10 Min Read Women's Health
Fibroids — noncancerous growths on the uterus — are one of the most common health problems people face during childbearing years. While not life-threatening, they can seriously impact your quality of life. The good news? The toolbox of uterine fibroid treatments just got a little bigger with a new approach that’s beneficial for those who want to have children in the future.
“Women with fibroids should know that there are options to help them address things like their heavy menstrual bleeding, which often leads to iron deficiency, and the potential impact on fertility,” says Dr. Arnold P. Advincula , chief of the Division of Gynecologic Specialty Surgery at NewYork-Presbyterian/Columbia University Irving Medical Center.
Here, Dr. Advincula explains what you need to know about this frustrating health problem, its symptoms, and the latest advances to treat it:
1. Fibroids can grow as big as a watermelon — or number in the dozens.
Fibroids, which are fueled by estrogen and progesterone, the hormones governing menstruation and ovulation, vary widely from one patient to another.
“Grapefruit size is about the standard that we see, but there are patients who show up with watermelon-sized tumors in their belly,” says Dr. Advincula. “They look like they’re pregnant. They’re often frustrated by people walking up to them and asking when they’re due.”
Conversely, some patients have multiple smaller fibroids. It’s not unusual for doctors to find 60 or more of these growths. “When I show patients the image, I tell them the uterus looks like it is full of tiny marbles,” Dr. Advincula says.
2. Fibroids can wreak havoc on your life.
Fibroids can cause menstrual bleeding so heavy that it results in anemia or interferes with a patient’s work and lifestyle.
“When you need a super tampon and a super maxi pad to try to avoid an accident when you’re on your period, that’s not normal,” says Dr. Advincula. “It’s not normal for women to have to stay home from work because they’re worried about soiling furniture because they bleed so heavily. Fortunately, there are treatment options to address these problems.”
Bowel and bladder symptoms, pelvic pain, and abdominal bloating are also common. Patients with fibroids frequently complain of having to urinate constantly, even when they have had only a small amount to drink.
“If the uterus is enlarged, it compresses the bladder and limits its capacity to hold fluid,” says Dr. Advincula. “Similarly, some women will complain of constipation because their pelvis is so full of fibroids that the bowel can’t function normally. We call those bulk symptoms.”
3. Fibroids can throw a wrench into family planning.
Fibroids can impact fertility and childbirth in several ways. For instance, they affect the inner lining of the uterus, called the endometrial cavity, where menstruation originates and a fertilized egg implants.
“Once the endometrial cavity is disrupted by fibroids, it causes heavy menstrual bleeding, which makes it difficult to get pregnant,” Dr. Advincula says. “It’s almost impossible to conceive if you’re constantly having a period.” The distortion of the endometrial cavity also makes it harder for an embryo to implant in the uterine wall.
Dr. Arnold Advincula
Even if an indiviudal is able to conceive, fibroids continue to grow because of the influence of pregnancy hormones. “When women who have fibroids get pregnant, their fibroids can experience accelerated growth,” Dr. Advincula says.
Fibroid growth can result in pain, cause a miscarriage, or lead to early or obstructed labor requiring a cesarean section. “One of the most common referrals that we get are from fertility specialists doing in vitro fertilization (IVF),” Dr. Advincula says, referring to an assistive reproduction technique. “They realize that they can’t do IVF on a patient because they’ve got a fibroid impinging on the endometrial cavity or blocking access to the ovaries for egg retrievals.” Transferring an embryo into the uterus is not likely to be successful under these circumstances.
4. African Americans suffer the most from fibroids.
African American women have three times the risk for developing fibroids when compared with white women. By the time Black women enter perimenopause at around age 50, more than 80% of them have had fibroids, compared to about 70% of white women.
Black women are also often diagnosed with fibroids at an earlier age, have larger and more fast-growing fibroids, and experience more severe symptoms.
At the same time, disparities and biases can negatively affect Black patients’ ability to get appropriate fibroid treatments. “For instance, if you’re Black, you’re less likely to have a conservative or minimally invasive option presented to you,” Dr. Advincula says. Minimally invasive procedures involve less pain and have a much shorter recovery — two weeks or less, compared to six weeks.
5. Fibroids should be treated earlier rather than later.
Many complications of fibroids can be minimized by addressing them from the beginning, Dr. Advincula says. For instance, it’s much more challenging to manage large fibroids in patients who wish to become pregnant.
Dr. Advincula says it’s important to weigh symptoms, the extent and location of fibroids, and an indiviudal’s childbearing goals at the time of diagnosis in order to avoid problems. “Otherwise, you may end up at a point where all of a sudden it does compromise your fertility or you are having heavy menstrual bleeding,” he says.
Often, small fibroids — 2 or 3 centimeters in diameter — don’t require attention. “But when you’re looking at a fibroid that has grown to 7 or 8 centimeters, it could have implications,” Dr. Advincula says. “You need to be on top of that.”
This is important even if you have no symptoms. “While most of the time in medicine you don’t need to treat things that are asymptomatic, fibroids are tricky,” says Dr. Advincula. Symptomless fibroids can still grow and interfere with pregnancy.
6. Fibroids treatments are better than ever, and options have expanded.
“We now have a number of good alternatives that we can customize to meet the needs of most patients,” says Dr. Advincula. There is no one-size-fits-all treatment, he says. Instead, treatments are tailored to women’s medical needs and preferences, including the size and number of fibroids and whether they desire children.
Treatment often starts with symptom relief. Hormonal-based therapies, like birth control pills, can reduce bleeding. Over-the-counter painkillers, like ibuprofen, can ease menstrual cramps. Other drugs, such as leuprorelin (Lupron), can shrink fibroids by triggering temporary menopause before a patient proceeds with surgery or pregnancy.
NewYork-Presbyterian/Columbia University Irving Medical Center physicians were involved in a clinical trial of a new medication called elagolix, approved to control heavy bleeding due to fibroids. It works by suppressing ovarian hormones and stopping periods.
“This is exciting because a lot of times we may treat women with fibroids surgically, but they still have a lot of fibroids left that may be problematic,” says Dr. Advincula. “This is an option that we can use either presurgically or postsurgically to try to manage symptoms. And some women may not even need to have surgery if we use this drug.”
When fibroids are large or numerous, they can be removed through a procedure called myomectomy. Physicians usually perform the surgery through an open incision (when fibroids are very large) or use minimally invasive methods: robotic myomectomy (through several tiny incisions in the abdomen) or hysteroscopic myomectomy (through the vagina and cervix). Patients are usually back on their feet in two to six weeks, depending on the method.
“We now have a number of good alternatives that we can customize to meet the needs of most patients.”
— Dr. Arnold Advincula
7. A new fibroid procedure may preserve childbirth options.
Although a myomectomy can preserve a patient’s fertility potential, patients should know that future pregnancy is not a guarantee, and, if successful, childbirth will often require a C-section. “Even though we take the fibroids out and repair the uterine muscle, that muscle integrity is forever changed, so, depending on the extent of the myomectomy, you don’t want to stress it with labor at term,” Dr. Advincula says.
Now, a new approach to fibroid removal, called transcervical radiofrequency ablation, may increase the likelihood of avoiding a C-section, and is available at NewYork-Presbyterian. It uses a miniaturized ultrasound probe to destroy fibroids from inside the uterus with high-energy waves. This outpatient, incision-free method also allows doctors to remove fibroids in hard-to-reach places and has an easier recovery — just a day or two with minimal to no pain. “We don’t make any big incisions on the uterus so it doesn’t automatically commit women to having a C-section when they have a baby in the future,” Dr. Advincula says. The procedure typically takes only two to three minutes to treat each fibroid, he says. “It’s very fast.”
“It is one of the newest minimally invasive surgical treatment options available, and we’re the first major academic medical center in the tri-state area to acquire and adopt it as an option for patients,” Dr. Advincula says. Although pregnancy data is still being collected and established, he says, “It is an extremely promising treatment that exclusively targets the fibroid and not only preserves a woman’s uterus but keeps the surrounding muscle intact.”
The ideal candidate is someone who has a small number of fibroids that are all less than 5 centimeters in diameter and are close to the endometrial cavity. “There’s a subset of patients that fit that profile,” says Dr. Advincula. “It gives them another option, where they would otherwise end up with a potentially more invasive procedure. And it not only preserves potential fertility, but may give them the option of going through vaginal childbirth in the future, barring any pregnancy-related reasons for undergoing a C-section.”
If fertility is not an issue, patients can opt for uterine fibroid embolization, in which particles are delivered through a catheter inserted in the groin or wrist and guided into the blood vessels that feed fibroids to cut off their blood supply and cause them to shrink. With hysterectomy, the entire uterus, including fibroids, is removed.
“There’s a role for every therapeutic,” Dr. Advincula says. “But the right choice depends on the patient’s clinical profile and future desires.”
Dr. Arnold Advincula is a paid consultant to AbbVie, the maker of elagolix.
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Arnold Advincula , M.D., is an obstetrician-gynecologist and chief of the Division of Gynecologic Specialty Surgery at NewYork-Presbyterian/Columbia University Irving Medical Center and chief of gynecology at the Sloane Hospital for Women. He is also the Richard U. Levine Professor of Women’s Health and vice chair of women’s health in the Department of Obstetrics and Gynecology at Columbia University Vagelos College of Physicians and Surgeons. Dr. Advincula is a leader in minimally invasive surgical techniques and gynecologic robotic surgery. He has published and taught extensively in the area of minimally invasive surgery and has developed surgical instruments in use worldwide. Dr. Advincula has extensive experience in treating complex and challenging cases of endometriosis, uterine fibroids, and pelvic masses.
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