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What to do about Fibroids

I mentioned in a previous post that I found out I had fibroids when I had my first sonogram during my 1st pregnancy.  It was the size of a small grapefruit! I was in SO much pain during my 1st trimester. There were days that I had to end my day early in the office because I was in so much pain, I could hardly walk. I initially took Ibuprofen for the pain but that stopped working.   I then tried a medication called Indomethacin which is a nonsteroidal anti-inflammatory drug usually used in pregnancy for preterm labor. However, this a medication that you can only take temporarily because there are risks to the baby. So, I took it for 1.5 weeks and felt better. By this time, I was reaching the end of my 1st trimester.  Fortunately, I didn’t have any pain from this disrespectful fibroid for the rest of the pregnancy however I did go into preterm labor at 24 weeks and had to be on bedrest for the rest of the pregnancy. I made it to 37 weeks and delivered a healthy baby!! I did worry about the fibroid causing an issue at time of delivery, but it didn’t, praise God! I also contemplated if I would get it removed after I recover from delivery.

I got a sonogram about 3-4 months after delivery to check on this fibroid.  It shrunk!! It was now the size of a plum.

Whew! A relief for me because I really didn’t want to undergo surgery if I didn’t have to.  But I know there are many women who are not as lucky and have to decide if surgical management of their fibroids is a good choice for them.

Common questions I hear in the office….

Can I get pregnant with fibroids?

Yes, you certainly can. Fibroids usually don’t prevent you from getting pregnant. The location of the fibroids and the size of them can impact the outcome of the pregnancy.  If you have a fibroid along the lining of the uterus or pointing inside the uterine cavity (this is called a submucosal fibroid), then this may make it difficult for a pregnancy to implant which can result in a miscarriage. Some women must decide if they want to have fibroids removed (a surgery called a myomectomy) before trying to conceive.

What happens to fibroids in pregnancy?

Pregnancy hormones can stimulate the growth of fibroids.  Fibroids can compete with the baby for blood supply.  And usually baby wins which causes fibroids to degenerate or shrink.  This HURTS!! So fibroids can cause pelvic pain in pregnancy which was my experience.

Fibroids can be large enough to prevent appropriate growth of the baby therefore leading to fetal growth restriction or low birth weight. If women have large fibroids in pregnancy, they have sonograms to check fetal growth throughout the pregnancy.

Fibroids can lead to…

-Preterm labor and/or preterm delivery (less than 37 weeks).

-Cesarean section if the location and size of the fibroid doesn’t allow the baby to come down the birth canal safely. Or baby may not be in the appropriate position for a vaginal delivery.

-Postpartum bleeding or hemorrhage because the fibroids make it difficult for the uterus to contract appropriately to slow bleeding down after delivery.

If I’m scheduled for a C-section, can you take the fibroids out at the time of the C-section?

No, we prefer NOT to do this. We don’t like to remove fibroids during the time of C-section due to the risk of significant blood loss. The uterus is very vascular in pregnancy and removing fibroids can increase the risk of postpartum hemorrhage.

But every patient is different. Size and location of fibroids matter so the answers to these questions can vary. It is important that you have the discussion with your physician to decide what you need to do (if anything) about fibroids before or after pregnancy.

Remember the more you know, the better prepared you’ll be to face any challenge.

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What do you know about fibroids?

Well, I didn’t know I had fibroids until I was pregnant with my first child.  I went for a routine ultrasound during my 1st OB visit and I discovered I had fibroids.

Many women have fibroids and don’t even know it.

Fibroids are benign, or noncancerous, tumors that arise in the muscle of the uterus.  It is the most common solid pelvic tumor in women. It occurs in about 70% of Caucasian women and more than 80% of African-American women. We still don’t know what causes fibroids but there are varying theories that suggest diet, hormones and genetics may play a role.  The size, location and number of fibroids can dictate various symptoms as well as treatment options.

You might have fibroids if you have:

1)      Heavy periods, especially so heavy that they cause anemia

2)      Pelvic pain, pressure or bloating, either during your period or in between periods.

3)      Pain with sex

4)      Difficult urination or bladder pressure

5)      Difficulty having a bowel movement

How would your Ob/Gyn or Primary Care Physician know you have fibroids?

 Sometimes, we can feel them during a pelvic exam. If there are large fibroids, we may even feel them on just an abdominal exam! But in any case, we will confirm this diagnosis with a pelvic ultrasound.

I have fibroids, so now what?

Personally, I was fortunate that mine didn’t really bother me after pregnancy.  But I know many other women who are not so fortunate. Fibroids can be managed conservatively with medication or may require minimally invasive procedures. Keep in mind, some of these treatments may only improve the symptoms of fibroids but not eliminate the fibroid.  Some women fear that they will automatically need a hysterectomy if they have fibroids which is not true.  Size, location and number of fibroids will determine which treatment is best. And as the patient, you have the opportunity to decide on which option best fit you and your treatment goals.

Treatment options:

-Medical treatment can be hormonal treatments like birth control pills or a Mirena intrauterine device (IUD). 

-Uterine artery embolization (UAE) is a procedure that is performed by an Interventional Radiologist that uses a blood vessel in the groin to block the blood supply to fibroids.

-The newest procedure is called an MRI-guided Focused Ultrasound Surgery which uses ultrasound waves to shrink fibroids.

-Myomectomy is a surgical procedure that removes the fibroids.  The size and location of the fibroids determine which kind of myomectomy is necessary. Be aware that after this type of procedure, there is a risk for the fibroids to come back.

                                -Abdominal myomectomy which requires one abdominal incision.

                                -Laparoscopic myomectomy which requires at least 3 very small abdominal incisions.

                                -Hysteroscopic myomectomy which uses a vaginal approach.

-Hysterectomy is the removal of the uterus and this is a definitive treatment.

So, if you are experiencing any of the symptoms stated above, talk to your physician about it and determine if you need further evaluation. If you do have fibroids, be reassured that there are options available to help you if your symptoms are affecting your quality of life. Don’t let fibroids control your life!

The more you know, the better prepared you’ll be to face any challenge. During your journey, you should say, “I am empowered to know my options and decide what enters my temple-mind, body and soul.” -excerpt from Loving Me, Myself and Her: Through Perimenopause & Beyond

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