Dear LADYist: AAAH I Have A Fibroid — Wait, What Is That?

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If you have a uterus, chances are high you could wind up with a fibroid. Or two. Or a dozen.

These tumors can be smaller than a pea or as large as a full-term pregnancy. They can cause debilitating pain, or you might feel nothing at all.

One National Institutes of Health study found that fibroids could affect up to 80 percent of some women by the age of 50, but estimates vary. Despite the staggering number of women affected, the cause of fibroids is still unknown.

This, unsurprisingly, leads to A LOT of questions — some general, some specific:

Can I get these removed? If I do, can I have a vaginal birth? Wait, can I even get pregnant!? Will a hormonal IUD make them grow? What are they even made of?

In this installment of LADYist we'll tackle some of the basics.

LOCATION, LOCATION, LOCATION (AND SIZE)

Whether fibroids wreak havoc on your life or go wholly undetected is largely based on their size and location in your body.

The tumors — made up of fibrous tissue and muscle cells — can grow anywhere in or around the uterus, or on surrounding organs.

Some grow inside the uterine wall, some grow in the uterine lining and some hang just outside the uterus. Those on the uterine lining are often the ones to blame for excessive menstrual blood. In some cases, they can also make it hard to get pregnant and/or increase risk for miscarriage or early labor.

SYMPTOMS

They vary wildly.

Sometimes there are no symptoms.

Sometimes there is pressure or pain which can be chronic or related to your period.

They can also make sex painful.

For some women, fibroids are linked to heavy menstrual bleeding, which can be dangerous if it crosses into the territory of low iron and intense fatigue. In extreme cases, women lose enough blood to need a transfusion.

ARE SOME WOMEN MORE PRONE TO FIBROIDS?

Yes. Genetics play a role.

That might be one reason black women are more prone to getting fibroids. Women with lots of biological kids are at lower risk.

Hormonal imbalances can also play a role; too much estrogen and not enough progesterone can make fibroids grow.

Some research suggests that diet can be a factor. One study of 22,000 African American woman found those who ate a dairy product at least once a day were less likely to develop fibroids than women who consumed dairy less frequently. Another study found that compounds from green tea inhibit the growth of human fibroid cells. Other research has indicated that eating fruits and vegetables can help stave off fibroids.

Chemical exposure could also be a factor. A 10-year study of more than 23,000 African-American women found an association between an increased use of hair relaxers and an elevated risk of developing fibroids.

REMOVING FROM THE PREMISES

There are a number of ways to shrink or remove fibroids — some more invasive than others.

A surgeon could use focused sound waves to destroy the tumor or use a technique that will cut off the blood flow to the fibroid.

Another approach is a procedure that kills the lining of the uterus along with the fibroids with microwaves or a small heated balloon.

Or, your doctor may want to cut out the fibroids — the procedure is called a myomectomy. It can range from minimally invasive surgery to a major operation, depending on the fibroids' size and location. (Even after surgery, you might grow new fibroids.)

Since hormones are a factor, sometimes hormonal birth control can help. Your gynecologist will likely prescribe a method that uses progesterone, which has a good track record of slowing fibroid growth and improving menstrual symptoms.

Consider making a list of all your questions before a consult with your OB-GYN. For example: How might the treatment affect my ability to have children? If I have surgery, how long will it take to recover? How long before the fibroids could return?

If you have concerns about how your OB-GYN is handling things, don't be afraid to switch doctors, said Alyssa Quimby, Assistant Professor of Clinical Obstetrics and Gynecology at Keck School of Medicine.

"If you don't connect with that person, and you don't feel like you're able to really trust them, then go to somebody else," she said.

Quimby says be sure to let your doctor know if you start to have heavier periods or more intense menstrual pain. Your OB-GYN should periodically check whether your fibroids have grown.

"A more definitive surgical treatment would be a hysterectomy, removing the uterus altogether," said Quimby.

She acknowledges that surgery is a big deal, but she said it's the best option in severe cases.

CAN I GET PREGNANT AFTER FIBROID SURGERY?

Some women could have a hard time getting pregnant after surgery, but for other women, getting rid of fibroids might help them conceive.

The options for giving birth after a fibroid surgery also vary. For women who've had a myomectomy — which cuts into the uterus — doctors will often recommend a C-section. You may be able to deliver vaginally after a less invasive procedure.

The key takeaway here is that you must find a gynecologist you trust, and be sure to go over the specifics of your situation. The potential impact on getting pregnant and giving birth affects people in different ways.

AN ALL-TOO FAMILIAR TALE

This is one woman's story: Jen, 39, a nurse from Culver City (she asked us to only use her first name, because she said she's been a target of harassment).

She suffered through awful periods for more than three years before a doctor determined that she had a fibroid. Sometimes the pain was so intense it had her doubled over, making it hard to walk and do routine activities.

For a time, she put up with it, saying that was because of her hard headedness.

"I can handle a lot of pain," she said. "I would just take some Tylenol and put on a heating pad."

Jen said a long history of contact sports and hiking helped her push through. Still, one doctor told her the pain was from not getting enough exercise. On top of the pain, there was the bleeding.

"I was going through about a pad an hour with a tampon," she said. "I was bleeding through my clothes. I had to wear dark colors," adding, "I had to set aside clothes that were just for this time of month, lots of laundry."

Jen started using a menstrual cup to measure the blood. It was 120 ml each month; about 30 is typical.

Her abdomen was distended and constantly looked bloated. Eventually, Jen couldn't take it anymore and got a second opinion from her primary care doctor. That doctor did a pelvic exam, and found a fibroid. A transvaginal ultrasound confirmed it was there.

Jen's iron was low and she had so much blood loss related to the fibroids that her doctor thought she might need a transfusion.

In Nov. 2015, Jen had a myomectomy. Hers involved an incision into her uterus. Since then she said she hasn't experienced the same type of menstrual pain or excessive bleeding, but it did leave her with nerve damage in the area.

Jen said she's frustrated that there isn't more research to help women prevent fibroids in the first place.

"We're still behind in women's medicine, and especially women's reproductive medicine," she said.

There is still a silver lining, said Jen. She feels she can draw on her experience to support friends who are dealing with fibroids.


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