As winter approaches and the weather changes, I find that most adults I know dread the snow; it’s wet, uncomfortable, and makes it hard to go to work. Just like uterine fibroids! The many women who have fibroids (it’s estimated that up to 40% of women have them) suffer from a vast array of symptoms that make life very difficult. While uterine fibroids are benign (noncancerous), they do grow over time and can cause many different issues. Just like how no two snowflakes are exactly the same, neither are any two fibroids. Depending on size, location, blood flow, hormone status, orientation of the uterus, and many other factors, each fibroid can cause its own unique set of symptoms. That can make a proper diagnosis difficult, but luckily, here at USA Fibroid Centers we see them all!
A Fibroid’s Circle of Life
While the exact cause of uterine fibroids is not known, they do tend to follow a particular growth pattern. We know that fibroids grow when hormones like estrogen and progesterone are high: when women are in their 20s and 30s or when they are pregnant. We know that it usually takes a few years of growth before a fibroid is big enough to cause symptoms. And we know that when hormone levels drop after menopause the fibroids stop growing and eventually shrink in size. This information plays a strong role in making the diagnosis and guiding treatment of fibroids. A teenager in unlikely to have grown a fibroid large enough to cause symptoms, and a 70 year old is unlikely to have grown a new fibroid at all. A symptomatic fibroid in a 30 year old is likely to grow and cause more problems in the coming years, while a small fibroid in a 50 year old is unlikely to grow or cause any issues.
When Fibroids Stay at Home
The two most common symptoms from uterine fibroids are excessive menstrual bleeding and pelvic pain. When a fibroid grows in the center part of the uterus, which is called the endometrium, it disrupts the natural menstrual cycle and causes heavier, prolonged, or more frequent bleeding. If left untreated these fibroids continue to grow and the bleeding gets worse and worse. This creates the logistical nightmare involving tampons, pads, adult diapers (unfortunate but true), always needing to be close to a restroom, and even requiring days off from work every month to control the bleeding. I’m always amazed at all the hoops I hear my patients jumping through to cope with excessive bleeding. And in case that wasn’t enough, anemia (low blood count) sets in from the bleeding, causing other symptoms like fatigue, shortness of breath, dizziness, and more. In contrast, a fibroid that grows in the outer part of the uterus far away from the endometrium typically does not cause many bleeding issues. Instead, pain is the dominant symptom. It is usually described as pelvic pain that is worse during menstruation and intercourse. Medicines like ibuprofen or naproxen can help the pain initially, but as the fibroid grows the pain gets worse and worse.
When Fibroids Visit Neighbors
The fibroid that grows near the uterine endometrium and causes bleeding and the fibroid that grows towards the outside of the uterus and causes pelvic pain are more straightforward to diagnose. But sometimes fibroids can cause other symptoms. This happens when a fibroid grows close by to another organ, or if a fibroid grows very large, or if there are so many fibroids that the overall size of the uterus can just no longer stay in its usual place and starts to push on the surrounding structures. When this happens the patients get symptoms that at first glance appear to be unrelated to the uterus and are frequently misdiagnosed.
The bladder is positioned directly in front of the uterus. A uterine fibroid that grows out of the front of the uterus can extend forward and compress the bladder, rendering it unable to fill up with urine. Since the bladder can’t expand, after only a little bit of fluid the bladder will signal that it is full and needs to urinate, however the patient only urinates the little bit of urine that the bladder is able to hold. I saw a patient recently who would restrict what she drank so she didn’t have to keep running to the restroom to urinate. She also woke up every night (despite dehydrating herself) needing to urinate. Aside from the anxiety this caused her when she left the house, she was chronically tired from not getting a full night’s sleep. After dealing with these symptoms for many years and undergoing fruitless invasive diagnostic urological testing to look for a cause for her urinary frequency she finally was referred to my office. She underwent the uterine fibroid embolization procedure to shrink her fibroids and 2 months later she reported that she no longer wakes up at night to urinate, has more energy now that she sleeps through the night, and was able to enjoy a trip overseas touring Europe without constantly having to find a restroom.
Constipation and Bloating
The colon (“large intestine”) is positioned directly behind the uterus. A uterine fibroid that grows from the back of the uterus can (you guessed it!) extend backward and compress the colon. The colon is a roughly 5 foot long tube of an organ that has an important job: gather the waste from the food we eat as stool and deposit it in the toilet when it’s convenient. When a fibroid encroaches on the colon it makes it harder for the colon to push stool past it during a bowel movement, resulting in constipation and bloating. The colon usually operates like a 6 lane highway with cars cruising along (hopefully not over the speed limit though, if you know what I mean!), but a large fibroid can squeeze the colon down to only 1 or 2 lanes, creating a very uncomfortable traffic jam behind the narrowing. Since constipation is a frequent byproduct of many medical issues and medications it often goes unmentioned, undetected, or just blown off. If it is discussed it may cause a trip to the gastroenterologist and an uncomfortable … uh… 18 wheel truck driving the wrong way up that colon highway, otherwise known as a colonoscopy. The colon of course is normal and laxatives and stool softeners are used to help move stool past the fibroid. FINALLY the patient comes to my office, the fibroids are discovered, and a treatment for the underlying cause can be performed, allowing the colon to once again do its job effectively and without medication assistance.
How does the uterus cause leg pain? Well our brain and spinal cord are in charge of pain and sensation signals. There are nerve fibers that travel from the spinal cord in our back, down each leg, and back to the cord, so our brain can process that pain and sensory information. In some cases, the fibroids grow out towards where these nerves are, and they can compress them, causing nerve symptoms like shooting leg pain, numbness, and tingling. Shrinking the fibroids will release the pressure on the nerves and cure the leg symptoms.
Similar to the nerves travelling to and from the legs, we also have blood vessels that bring blood from the heart down to the legs and feet (called the arteries) and vessels bringing the used blood from the legs back up to the heart (called the veins). A fibroid compressing the blood vessels can cause many different leg symptoms, from pain to bulging veins to even a blood clot.
Fibroid Diagnosis and Treatment
Like everything in life, fibroids are not always simple and straightforward. Since fibroids are so common, it’s important for healthcare providers and informed patients to look out for them as an explanation to a variety of symptoms. The symptoms described here in this article are only a few out of the many that fibroids can possibly cause. Making an appointment with USA Fibroid Centers is a good first step if you have any of these symptoms. An initial consultation involves a thorough history and physical examination, and an ultrasound picture of the uterus. From there we can determine if you do in fact have fibroids, whether it’s causing any symptoms, and if any further testing is needed.
Once diagnosed with symptomatic uterine fibroids there are different treatment options available, one of which is uterine fibroid embolization (UFE). This is a minimally invasive, same-day procedure performed in our offices. The procedure is completely painless and recovery, while uncomfortable, typically lasts only about a week. UFE is very effective at shrinking fibroids and relieving the symptoms associated with them.
Check out the first installment of our “Ask the Doctor” series with Dr. Jacob White HERE.
Jacob White, M.D.
Dr. Jacob White has been studying and practicing interventional radiology for 15 years. He has conducted research at Drexel Hahnemann University Hospital Radiology, Georgetown University Hospital Radiology, and the National Institutes of Health Radiology. He has contributed extensive research and knowledge to the medical academy through a multitude of presentations and publications. He is one of 12 doctors on our interventional radiology team. All of our doctors specialize in minimally invasive, non-surgical procedures to treat uterine fibroids.
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