commonCONDITIONS
Uterine fibroids account for 4 out of 10 hysterectomies in the U.S. each year.
THE SILENT TUMOR Many Women Unaware They Have Uterine Fibroids
BY KAREN FINUCAN CLARKSON
T
hey afflict up to threequarters of women, yet most who have them experience no symptoms. Still, they account for 40 percent of the 600,000 hysterectomies performed each year in the U.S., according to the American Congress of Obstetricians and Gynecologists. They are uterine fibroids, noncancerous tumors that grow within the wall of the uterus. The term fibroid is a bit of “a misnomer,” said Elliece S. Smith, M.D., a gynecologist and cosmetic surgeon in Lanham with privileges at Doctors Community Hospital, in that the tumors “are actually made of smooth muscle, tightly bound.” The benign tumor is “distinct from the surrounding muscle of the uterus,” said James S. Powers, M.D., a Chevy Chase gynecologist and former chief of the division of gynecology at Suburban Hospital in Bethesda. “It tends to grow in very discrete spots.” Those spots—of which there are three—dictate what type of symptoms a woman may experience. Uterine fibroids cause symptoms in a quarter of reproductive-age women, according to the Center for Uterine Fibroids at Boston’s Brigham and Women’s Hospital. While pain is uncommon, according to Powers, other symptoms can detract from a woman’s quality of life.
12 Gazette Health | Fall 2013
want to get pregnant. “Fibroids can sometimes interfere with the implantation of a fertilized egg,” said Powers. The rate of spontaneous miscarriage may be as much as 85 percent higher in women with fibroids than those without, according to a 2010 study in Reviews in Obstetrics & Gynecology. Fibroids that grow within the muscular wall of the uterus, known as intramural fibroids, can distort the shape of the uterus and also may cause longer periods with heavier bleeding. When these tumors get large enough, “they can cause the abdomen to poke out and the woman to look pregnant,” said Smith.
A GAZETTE PUBLICATION
Subserosal fibroids, which project to the outside of the uterus, may press on the rectum or bladder. “If the fibroid is posterior, it can cause constipation. If anterior, the result can be frequent urination,” Smith said. The two most common symptoms are abnormal uterine bleeding and pelvic pressure. Whereas normal menstrual periods typically last four or five days, seven or more days is not unusual among symptomatic women. “Women with fibroids also can have such heavy bleeding that they need to change sanitary protection frequently (perhaps every hour) or hesitate to participate in their normal activities for
FIBROIDS OFTEN ARE DISCOVERED by a gynecologist during an internal exam. A sonogram may be used to confirm the finding. In most cases, the patient is unaware of the fibroids’ existence, said Powers. Fibroids aren’t
DIGITAL VISION/THINKSTOCK
THE LEAST COMMON FIBROIDS ARE those that grow into the inner cavity of the uterus, noted the Center for Uterine Fibroids. Submucosal fibroids, which represent 5 percent of these tumors, are more likely to cause prolonged, heavy menstrual bleeding and can be a problem for women who
Submucosal fibroids, which represent 5 percent of these tumors, are more likely to cause prolonged, heavy menstrual bleeding.
fear of socially embarrassing bleeding,” noted the Center for Uterine Fibroids’ website. Such bleeding can cause anemia, which can be a problem when treating fibroid patients, said Smith. Fibroids come in a variety of shapes and sizes, and where there is one, there probably are more. The average affected uterus contains six to seven fibroids, according to the Center for Uterine Fibroids. They can be as small as an apple seed or as large as a soccer ball, said Smith, and “neither pain nor bleeding is correlated with the size of the fibroid.” Fibroids, which occur primarily between the ages of 30 and 40, are about three times more prevalent in black women than in white women, according to the Center for Uterine Fibroids. The tumors tend to develop in African-American women at a younger age, grow more rapidly and be more likely to cause symptoms. The reason for the discrepancy between races is not understood, said Smith. Overweight and obese women are two to three times more likely to get fibroids, according to the National Women’s Health Information Center. That may be due to the fact that fat cells raise estrogen levels in the body and estrogen is known to promote fibroid growth. Diet, too, is a risk factor. Eating a lot of red meat and ham has been linked to fibroid development. Family history is also thought to play a role. The risk of fibroids is about three times higher for a woman whose mother had them.