"I Have Uterine Fibroids. What Should I Do?"
Could knowing the size and exact location of fibroids change everything about your treatment plan?
By their 50th birthday, 70% of white women and 80% of Black women will have been diagnosed with uterine fibroids. But despite affecting millions of women, fibroids remain ridiculously overlooked.
Uterine Fibroids 101
- The What: Uterine fibroids are non-cancerous tumors made up of muscle and connective tissue. They develop in or around the uterine wall.
Uterine fibroids can be tiny (like a seed) or huge (like a pomegranate). Some women have just one. But others? They can have several. About 50% never notice symptoms, while the rest may experience:
- Symptoms: Pelvic pressure, pain with sex, peeing frequently, heavy periods, back and leg pain, or abdominal enlargement.
“What causes fibroids?” We’re not 100% sure. But we do know that genetics and hormones play a role. This is likely why fibroids appear during our reproductive years and shrink about 30% after menopause, when estrogen and progesterone levels drop. (That’s one plus!)
But fibroids will rarely totally disappear. And that reality makes your treatment options nuanced.
How to Treat Uterine Fibroids
The right treatment depends on your situation. Do you want kids? Done with that chapter? Just want the bleeding or pain to stop? Your answer will determine your treatment plan (along with the size, number, and location of your fibroids).
If you are told you have fibroids, the most important questions to ask are, “Where are they located exactly?” and “How large are they exactly?” The size number should be given in centimeters, not fruit-analogy.
Think of treatment as a spectrum, from medication to surgical procedures. Here’s how a few treatment options line up:
1. Medications
- GnRH antagonists: Meds like Oriahnn and Myfembree block the hormones in your ovaries, helping shrink fibroids and reduce bleeding.
- Levonorgestrel IUD: This won’t shrink your fibroids, but it can help lighten heavy bleeding. Bonus: it works for years once inserted.
- Tranexamic Acid: A non-hormonal option that helps your blood clot faster, and you only take it when you’re actually bleeding heavily. (Read: no daily pills required.)
2. Minimally Invasive Procedures
These can give you great results without major surgery. Think uterine artery embolization (cutting off blood supply to the fibroids) or radiofrequency ablation (using heat to destroy fibroid tissue).
These are performed by interventional radiologists not gynecologists and sadly, many Gyn’s may not even inform their patients of these options since they don’t offer them personally.
- Cons: These procedures may require repeat treatment and could impact fertility in pre‑menopausal women.
3. Surgery.
If you’re done having kids, a hysterectomy could be an option. It ends your fibroid problems forever, but obviously also ends your ability to get pregnant.
There are multiple types and routes of hysterectomy (open, laparoscopic, robotic, vaginal) so make sure to ask your Gyn about all of them, including the ones that she/he may not perform. You may want to be referred to another Gyn surgeon who DOES perform all routes of hysterectomy.
If that’s not something you’re comfortable with, a myomectomy surgically removes the fibroids while preserving the uterus. Some fibroids can be removed hysteroscopically, through the cervix/vagina, in a same-day surgical procedure. This is often a great treatment for small fibroids located on the inside of the endometrial cavity that cause heavy bleeding.
What This Means For You
No two fibroid stories are the same. If your symptoms are mild, waiting to see if symptoms develop is a valid option. As I like to say, if it’s not bothering you, you don’t have to bother it! Often fibroids will ‘shrink’ approximately 30% after menopause and thus, the symptoms they cause may diminish significantly.
But if your fibroids cause post-menopause bleeding, that’s not a “wait and see” situation. The American College of Obstetricians and Gynecologists suggests you get medical attention immediately.
Whatever your situation, remember you have options. Don't let anyone convince you that suffering through symptoms is just part of being a woman. It's not.
