Hormones, Age, and Fibroids: Managing Uterine Health Naturally After 30

Diet, Detox, and More: Holistic Ways to Manage Uterine Fibroids After 30

As we navigate the landscape of women’s health, certain topics arise frequently, often carrying varying degrees of concern and confusion. Uterine fibroids are certainly one such topic. Common, yet often misunderstood, these growths can significantly impact well-being for many of us. We’ve set out to explore what fibroids are, why they occur, how they manifest, how they are identified, and what options we have for managing them.

What Exactly Are Uterine Fibroids?

To begin, let’s define what we’re talking about. Uterine fibroids, also known by their medical term “leiomyomas” or simply “myomas,” are non-cancerous (benign) growths that develop in or on the walls of the uterus. They are essentially bundles of smooth muscle tissue and fibrous connective tissue.

We understand that fibroids can vary dramatically in size and number. They might be microscopic and undetectable without imaging, or they can grow to be several inches in diameter, sometimes filling the entire abdominal cavity. A person might have just one fibroid, or they might have multiple.

We classify fibroids based on where they are located within the uterus:

• Intramural Fibroids: These are the most common type. They grow within the muscular wall of the uterus.
• Subserosal Fibroids: These form on the outer surface of the uterus. They can sometimes develop a stalk, becoming “pedunculated” fibroids.
• Submucosal Fibroids: These grow just beneath the inner lining of the uterus (the endometrium). They can protrude into the uterine cavity and are often associated with heavy bleeding. Like subserosal fibroids, they can also be pedunculated.
• Cervical Fibroids: Less common, these grow in the wall of the cervix (the lower, narrow part of the uterus).

Understanding these locations is crucial because where a fibroid grows often influences the symptoms we experience.

Why Do We Get Fibroids? Exploring the Causes and Risk Factors

While the exact causes of uterine fibroids are not fully understood, research points to several key factors that appear to play a role in their development and growth. We know they primarily affect individuals during their reproductive years, suggesting a strong link to hormones.

Here are some of the most significant factors we’ve identified:

• Hormones: Estrogen and progesterone, the two main female reproductive hormones, appear to stimulate the growth of fibroids. Fibroids contain more estrogen and progesterone receptors than normal uterine muscle cells. They tend to grow during the reproductive years when hormone levels are high and shrink after menopause when hormone levels decline.
• Genetics: We’ve observed that fibroids often run in families. If our mother or sister had fibroids, we are at a higher risk of developing them ourselves. Specific genetic changes have been identified in fibroid cells.
• Race: Black women are significantly more likely to develop fibroids than women of other racial groups. They also tend to develop them at younger ages, have larger or more numerous fibroids, and experience more severe symptoms. The reasons for this disparity are complex and likely involve a combination of genetic, environmental, and socioeconomic factors.
• Age: Fibroids are most common in women in their 30s, 40s, and early 50s. As mentioned, they usually shrink after menopause.
• Other Factors:
  • Obesity: Being overweight or obese increases the risk.
  • Diet: A diet high in red meat and alcohol, and low in green vegetables and fruits, may be associated with a higher risk.
  • Vitamin D Deficiency: Some studies suggest a link between low vitamin D levels and fibroids.
  • Early Onset of Menstruation: Starting periods at a younger age may increase risk.
  • Never Having Given Birth: Some research suggests that having given birth may offer some protection against developing fibroids, though this link is not definitively proven as causal.

It’s important to remember that we cannot control all these factors, but understanding them helps us appreciate why some individuals are more susceptible than others.

The Silent to the Severe: Recognizing the Symptoms

One of the most challenging aspects of uterine fibroids is the variability in symptoms. Many of us with fibroids experience no symptoms at all. These fibroids are often discovered incidentally during a routine pelvic exam or imaging for another reason. However, for others, fibroids can cause significant discomfort and problems. The type, size, and location of the fibroids heavily influence the symptoms.

Here are some of the symptoms we might experience:

• Heavy Menstrual Bleeding (Menorrhagia): This is one of the most common symptoms, particularly with submucosal fibroids. It can lead to anemia due to excessive blood loss.
• Prolonged Menstrual Periods: Menstrual periods that last longer than seven days.
• Pelvic Pressure or Pain: A feeling of fullness or pressure in the lower abdomen. This can range from a dull ache to sharp pain, depending on the size and location of the fibroids.
• Frequent Urination: Large fibroids pressing on the bladder can cause a need to urinate more often.
• Difficulty Emptying the Bladder: Fibroids pressing on the bladder or urethra can interfere with urination.
• Constipation: Fibroids pressing on the rectum can cause difficulty with bowel movements.
• Backache or Leg Pains: Fibroids pressing on nerves in the pelvis or back can cause referred pain.
• Pain During Intercourse: Depending on their location, fibroids can cause discomfort during sexual activity.
• Abdominal Enlargement: Large fibroids can cause the abdomen to swell, sometimes mistaken for weight gain or pregnancy.
• Infertility or Pregnancy Complications: While many women with fibroids can conceive and carry pregnancies without issues, the location and size of fibroids (especially submucosal ones) can sometimes interfere with implantation, increase the risk of miscarriage, premature labor, or complications during delivery.

If we experience any of these symptoms, especially if they are new, worsening, or affecting our quality of life, it’s a sign to seek medical advice.

How We Diagnose Uterine Fibroids

The path to diagnosis often begins when we report symptoms to our healthcare provider or when fibroids are suspected during a routine examination.

The diagnostic process typically involves:

1. Medical History and Physical Exam: Our doctor will ask about our symptoms, menstrual cycle, and family history. A pelvic exam may reveal irregularities in the shape or size of the uterus, suggesting the presence of fibroids.
2. Imaging Tests: These are essential for confirming the diagnosis, mapping the location, size, and number of fibroids.
   1. Ultrasound: This is the most common imaging technique. It uses sound waves to create images of the uterus and ovaries. Both transabdominal (over the abdomen) and transvaginal (a probe inserted into the vagina) ultrasound may be used for a clearer view.
   1. Magnetic Resonance Imaging (MRI): MRI provides more detailed images than ultrasound and is often used for larger or more complex cases, or when planning surgical treatment.
   1. Computed Tomography (CT) Scan: Less commonly used for basic fibroid diagnosis, but may be used if fibroids are very large or when evaluating other pelvic organs.
3. Other Procedures (Less Common for Initial Diagnosis):
   1. Hysteroscopy: A thin, lighted telescope (hysteroscope) is inserted through the cervix into the uterus. This allows the doctor to visualize the inside of the uterus directly and is particularly useful for identifying and sometimes removing submucosal fibroids.
   1. Laparoscopy: A minimally invasive surgical procedure where a small incision is made in the abdomen, and a camera (laparoscope) is inserted to view the outside of the uterus and other pelvic organs. This is less common purely for diagnosis but might be used if other imaging is inconclusive or when exploring other potential causes of pelvic pain.

Through these diagnostic methods, healthcare providers can accurately identify fibroids and gather the information needed to discuss treatment options.

Navigating Treatment Options: Finding the Right Path

Once fibroids are diagnosed, we work with our healthcare provider to determine the best course of action. The approach largely depends on whether we are experiencing symptoms, the severity of those symptoms, the size, number, and location of the fibroids, our age, overall health, and critically, our desire for future pregnancy.

“The power of being in control of our own health decisions cannot be overstated. When faced with conditions like fibroids, understanding our options is the first step towards choosing the path that feels right for us.”

Here are the main categories of treatment options available:

1. Watchful Waiting: If we have fibroids but no bothersome symptoms, or only very mild ones, the doctor might recommend simply monitoring them over time. Fibroids are benign and often don’t require treatment if they aren’t causing problems. Regular check-ups and ultrasounds may be done to track any changes.
2. Medications: These treatments primarily focus on managing symptoms, particularly heavy bleeding and pain. They do not eliminate the fibroids but can significantly improve quality of life.
   1. Over-the-Counter Pain Relievers: Such as ibuprofen or naproxen, can help with mild pain.
   1. Hormonal Birth Control: Pills, patches, rings, or injections can help control heavy bleeding and regulate periods.
   1. Progestin-Releasing Intrauterine Device (IUD): Can significantly reduce heavy bleeding.
   1. Tranexamic Acid: A non-hormonal medication taken during periods to reduce blood loss.
   1. Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists: These medications (like leuprolide or elagolix) block the production of estrogen and progesterone, causing fibroids to shrink and stopping menstruation. They are powerful and typically used for short periods (e.g., before surgery) due to potential side effects like hot flashes and bone loss.
3. Minimally Invasive Procedures: These techniques aim to destroy or remove fibroids with less impact than traditional surgery.
   1. Uterine Artery Embolization (UAE): Tiny particles are injected into the arteries supplying the uterus, cutting off blood flow to the fibroids, causing them to shrink and die. This is performed by an interventional radiologist.
   1. MRI-Guided Focused Ultrasound Surgery (FUS): Uses high-intensity ultrasound waves, guided by MRI, to heat and destroy fibroid tissue. This is non-invasive but not suitable for all fibroids.
4. Surgical Options: These are considered when symptoms are severe, other treatments haven’t worked, or when fibroids are large or causing fertility issues.
   1. Myomectomy: This procedure removes the fibroids but leaves the uterus intact. It is often the preferred option for women who wish to preserve their fertility or uterus. Myomectomy can be performed in several ways:
      1. Hysteroscopic Myomectomy: For submucosal fibroids bulging into the uterine cavity, removed through the cervix using a hysteroscope.
      1. Laparoscopic or Robotic Myomectomy: Minimally invasive removal of fibroids through small incisions in the abdomen.
      1. Open Abdominal Myomectomy: Removal through a larger incision in the abdomen, typically used for large or numerous fibroids.
   1. Hysterectomy: This involves surgically removing the entire uterus (or sometimes just the uterus and not the cervix, depending on the procedure). It is a definitive treatment for fibroids, as they cannot regrow once the uterus is removed. Hysterectomy can be performed abdominally, vaginally, laparoscopically, or robotically. It results in the inability to become pregnant and the cessation of menstruation.

Our doctor will help us weigh the pros and cons of each option, considering factors like effectiveness, recovery time, risks, and impact on future fertility.

Here’s a simplified comparison of some primary treatment approaches:

Note: Impact on fertility can vary significantly based on individual circumstances, fibroid characteristics, and procedure specifics. Discussion with a fertility specialist may be necessary.

Living with Fibroids