In this section, we will address the important issue of fibroids and your health.
What causes uterine fibroids? What influences their growth?
Although no knows what causes fibroids there is increasing evidence that these tumors represent some genetically altered tissue. The abnormalities of many fibroids can be found in certain chromosomes–6, 7, 12 and 14. The exact mechanism by which these altered chromosomes produce a “fibroid” is unknown, however. We do know that fibroids are sensitive to a variety of hormones including estrogen, growth hormone and progesterone. Myomas generally begin producing symptoms during the reproductive years (ages 13 – 45). They can undergo dramatic growth spurts especially during pregnancy. Often, fibroids will grow to a certain size and remain stable and unchanged. Typically, myomas shrink—but do not disappear–with menopause.
There has been a fair amount of media attention during the past year (2014-5) on fibroids and a type of cancer called leiomyosarcoma or uterine sarcoma. These are rare cancers whose incidence is estimated to be approximately one per thousand. The likelihood of leiomyosarcoma increases with age and is greatest in postmenopausal women of African American descent.
Do fibroids cause pain?
Only rarely do fibroids cause pain. When fibroids do cause pain it is usually in the form of very painful menstruation. Depending on the location of a fibroid it can cause difficult on painful intercourse. One of the common misconceptions we encounter in women who seek a second opinion is the belief that their fibroids are causing pelvic and abdominal pain. It is uncommon for fibroids cause pain other than during menstruation. The fact remains that pelvic pain is common in women and so are fibroids. However, there is not a strong “cause and effect” relationship between the two outside of menstruation. But, women with fibroids may also have other issues that can cause pelvic pain—pelvic endometriosis or pelvic adhesive disease.
Do fibroids cause heavy menstrual bleeding?
Yes and no—it depends where they’re located. Not all fibroids have the capacity to cause heavy menstrual bleeding. In general, fibroids that are not close to the central portion of the uterine cavity do not cause heavy periods while those that are near the center (see below under “submucous”) cause the heaviest menstrual periods and can even cause outright hemorrhage.
How do submucous fibroids affect periods?
Although there is no “typical bleeding pattern” with fibroids listed below are some of the changes that women with fibroids often report.
Regularity of cycles. Typically women with bleeding from fibroids experience heavy periods but their cycles (defined as the number of days from the first day of one period to the first day of the next) remain fixed—usually between every 25 and 35 days.
Frequent pad or tampon changes. Women who develop fibroids often report that their use of tampons and pads (or both) increases. It is not unusual for women with fibroids to report pad or tampon changes as often as every 45 – 60 minutes. Occasionally women report that during the worst days of flow they can barely leave the bathroom.
Passage of clots. Women who develop fibroids often begin to experience clotting for the first times in their lives or – if they’re already accustomed to clots—they report the clots to be larger. It is not unusual for women with fibroids to pass clots the size of a quarter, half-dollar or larger.
Cramps. The occurrence of cramps can be very variable in women with fibroids. Most women with heavy vaginal bleeding attributable to fibroids experience an increased intensity of menstrual cramps. Some women, however, note that while the bleeding can be frighteningly heavy they experience few if any cramps. These differences depend on a variety of factors include the blood supply to the fibroid.
Periods that interfere with your life. In extreme cases women with fibroids anticipate such heavy periods that they must plan for 3-7 days (or longer) during each cycle when they can rarely be far from a bathroom and must equip themselves with a large stockpile of pads and tampons.
Continuous or “non-stop bleeding”. Occasionally some women will suffer quite a long time with fibroids until they experience nearly continuous bleeding. Women sometimes report bleeding for 30-60 days in a row before seeking help.