In-depth Responses to Common Uterine Fibroid Inquiries, as Provided by a Specialist
Uterine Fibroids Prevalence and Management: Q&A With Dr. Seine Chiang
Uterine fibroids, benign tumors that form in the uterus, often quietly persist, often unnoticed, but affecting a significant portion of the population. According to a study, 70 percent of white women and 80 percent of Black women are diagnosed with fibroids by age 50. Around 30 percent of these cases require treatment due to severe symptoms.
Located within or on the uterine wall, fibroids are non-cancerous growths made up of muscle and connective tissue cells. Treatment options, including surgical and non-surgical methods, may be administered to alleviate discomfort and manage symptoms. However, should you be concerned if diagnosed with fibroids and consider removal? Dr. Seine Chiang, gynecologist at UW Medicine, specializing in minimally invasive gynecologic surgery and the treatment of uterine fibroids, provides answers to common questions.
Causes
While the exact cause of uterine fibroids remains undetermined, there are several factors associated with their formation, including hormones, genetics, and environmental factors. Hormones such as estrogen and progesterone contribute to their growth; however, treatments aimed at suppressing these hormones can decrease their size and alleviate symptoms.
Studies have indicated that Black individuals experience earlier onset of fibroids with higher disease burden than white individuals. One study suggests that the prevalence of fibroids is three times greater in Black individuals and two times greater in Asian-Chinese individuals compared to white and Hispanic individuals.
Possible contributors to the increased prevalence among Black individuals include genetic mutations, epigenetic differences, and genetic markers associated with early menarche and higher fibroid risk. Biological and reproductive factors, such as age at menarche, nulliparity, increasing age, higher body mass index, and a history of hypertension are also potentially factors.
Symptoms
Many individuals with fibroids may experience no symptoms or only vague symptoms due to the slow growth of the tumors. The rate of growth, location, and overall size of the uterus can influence symptoms and their severity.
Large uterine fibroids can lead to noticeable symptoms such as pelvic pressure, pain during intercourse, frequent urination, and an enlarged abdomen. Fibroids within the uterine cavity can affect menstruation, causing heavier and longer periods or more frequent periods, even without an enlarged uterus.
Fibroids can also cause anemia due to blood loss. Diagnosis of anemia can often occur through blood tests as it does not always cause recognizable symptoms. In cases of excessive bleeding during menstruation, this may constitute a medical emergency requiring immediate intervention.
Diagnosis
Uterine fibroids can often be detected during a pelvic exam, by feeling a palpable, enlarged uterus. They can also be incidentally discovered through an ultrasound or CT scan performed for other health conditions or purposes.
Individuals with symptoms suggestive of fibroids should receive an abdominal and pelvic exam, followed by a pelvic ultrasound. Further tests, such as imaging studies or genetic testing, may be considered according to the ultrasound's results, symptoms, and management goals.
Long-term Management
It is essential to consult with a healthcare provider periodically for the evaluation of fibroids, fertility plans, assessment of fibroid size, and reevaluation of treatment options. Untreated fibroids can grow over time, and small, fibroids not causing enlargement may not cause symptoms unless they are in or near the uterine cavity.
Treatment options include myomectomy, a less invasive surgical procedure that removes the fibroids while preserving the uterus and maintaining future fertility options. Other treatment procedures, such as uterine fibroid embolization and radiofrequency thermal ablation, may also be considered. The only definitive cure for fibroids is surgery to remove the uterus or hysterectomy.
Medical treatment options for targeting specific symptoms include nonsteroidal anti-inflammatory medications, tranexamic acid, birth control pills, hormonal IUDs, progesterone pills, and hormonal medications to slow heavy menstrual bleeding and decrease blood loss. Some medications can shrink the fibroids but may have side effects mimicking menopause.
Fibroid development can affect fertility and pregnancy outcomes. Consulting with a physician is essential to determine the risks and available treatment options for individuals seeking to conceive. Regular monitoring for symptoms and managing anemia and low iron levels can help keep potential complications at bay and aid in maintaining overall health.
- As recent news in the health-and-wellness sector reveals, uterine fibroids, despite being benign, are a significant concern, particularly among women of color, with studies showing that Black individuals experience earlier onset and higher disease burden than white individuals due to factors such as genetics, epigenetics, and environmental factors.
- In the realm of science, research indicates that aging may intensify the symptoms of uterine fibroids, making long-term management essential. This includes regular monitoring, various treatment options like myomectomy or hysterectomy, and managing anemia associated with excessive bleeding, to maintain overall health-and-wellness and ensure the best possible outcomes for women's health.
