Recently, I discovered that a close friend had her second surgery to remove recurrent, problematic fibroids. Pam’s mother, assorted aunts, and youngest sister have also had surgical treatment for these uterine growths. Pam is 37 years old .She is black. She is overweight. She is like an estimated 80% of American women.
Uterine fibroids are incredibly common. According to the Mayo Clinic, upwards of 75% of American women are likely to be afflicted, many without ever showing any symptoms. In fact, for those who do manifest the most common symptoms of fibroids — heavy menstrual bleeding, cramping, frequent urination, pelvic pressure, painful intercourse, and lower back pain — the trouble and bother is insufficient to seek relief beyond that offered by over-the-counter pain medications. And although uterine fibroids, or uterine leiomyomata, are technically considered tumors, the word should not cause undue concern: the overwhelming majority of fibroids are non-cancerous. Furthermore, having fibroids does not make you statistically more likely to develop uterine cancer.
That was small comfort to Pam, however, who has suffered from the effects of many large fibroids for over a decade. She developed them as an adult, and they have plagued her, off and on, since their onset. It has interfered with her work and social life, and it has understandably made her concerned about her general reproductive health.
No one knows why, but black women seem to be more prone to developing fibroids. They tend to occur earlier in this population and with more severity. Some doctors estimate that black women get fibroids three times more often than women of other races. It is certain that black women are diagnosed with fibroids 2-3 times more often white women are, which would indicate that the fibroids have become problematic enough to seek treatment. For fibroids to cause sufficient problem for a patient to seek treatment, they are generally large and numerous.
But what exactly are fibroids? Uterine fibroids are growths on the uterus, but their cause is unknown. The production of estrogen and progesterone appear related to their development, but the exact link is unclear. What is known is that fibroids tend to drastically decrease in size and severity after menopause, when the production of those hormones slows. Fibroids can appear singly or in groups, and their size can vary from under an inch to over eight inches across (about the size of a grapefruit). In fact, fibroids grow to such size that a woman may appear pregnant.
You are more likely to develop fibroids if:
- You are overweight
2. You have a family history of fibroids
3. You are black/African-American
4. You are of child-bearing age
As noted above, the major symptoms of fibroids are heavy menstrual bleeding and cramping; painful intercourse; frequent urge to urinate; pelvic pain and pressure; and lower back or leg pain. Apart from the inconvenience and pain of fibroids, however, there can be other potentially serious complications. These include anemia, or the inability to conceive or even carry a child to term successfully.
Most health care professionals advocate a “watchful waiting” approach. After all, the vast majority of fibroid sufferers are not actually suffering. For those who do experience unbearable discomfort, however, over-the-counter pain relievers may alleviate the symptoms to an acceptable degree. Consumption of iron-rich foods like leafy green vegetables can combat the enervating effects of anemia brought on my heavy blood loss.
For those women who are not able to achieve relief from home-based remedies, however, there are several other options. These include surgical and non-surgical treatments. By far the most serious is a hysterectomy, and unfortunately, for many years this was the default treatment. A hysterectomy involves the complete removal of the uterus, and is the only way to be completely certain that fibroids will not recur. This option should only be considered in the most dire of cases, however, as a hysterectomy is major surgery, and of course, eliminates the possibility of future childbirth. For many women this is simply not an option. Nevertheless, the number of American women who have this surgery is staggering: according Curt Pesman, author of “5 Operations You Don’t Want to Get – and What to Do Instead,” American women have hysterectomies at double the rate of British women, and four times the rate of Swedish women. In addition, Pesman quotes Dr. Ernst Bartisch, a gynecological surgeon who asserts that of the over 600,000 hysterectomies performed each year, between 76-85% may be unnecessary.
Those seeking a less drastic surgical option may benefit from a myomectomy, which allows the woman to keep the uterus. Because the uterus stays, however, fibroids may reappear; at www.fibroids.com, they put the likelihood of recurrence at 30%. Myomectomies differ depending upon the entry point (abdomen, vagina), depending upon the number and size of your fibroids, for instance, or whether your fibroid extends into the uterine cavity rather than out, your surgeon may choose a hysteroscopic myomectomy over a laproscopic myomectomy.
For women who are understandably nervous about any surgical treatment, regardless of whether or not they keep the uterus, there is a third major option that is increasingly gaining favor. Uterine fibroid embolization, in which the fibroids are starved of blood supply and shrink of their own accord, is a much less invasive procedure and has the added benefit of a shorter recovery time. According to the medical information provided by the Fibroid Treatment Collective (www.fibroids.com), in another advantage of embolization is that fibroids do not recur.
Pam does not know what she’ll do next if her fibroids come back. Like increasing numbers of women in their mid-30s who are still weighing the option of becoming mothers, Pam does not want to prematurely forestall that possibility by having a hysterectomy. Many black women in her position did not have that choice, and lost their reproductive capacity and for some, a nebulous sense of their femininity. Pam has every hope that her fibroids have now been eradicated for good, but as one of the unlucky few whose fibroids have been a problem in the past, she worries that, outside of a hysterectomy, she can never be entirely sure that they won’t be a problem again. For now, all she can do is wait.