According to a number of reputable studies, up to 80 percent of women will develop uterine fibroids by the age of 50. Some researchers have also studied the link between the growth of uterine fibroids and certain risk factors, such as heritage, ethnicity, family history and other features. Therefore, it is extremely important for women to know about this complex condition and how to carry out a healthy and high-quality lifestyle, in case of their development. It is also important for women to follow the updated research, as it is a quickly evolving field of medicine and the more women are informed, the more empowered they can be to better manage their condition.
One of the most important facts to remember is that uterine fibroids are non-cancerous tumors. They are not life-threatening and many women experience no symptoms at all. However, if you are one of the 25% to 50% of women who experiences symptoms, it’s also important to consider all the available treatment options and, with your doctor, choose the one that’s best for you.
Uterine fibroids Overview: Characteristics, Symptoms, and Diagnosis
Uterine fibroids develop in and around the uterus and are mainly made of muscular and connective tissues. Women can have a single fibroid or multiple fibroids and they can range in size (from 1 mm up to 40 cm), shape, and location within and around the uterine wall. In most cases, this condition is affected by the production of (and sensibility to) hormones in the body. Specifically, too much estrogen and progesterone, hormones which are responsible for a number of bodily functions and help thicken the lining of the uterus during the menstrual cycle, might influence the growth of uterine fibroids.
Despite the fact that fibroids are benign (non-cancerous), they can still strongly impact a woman’s life, since symptoms can range from simply bothersome to debilitating.
The main symptoms that might be experienced with uterine fibroids include the following:
- Heavy or long periods
- Pelvic pressure and pain
- Pain during intercourse
- Bleeding in between periods
- Low back pain
- Low chances of getting pregnant
According to studies, these symptoms may be influenced by the size, location, and number of fibroids, but symptoms vary greatly from woman to woman.
Because of their uncertain causes and symptoms, which often overlap with other conditions such as endometriosis, it may be difficult to quickly diagnose uterine fibroids. Often, they are diagnosed coincidentally, when a woman is treated for other conditions.
However, researchers have agreed that a number of tests are useful in effectively diagnosing the presence of uterine fibroids. These tests often include the following:
- Lab tests – Some of these diagnostic panels, such as a complete blood count, can help understand if you have related conditions, such as anemia, which can occur if you have heavy bleeding associated with fibroids.
- Ultrasound – This is a very common gynecological assessment, during which a small device is used to evaluate vaginal or abdominal tissue for any abnormalities. Ultrasound machines use sound waves to get a picture of your uterus to confirm the diagnosis and measure the size and location of fibroids.
- Hysterosalpingography (HSG) – A radiologic procedure to investigate the shape of the uterine cavity and fallopian tubes, this may help medical professionals clearly visualize the presence of uterine fibroids, especially in the case of blocked fallopian tubes.
- Hysteroscopy – Often used to diagnose causes for abnormal uterine bleeding, during this procedure saline solution is injected into the uterus which allows a clear view of the uterus lining, using a small telescope.
- Hysterosonography – Similar to hysteroscopy, saline is injected into the uterine cavity. However, instead of visualizing the uterine wall with a small telescope, sound waves are used to create a clear image.
- Magnetic resonance imaging (MRI) – This kind of test might be more detailed, since it gives more realistic images of your uterus. This procedure is often advised when you have a large uterus or you are close to menopause.
Uterine fibroids treatments: which one is the best for you
As stated previously, the number, size, location, and associated symptoms of uterine fibroids vary greatly from woman to woman. Therefore, it’s not possible to take a “one-size-fits-all” approach. There are many kinds of treatments that doctors might propose, depending on your individual case and medical history.
There are four main categories of treatment for uterine fibroids, which can be classified based on their intensity and level of invasiveness:
- Pharmacological medications (prescription medications)
- Non-invasive / minimally invasive interventions
- Traditional surgery
- Alternative therapy
The first option that might be taken into account are medications, in particular those that can regulate your menstrual cycle and, as a consequence, also lighten or completely treat some of the symptoms caused by uterine fibroids. The most commonly prescribed options include the following:
- Gonadotropin-releasing hormone (GnRH) agonists – These medications put women into a temporary state of menopause, by blocking the production of estrogens and progesterones. This generally causes fibroids to stabilize or shrink in size and many symptoms are reduced. However, they should not be used for more than six months, because their long-term use can cause severe side effects such as bone loss, though some side effects can be ameliorated by using “hormone add-back therapy”. They often used as a treatment just prior to surgery, in order to make uterine fibroids more easily operable. GnRH agonists can also be used in the perimenopausal period to reduce symptoms as you transition into menopause. Remember, most fibroids stabilize and/or reduce in size on their own once a woman reaches menopause, due to the reduction in hormone production.
- Progesterone / Progestogens – Progesterone is a natural hormone, while progestin is a synthetic progestogen that can be administered orally, vaginally or by intramuscular injection. Progestogens have been used all over the world for many years in the management of uterine fibroids, despite the lack of evidence and absence of adequately designed and powered studies, so efficacy remains somewhat unknown.
- Progestin-releasing intrauterine devices (IUD) – This type of contraceptive medication is widely used because it can reduce heavy bleeding and pain caused by fibroids, directly within the uterine environment. However, studies are inconclusive about whether they can reduce the size and volume of fibroids, and the expulsion rate of IUDs is higher in women with uterine fibroids versus those without.
- Tranexamic acid (LYSTEDA) – This is a non-hormonal medication which is used to reduce heavy bleeding, especially during the menstrual cycle. It is recommended to be taken for no more than 5 days per month. It has also been shown to reduce bleeding associated with myomectomy surgery and side effects are generally mild. However, women who have a history of blood clots should not take it.
If medications aren’t enough, doctors might recommend more aggressive treatment, including non-invasive and minimally invasive procedures. The main options are as follows:
- Magnetic resonance-guided focused ultrasound surgery (MRgFUS) – This is a minimally invasive treatment which has been developed with patient safety in mind. In fact, studies have shown there are minimal associated risks as compared to myomectomy and hysterectomy. The procedure is performed with an MRI scanner, which creates detailed images of your uterine wall and then uses sound wave technology to heat and destroy the fibroids.
- Radiofrequency ablation – Very similar to MRgFUS, the procedure entails the use of radiofrequency energy, which destroys the uterine fibroids and shrinks blood vessels which provide essential nutrients for uterine growth. This surgery can be performed in two ways: using a laparoscopic or transvaginal approach. The first option requires some incisions in the abdomen, so that a small camera can detect the fibroids. The transvaginal option uses ultrasound guidance to identify the fibroids. In both options, tiny instruments are used to heat and destroy the fibroid tissue using radiofrequency, laser, or microwave energy.
- Endometrial ablation – This intervention also uses heat, but instead of destroying individual fibroids, it targets the lining of your uterus. It works best for women with small fibroids located on the inside wall (submucosal) of the uterus. Again, while it doesn’t destroy the fibroids themselves, it does help reduce heavy bleeding. Women who wish to become pregnant should not undergo this technique.
- Uterine fibroid embolization (UFE) – This minimally invasive procedure uses fluoroscopy, which is like an x-ray movie, and a catheter which allow the interventional radiologist to guide embolic agents into the arteries that feed blood to the problematic fibroids. These agents block blood flow to the fibroids, resulting in fibroid shrinkage due to lack of blood supply.
If you have larger fibroids or your symptoms are very severe, your doctor may recommend a more traditional surgical approach to remove your fibroids. There are two main options, but there are different approaches associated with each type of surgery.
- Myomectomy: This traditional surgical technique to remove uterine fibroids can be done in one of three ways and depends on your unique circumstances.
- Abdominal myomectomy: allows your surgeon to remove your fibroids through an open surgical cut in your lower belly. This is best for those with many or very large fibroids, especially if they are located within the uterine wall (intramural fibroids).
- Laparoscopic myomectomy: allows your surgeon to remove your fibroids through several small incisions. This may be done robotically. It’s less invasive than other techniques and recovery is faster than with traditional abdominal myomectomy. This is best for patients with smaller or fewer fibroids.
- Hysteroscopic myomectomy: With this technique, your surgeon uses a special scope to visualize your fibroids through your vagina and cervix. They then use a device to cut or destroy the fibroids. This is also best for women with smaller or fewer fibroids.
- Hysterectomy: The most invasive treatment for uterine fibroids, this procedure removes part or all of your uterus. Hysterectomy is the only surgery that cures uterine fibroids and fully relieves their symptoms permanently. However, women undergoing hysterectomy will no longer be able to have children, so it must be considered carefully by both the patient and surgeon. Like with myomectomy, there are three main techniques:
- Laparotomy or abdominal hysterectomy: with this option, your surgeon makes a cut in the lower abdomen and removes your uterus. Recovery takes 6 to 8 weeks.
- Vaginal hysterectomy: this technique allows the surgeon to remove your uterus through the vagina. While this approach may not work for very large fibroids, recovery time is quicker than with laparotomy.
- Laparoscopic hysterectomy: Like with other laparoscopic techniques, the surgeon inserts instruments and removes the uterus through very small incisions. This procedure can be done robotically. Due to small incision size, recovery is quicker than with traditional hysterectomy.
While myomectomy and hysterectomy are good options for many women, they are often utilized after other treatment options have failed due to the recovery time, surgical risks and, in the case of hysterectomy, permanent infertility.
Alternative treatments for uterine fibroids: oral supplementation and nutraceuticals
Over the last few years, many studies have proven the efficacy of alternative herbal and medicinal treatments for uterine fibroids. In particular, this research has demonstrated that some substances may be safely used for chronic treatment, with little to no side effects.
The main substances that have been proven to work are the following:
- Epigallocatechin gallate (EGCG)
- Vitamin D
One of the most important natural ingredients that can treat uterine fibroids is epigallocatechin gallate (EGCG), which can be found in high concentrations in green tea extract and other kinds of tea products. In particular, ECGC is a polyphenol that has many beneficial biological effects, such as anti-inflammatory, antiproliferative, and antioxidant effects. These actions not only help minimize the symptoms of uterine fibroids, they also work to reduce fibroid size and volume. In fact, recent studies have shown that after 4 months of treatment, patients experience more than a 30% reduction in fibroid volume and a 30%+ improvement in symptoms.
Vitamin D has also been proven as an effective treatment of uterine fibroids. Considered to work like a hormone, Vitamin D has many effects on cell proliferation and differentiation and has been shown to both inhibit and stabilize fibroid growth.
While many dietary supplements exist to treat fibroids and ECGC and Vitamin D have been proven to be effective when used alone, studies have proven enhanced efficacy when used in combination. The specific combination of EGCG (300mg), vitamin D (2,000 IU) and vitamin B6 (10mg) (Delphys, Lo.Li. Pharma International) dosed twice a day for 4 months has been shown to be effective in reducing fibroid volume while improving both symptoms and overall quality of life. One study even showed that this combination was at least as effective as a pharmacological agent (Esmya®, ulipristal acetate, Gideon Richter) when comparing symptom severity and quality of life.
Like with any treatment, it is essential for patients and doctors to fully evaluate a woman’s unique set of circumstances, including her desire to have children or not before choosing the best one. While many of the most common uterine fibroid management options are listed in this article, it’s also important to consider that new alternatives are becoming available on a regular basis, so your choices may differ compared to the options you see here. Lastly, know that you may need to try a variety of treatments before you find the one that works best for you; so stay patient and remember, the I Don’t Wait community is here to support you along your treatment journey.