Q: Does a woman in her 40s with large fibroids causing heavy periods always have to have a hysterectomy?

Uterine fibroids are non-cancerous growths that form in or on the uterus. Fibroids occur in approximately 75% of women by age 45; up to 50% of women who have fibroids report no symptoms. The growth of fibroids is stimulated by oestrogen so they generally grow during the childbearing years and shrink after menopause. A hysterectomy is a surgical procedure that removes all or part of the uterus. A myomectomy is the surgical removal of the fibroids while leaving the uterus intact.

Women with fibroids can experience:

Heavy periods

Periods lasting > 7 days

Painful periods

Abdominal distention

Urinary frequency/ urgency

Difficulty urinating

Constipation

Lower back/ leg discomfort

Painful intercourse

Fullness or pressure in the lower abdomen

Anemia

Reduced fertility

Pregnancy complications

Women at greatest risk for the development of fibroids:

Having high levels of circulating oestrogen and progesterone
Pregnant

30 or older

Black women

Overweight

Family history of fibroids

Vitamin D deficiency

Women using hair straightening creams and lotions

Diagnosis made by:

Doctor conducting a pelvic exam

Ultrasound

Psychosocial consequences of fibroids:

Missing work/ loss of job

Relationship issues

Social and physical isolation

Depression

Anxiety

Treatment

Treatment of symptomatic fibroids depends on the patient’s:

Desire for children

Wishes re preserving the uterus

Proximity to menopause If the patient is pre-menopausal a “wait-and-see” approach is often adopted; for once the patient enters menopause the fibroids often cease to be significantly symptomatic.

Treatment can be considered under 4 headings:

Pharmacological

Dietary/ lifestyle

Minimally invasive procedures

Surgical

Pharmacological

Medicines that reduce hormone levels may be prescribed to shrink fibroids. Gonadotropin-releasing hormone (GnRH) agonists can be given intramuscularly, subcutaneously, or as an intranasal spray. These induce a reversible menopause-like state by indirectly reducing circulating estrogens and progesterone. Ultimately the periods stop and the fibroids shrink.

Other pharmaceutical options that can help control bleeding and pain, but won’t shrink fibroids, include:

Progesterone impregnated intrauterine device

Nonsteroidal anti-inflammatory medications

Oral contraceptives pills

Tranexamic acid

Dietary/ Lifestyle

Eat lots of fresh and cooked vegetables, fresh fruit, legumes, and fish

Reduce alcohol consumption

Beware of your intake of phytoestrogens – e.g. soy products, black bean sauce, flaxseeds, tofu, wild yam

Stop using hair straighteners

Ensure adequate Vitamin D intake (via sunshine exposure, or supplements)

Minimally invasive interventions

Endometrial ablation – The uterus’ lining is destroyed by way of heat, electric current, or extreme cold.

Uterine Artery Embolization (UAE) – A catheter is inserted by an interventional radiologist into the artery supplying the fibroids and pellets are released into the artery thereby cutting off the blood supply to the fibroids.

Forced Ultrasound Surgery (FUS) – The inside of the uterus is visualized via MRI and high-energy ultrasound waves are directed at the fibroids, destroying them in the process.

Surgery

Generally reserved for women with:

Rapidly enlarging fibroids

Heavy periods refractory to non-surgical therapy

Severe or persistent pain and discomfort

An extremely large uterus

Pregnancy no longer desired

Author: Dr. C. Malcolm Grant – Family Physician, c/o Family Care Clinic, Arnos Vale, www.familycaresvg.com, clinic@familycaresvg.com, 1(784)570-9300 (Office), 1(784)455-0376 (WhatsApp)
Disclaimer: The information provided in the above article is for educational purposes only and does not substitute for professional medical advice. Please consult a medical professional or healthcare provider if you are seeking medical advice, diagnoses, or treatment. Dr. C. Malcolm Grant, Family Care Clinic or The Searchlight Newspaper or their associates, respectively, are not liable for risks or issues associated with using or acting upon the information provided above.