The Hard Truth: All About Fibroids

⚠️ FIBROIDS⚠️

Let’s talk fibroids my sistas.  FYI, because this affects so many black women, this is important to me, so this will be a LONG post! Hope I don’t bore ya!

Fibroids, also known as uterine leiomyomas or myomas, are extremely hard spherical tumors of smooth muscle that can arise in the muscular layer of the uterus and/or pelvis.  They are the most common pelvic tumor in reproductive aged females and are especially prevalent in black women.  The incidence is two- to threefold greater in Black women, likely due to differences in diet, psychosocial stressors, and delayed diagnosis, all mainly secondary to systemic racism.  They typically grow in size in response to an increase estrogen hormones.  

They are noncancerous and typically do not transform into cancer, and when they do, it is ~0-1% of the time. When symptomatic, they can cause heavy & abnormal uterine bleeding, pelvic pain, pressure, infertility, and/or adverse pregnancy outcomes.  

These tumors can typically be diagnosed during a pelvic exam, can be seen and measured on ultrasound (below), or can be seen incidentally on any other imaging that you may be receiving for another medical problem.  

Tips when being diagnosed with fibroids:

1️⃣ Ask how many there are

2️⃣ Ask if they extend into the endometrium (the lining inside the uterus)

3️⃣ Ask how big they are in centimeters

4️⃣ Ask if they are on or near the cervix, bladder, and/or rectum, as this can contribute to painful sex, frequent urination, and/or constipation, respectively.   

5️⃣ If you are at a center that strictly performs imaging with no direct feedback, ask for a printout of the images for your records.  

Seek treatment if you have any of the above symptoms that cause severe debilitation, no matter the size.  Treatment is going to depend on the following things:

1️⃣ If you have symptoms or not

2️⃣ If you want children or not in the future

3️⃣ Where the fibroids are & their size

4️⃣ Your weight and overall general health

No symptoms = likely no treatment.  

If you have symptoms and don’t want any more children & are a decent weight with little to no medical problems, the answer is simple: Try to control the symptoms with hormones first, then proceed to a hysterectomy if you have persistent symptoms, or after you have lost weight and/or controlled your medical problems.  

If you want children, the situation becomes a little more sticky.  

Fibroids can present problems during conception and during pregnancy.  You should know that fibroids in most women will not impair their fertility or affect pregnancy.  For others, they can lead to infertility, recurrent miscarriages, severe pain, pressure, urinary frequency and constipation during pregnancy, and increased risks for breech presentation, preterm delivery, and hemorrhage.  Fibroids also have potential to remain the same in size, shrink, or grow in pregnancy.  This is why if your fibroids are presenting you with major problems outside of pregnancy, you may benefit from treating them prior to pregnancy.  

As you can see above, fibroids can be located in several places.  Type 0, 1, and 2 extend into the endometrial cavity.  This can cause the heaviest type of bleeding, and infertility as the fertilized egg may have a hard time finding a space to implant.  If your main struggle is infertility, you may be able to try a hysteroscopic resection of the portion of the fibroid that is protruding into the cavity and a manageable size (below).

Types 3-8 mainly include the muscular portions of the uterus.  If you have fibroids that are extremely large regardless of type/location, or are type 3-8,  you may benefit from a laparoscopic or abdominal myomectomy depending on fibroid size and surgeon experience.   If the uterine cavity is entered, there is an increased risk for uterine rupture in your pregnancy and a c-section may be necessary.  However, your fertility shouldn’t be decreased after surgery.

No matter the location, if you desire fertility, you can always opt for a uterine artery/fibroid embolization (UAE/UFE).  This procedure involves the injection of particles into the uterine artery.  The fibroids grow via the blood supply from this artery (below).  Sealing this artery will stop all oxygen and nutrients contributing to fibroid growth.  You should know however, that with this procedure, there are concerns regarding fetal growth and abnormal placentation in pregnancies following the procedure.  You may also have severe pain, fevers, and vaginal discharge after the procedure from the fibroid degenerating.  

If you aren’t friends with the idea of surgery or procedures, you may opt for oral or injectable birth control or an IUD to control the bleeding.  These birth control options work by stabilizing the lining inside the uterus and decreasing bleeding and other symptoms.  You may also consider an injection known as Depo Lupron, which essentially shuts off the ovary from making any more hormones.  If we shut down the hormones, the fibroids have a great potential to shrink in size over the course of several months.  However, with this option, menopausal symptoms like hot flashes, mood swings, and vaginal dryness, all can arise from the lack of estrogen hormones.    

All of these methods are safe in the hands of an experienced OBGYN surgeon, but none, unfortunately, will be free from consequence.  

There aren’t any evidence based guidelines regarding yoni steaming and reduction in fibroid size, as there is a lack of randomized clinical trials.  

If you are interested in trying yoni steaming, be aware of the possibility of vulvar burning and irritation and cease this if this arises.  If you are truly gung-ho on trying this & can tolerate it, I would recommend getting an ultrasound dictating the fibroid size, trying the yoni steaming, and re-measuring the fibroids in 3 months.  If no decrease in size is seen, you have your answer! Please also bear in mind that natural remedies, if tried, may not be as effective, if at all.

Here are some tips for fibroid prevention:

1️⃣ Increased fibroid risk is associated with consumption of red meats, pork, and carb-heavy meals; therefore, avoid these if you can.

2️⃣ High blood pressure also increases your risk for fibroids, so try to control this if you have hypertension.

3️⃣ Consumption of alcohol, especially beer, appears to be associated with an increased risk of developing fibroids.  So avoid the sauce ladies 😅.

4️⃣ Dietary vitamin A may also be associated with decreased fibroid risk, so consider increasing your consumption of foods rich in vitamin A.

5️⃣ There have been studies that have shown that dairy consumption reduces fibroid risk, as they contain high amounts of calcium, magnesium, and phosphorus, which all may help prevent growth of fibroids.  HOWEVER, these studies were performed during the 1990’s to early 2000’s, and were conducted from questionnaires and food diaries.  The food industry IS DIFFERENT now and there are presumably more hormones in milk now, which can lead to fibroid growth, so I would actually recommend avoiding dairy.

6️⃣ Thyroid function can affect your bleeding pattern and may contribute to fibroid growth if uncontrolled.  Seek a primary care doc or OBGYN for baseline testing or your endocrinologist if you suffer from thyroid dysfunction.  

As mentioned earlier, because fibroids grow in the presence of estrogen, fibroids are expected to shrink after menopause.  However, you may reach menopause at a later age if you continue to bleed excessively from the fibroids.  

This post will be saved on the blog for future reference if you ladies ever need it! This was a major concern for you all based off of the comments yesterday, so, let me know if you have any further questions! I’m always rooting for you! 🤗✌🏾