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Alexandra's ob-gyn diagnosed her as having multiple uterine fibroids and suggested that she have surgery to remove the growths. Afraid that her uterus would be scarred beyond repair, Alexandra declined. Instead, she decided to endure the inconvenience and anemia (blood-iron deficiency) that resulted from heavy bleeding, in hopes that one day she would still be able to bear a child.

"My sense was that while the surgery may have reduced my bleeding, the scarring might leave me in worse shape than the fibroids, from a fertility standpoint," Alexandra says. "Plus, there was also a risk that surgical complications might cause me to lose my uterus altogether!"

What are fibroids? What causes them? How do doctors diagnose this condition? Read on to learn more about uterine fibroids. In Part 2, posted on January 5, NiaOnline will delve into whether surgery is Alexandra's only option--and whether her fears about infertility are warranted.

*Not her real name.

Q: What are fibroids?

A: Fibroids (also known as leiomyomas, myomas, and fibromyomas) are solid, noncancerous lumps of muscle and connective tissue located in or on the uterus. They can be located on the outer wall (intermural or interstitial), within the uterine muscle itself (serosal or subserosal), or in the endometrium (submucosal), the uterus's inner lining.

Q: Who gets them?

A: According to the Center for Uterine Fibroids, up to 80 percent of women get fibroids at some point during their reproductive years.

For reasons that are not clearly understood, Black women develop them two to five times more often than White women do. In It's a Sistah Thing: A Guide to Understanding and Dealing With Fibroids for Black Women (Dafina; $15), author Monique Brown states that they create symptoms in about 50 percent of African-American women.

Q: What causes them?

A: As common as fibroids are, not much is understood about why they develop. Estrogen is known to stimulate their growth, progesterone is believed to be involved, and heredity is another likely factor.

What we eat may also play a role because some foods can increase the estrogen level in our bodies, including nonorganic eggs, dairy products, red meat, and poultry; "bad" dietary fats; sugar and aspartame; caffeine; alcohol; and food additives, Brown states.

In addition, many women find that their fibroids grow when they're stressed out. Some experts, such as Jewel Pookrum, M.D., Ph.D., assert that emotional wounds involving negative or unresolved romantic or work relationships are catalysts. And excess weight concentrated around the middle of the body may contribute to fibroid growth in many women, since excess body fat increases estrogen levels.

Other possible causes include ingesting herbs such as black cohosh and licorice, which behave like estrogen; being chronically constipated, which prevents the proper elimination of estrogen; and having a poorly functioning thyroid gland.

Q: What are the symptoms?

A: The most common symptom of fibroids is heavy bleeding, experienced by about one-third of women. You may bleed heavier during your period, your cycle may last longer than normal, or you may keep bleeding after your cycle ends. As a result, you may become anemic, causing you to feel fatigued, weak, or lightheaded.

Other common complaints include cramps, pelvic pressure, a feeling of abdominal heaviness, frequent urination or incontinence, abdominal pain, constipation, pressure on blood vessels or nerves, discomfort during sex, and problems with pregnancy.

Q: What can I do about them?

A: It's important to see a doctor if you suspect that you have fibroids. You will definitely need to undergo a pelvic exam. From it, your doctor will be able to determine the size of your fibroids, which may be compared with the stage of a pregnancy. For example, your fibroids may be distending your uterus to the point that it is similar in size to a 12-week pregnancy.

Doctors also commonly talk about fibroids as being the size of different objects. A healthy uterus is about the size of a small pear. Fibroids can be described as being the size of a pea, walnut, golf ball, lemon, orange, grapefruit, pineapple, cantaloupe, or watermelon.

Your doctor will perform a variety of tests to determine how the fibroids are affecting your health. The doctor will also make sure--a Pap test is one such method--that the symptoms you're experiencing aren't caused by uterine cancer or some other cancer. And he or she may want your blood drawn to determine whether you're anemic.

Depending on the findings, your doctor may order additional tests. Some of the most common include these:

• Ultrasound. Performed abdominally or vaginally (if the ovaries are obstructed by the fibroids, for instance), this test determines the size, number, and position of fibroids in your uterus.
• Hysteroscopy. A small, lit camera is threaded through your vagina and cervix and into your uterus. It gives your doctor a view of what's happening inside your womb, which is particularly important if you are trying to get pregnant. It may also identify fibroids and polyps inside the uterus that may be causing heavy bleeding.
• Laparoscopy. Your doctor makes a small incision in your abdomen and inserts a camera. It gives your doctor a look at the exterior of your uterus and the surrounding abdominal cavity.

A: Depending on whether your fibroids are causing you problems, whether they are growing or stable, or whether you are trying to get pregnant, your doctor will suggest a course of treatment. For more information about medical and holistic treatment options and their implications for your fertility, please come back and read Part 2 in January.

Do you have fibroids? If so, what steps are you taking to get them under control? Tell us about it in the comments section below.

Hilary Beard is a Philadelphia-based writer

Published on: 12/01/2003

Fibroidnetworkonline.com  
National Library of Medicine and National Institutes of Health: Uterine Fibroids  
National Uterine Fibroids Foundation  






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