterine cavity. It employs sound waves to produce images of the inside of the uterus, aiding in the visualization of fibroids and the uterine lining.
• Hysterosalpingography (HSG): An X-ray test where contrast material is injected, followed by X-rays of the uterus. HSG helps determine if the fallopian tubes are open or blocked and if submucosal fibroids are present.
• Laparoscopy: Also known as keyhole surgery or minimally invasive surgery, this procedure allows the surgeon to visualize the inside of the abdomen and pelvis without large incisions. A thin, flexible tube with a camera is inserted to closely examine internal organs through a small incision in the lower abdomen.

Uterine fibroids can’t be prevented. However, the risk can be reduced by making healthy lifestyle choices and undergoing regular pelvic examinations.

The following pointers can be helpful in reducing the risk of uterine fibroids:

Do’s

• Monitor your menstrual cycle (duration and frequency)
• Go for regular screening in case of a family history of uterine fibroids
• Maintain a healthy weight
• Add whole grains, vegetables, and fruits to your diet
• Maintain optimum Vitamin D levels by basking in the morning sun and, if required, adding supplementation
• Drink plenty of water to flush out toxins

Don'ts

• Avoid eating too much red meat, processed, and packaged foods
• Steer clear of foods or drinks loaded with additives
• Minimize stress in day-to-day life
• Limit alcohol consumption

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There's no single best approach to uterine fibroid treatment; a combination of different treatment options exists. Treatment for uterine fibroids can involve medication to manage symptoms as well as surgical procedures to remove tumors in a few cases. The best treatment option depends upon:

• The severity of the symptoms
• The amount of fibroid tissue in the uterus
• Whether the individual wants to conceive in the future

1. Be watchful of the symptoms

Many women with uterine fibroids experience no signs or symptoms, or only mild signs and symptoms that they can live with. In that case, watchful waiting could be the best option. The treatment plan depends on the following options:

• Number of fibroids
• Size of the fibroids
• Location of fibroids
• Symptoms you are experiencing related to the fibroids
• Desire for pregnancy
• Desire for uterine preservation

2. Medications

Medications for uterine fibroids target hormones that regulate your menstrual cycle and help in treating symptoms such as heavy menstrual bleeding and pelvic pressure. Medications can temporarily ease symptoms but will not eradicate the growth of fibroids. Medicines to manage fibroid symptoms include:

• Gonadotropin-releasing hormone (GnRH) agonists: These medications act by blocking the production of estrogen and progesterone, putting the individual into a temporary menopause-like state. As a result, menstruation stops and fibroids shrink in size. Examples include:
  • Leuprolide
  • Buserelin
  • Triptorelin
  • Nafarelin

Note: These medications are not used for more than 3-6 months because symptoms return when the medication is stopped, and long-term use can cause loss of bone.

• Birth control: Also known as hormonal birth control, can help alleviate fibroid symptoms like heavy bleeding and menstrual pain but does not reduce the size of fibroids. Examples of birth control options include:
  • Low-dose oral contraceptive pills
  • Intravaginal contraception

• Progestin-releasing agents: Pills, implant, injection, or intrauterine devices (IUD) release a type of hormone called progestin. This may help relieve heavy bleeding caused by fibroids. This method only provides symptomatic relief and doesn't shrink fibroids or make them disappear.

• New drugs: Two new oral therapy drugs have emerged:
  • Elagolix
  • Tranexamic acid

The role of elagolix is the management of heavy uterine bleeding in people who haven't experienced menopause with symptomatic uterine fibroids. The role of tranexamic acid is as an antifibrinolytic drug used for the treatment of cyclic heavy menstrual bleeding in people with uterine fibroids.

• Analgesics and anti-inflammatory drugs: Pain relievers known as nonsteroidal anti-inflammatory drugs may be prescribed to ease pain caused by fibroids. Examples include:
  • Ibuprofen
  • Naproxen

• Iron supplements: If a woman is experiencing anemia due to heavy blood loss, doctors may recommend iron supplements. Examples include:
  • Ferrous bisglycinate
  • Ferrous fumarate
  • Ferrous sulfate

3. Surgery

There are several factors to consider when opting for different types of surgery for fibroid removal. The choice of surgery is dependent not only on the size, location, and number of fibroids but also on future pregnancies. Some surgeries are noninvasive, some are minimally invasive, while few are conventional surgical procedures.

Non-invasive surgeries

• MRI-guided focused ultrasound surgery (FUS): A non-invasive procedure that helps preserve the uterus and requires no incision. High-intensity focused ultrasound waves are used to heat and destroy fibroid tissue.

Note: This procedure is performed while a person is inside an MRI scanner equipped with a high-energy ultrasound transducer for treatment.

Minimally invasive surgeries

• Radiofrequency ablation (RFA): In this procedure, radiofrequency energy destroys uterine fibroids and shrinks the blood vessels that feed them. It is a laparoscopic-guided procedure where laparoscopic ultrasound helps visualize the inside of the uterus and map the locations of fibroids. After locating the fibroid, the doctor uses a specialized device to heat the fibrous tissue and destroy it.

Note: This procedure is considered a safer, newer, and noninvasive alternative to hysterectomy and myomectomy.

• Uterine artery embolization (UAE): A procedure that treats fibroids without surgery by injecting tiny particles into the blood vessels that lead to the uterus, cutting off the blood flow to the fibroid and causing it to shrink.

• Hysteroscopic myomectomy: The most minimally invasive procedure to treat fibroids, where fibroids are removed through a hysteroscope inserted into the uterine cavity through the cervix and vagina.

• Robotic myomectomy: A type of laparoscopic myomectomy, where a small incision is made in or near the belly button to remove uterine fibroids. Larger fibroids can be removed through smaller incisions by breaking them into pieces through a process called morcellation.

Note: In all the above procedures, since the uterus is not removed, there is a risk that new fibroids could grow and cause symptoms.

Conventional surgical procedures

• Abdominal myomectomy: Used in cases of multiple or very deep fibroids, this open abdominal surgical procedure removes the fibroids while leaving the uterus intact. It involves making an incision through the skin on the lower abdomen to remove the fibroids from the wall of the uterus.

• Hysterectomy: For women with severe symptoms or intense fibroid growth, a hysterectomy involves removing the entire uterus. After this procedure, a woman does not have a menstrual period and cannot become pregnant.

Home care goes hand in hand with the conventional treatment of fibroids. The following pointers can be helpful in managing uterine fibroids:

Diet

Research suggests that diets high in the following may be helpful to prevent or slow fibroid growth:

• Fibrous fruits: Fruits enriched in dietary fibers and fluid content are beneficial for managing uterine fibroids. The fiber helps eliminate toxins and excess estrogen from the body. Include apples, bananas, raspberries, strawberries, blueberries, apricots, and pineapple in your diet for their anti-inflammatory properties.
• Whole grains: Grains help release excess estrogen from the body. Oats, brown rice, barley, and quinoa have healing effects that support uterine health.
• Eggs: Rich in proteins and omega-3 fatty acids, consuming 1-2 eggs daily promotes good uterine health and contributes positively to the condition of uterine fibroids.
• Green tea: Green tea contains bioflavonoids and epigallocatechin-3-gallate (EGCG). Studies indicate that the bioflavonoid in green tea may help reduce the size and number of fibroids in the uterus.

Special Ingredients

The following natural ingredients are known to benefit female reproductive health, including the management of uterine fibroids. Consult your doctor before consuming them:

• Chasteberry tincture: Also known as Vitex, chasteberry is effective for heavy menstrual flow, cramps, and other symptoms of uterine fibroids. Taking 20-30 drops of chasteberry tincture twice daily for about two months can shrink small to medium-sized uterine fibroids.
• Black Cohosh: Studies indicate that black cohosh can help address gynecological problems by lowering estrogen levels and increasing progesterone levels, thereby reducing and shrinking fibroids. Black Cohosh root powder can be consumed daily in tea or tablet form for natural fibroid management.

Exercise

Regular exercise helps eliminate toxins from the uterus and is effective in shrinking fibroids. However, avoid workouts that may worsen symptoms, such as:

• Avoiding heavy lifting, as this can increase blood flow to the abdomen and lower body, potentially increasing fibroid blood supply.
• Engaging in cardiovascular exercises like walking, jogging, or swimming is beneficial. Cardio exercises help manage weight and improve overall well-being.

Did you know? A recent study has shown that women with fibroids are more likely to have cardiovascular risk factors than women without fibroids. Therefore, it is crucial to boost heart health through cardiovascular exercise when you have fibroids.

Most women do not experience any symptoms of fibroids, but in rare cases, the fibroids can cause significant problems.

• Anemia: Also known as a lack of red blood cells, which can lead to fatigue, dizziness, shortness of breath, or a rapid heartbeat if left untreated.
• Issues during Pregnancy: If fibroids are present at the time of pregnancy, they can lead to problems with the development of the baby or difficulties during labor.
• Miscarriage: In rare cases, fibroids can cause miscarriage (the loss of a pregnancy during the first 23 weeks).
• Infertility: The inability to become pregnant may occur in cases where a woman has large fibroids.
• Cardiovascular Diseases: Women with fibroids may have thicker arteries, increasing the risk of cardiovascular diseases such as heart attack and stroke.

Acupuncture

This procedure involves the insertion of very thin needles through your skin at strategic points on the body. It is beneficial in promoting blood flow in the uterus and helping to reduce fibroid sizes.

Yoga

Yoga has an amazing remedial effect on uterine fibroids. The following yoga asanas are highly recommended for uterine fibroids:

• Bhujangasana (Cobra Pose)
• Paschimottanasana (Seated Forward Bend)
• Baddha Konasana (Bound Angle Pose)

Uterine fibroids are benign noncancerous growths in the uterus that can cause frustrating symptoms like heavy bleeding and pain. These symptoms can affect the quality of life as well as mental health. Some tips that can help in managing the symptoms of uterine fibroids in women include:

Handle Heavy Menstrual Flow and Its Effects

One of the hallmarks of uterine fibroids is heavy menstrual bleeding. High blood loss each month can deplete the body’s iron stores over time. Low iron can lead to iron-deficiency anemia, which causes weakness, tiredness, and affects the oxygen supply to the vital organs.

If a woman is experiencing heavy periods, it is important to get regular blood tests to ensure that iron levels are within healthy limits. In the case of low levels, iron supplements are recommended.

Relieve Pelvic Pain

If someone is facing mild mental health symptoms, some strategies that can help in coping with the effects include:

• Engaging in regular exercise to help reduce stress and combat mild or moderate depression.
• Prioritizing sleep and aiming for at least 7-8 hours of rest each night.
• Avoiding or limiting the intake of caffeine from coffee, tea, and energy drinks, as these can exacerbate anxiety symptoms.
• Incorporating foods into the diet that are high in omega-3 fats and vitamin B complex to help reduce stress and anxiety.

Seek Medical Help

Keep a close eye on your health and menstrual cycle. Seek medical help if you experience symptoms such as:

• Bleeding between periods
• Pain during urination
• Signs of anemia

Here are a few signs of anemia that you might be ignoring: