Uterine Fibroids

Twenty-five years old, and you say I have what? Though my passion is public health where I understand the importance of understanding family history, healthy eating, and what it means to be “healthy”, in the past, I perceived myself as healthy based on my body type and size. Society has conditioned many of us to think our health status is solely based on the way our body looks; this is entirely wrong. For many years I considered myself healthy because I have a rapid metabolism; many of my former coworkers, family, and friends can attest to my unhealthy eating habits which included overconsumption of fast food. Though this was my diet, I still considered myself “healthy.” It was vital for me to realize that this unhealthy lifestyle will lead to significant health complications in the future, regardless of size. On January 8, 2020, I walked out of Planned Parenthood with an ultrasound that scared me left me lost for words. No, I was not pregnant; the ultrasound showed a Uterine Fibroid. I received little to no information about uterine fibroids from Planned Parenthood. I was instructed to see my primary care physician; this was difficult because I didn’t have one in Cleveland.

As I googled fibroid, this is what I saw, safe to say Google can be your worst enemy at times

I texted a few friends and family responses ranged from:

“That’s huge.” “Are you going to have to get surgery?” “Oh dang. I’m sorry to hear that. Okay. I would love to see a picture lol” — My best friend is a medical student I knew she would love to see a pic “Are you sure you aren’t pregnant?” “Are you ok with getting surgery?” “There are other holistic options, don’t just jump right into surgery.”

As I type this blog, the ultrasound sits on my desk as I remember the fear, uncertainty, and confusion that came from receiving this news. So much of these emotions, combined with the lack of education, led to me waiting two months before seeing a physician. After having an appointment with my OB/GYN on March 25, 2020, I still don’t know much, but here is what I do know and would like to share:

Uterine Fibroids

The uterus is a muscle, and fibroids are an overgrowth of muscle cells within the uterus. Researchers are not exactly sure what triggers their formation. Scientists know that they cause hormonal receptor changes and respond to hormone changes themselves. They also know that they are in part genetically passed on and disproportionately affect black women. Fibroids are associated with having a first period before the age of ten and obesity.

Black Women

Fibroids affect black women disproportionately, but scientists can’t figure out why. In many women, fibroids are asymptomatic. For example, more than 80% of black women and 70% of white women will have fibroids by the age of 50. However, only 20-50% of women will have symptoms. Some women – black women in particular – are more likely to be symptomatic. Black women have a higher number of newly diagnosed cases of fibroids, worse symptoms, and present at a younger age than other women. Their fibroids also grow quicker and to a bigger size. Additionally, black women are more likely to be hospitalized for fibroids and undergo more invasive treatments, like a hysterectomy, than white women.

Symptoms

Symptoms are different for everyone, but they often depend on the size of the fibroids. Typically, women complain of heavy bleeding or long periods. As the fibroids get bigger, they may also complain of pressure, pain, and a sense of fullness. If there’s compression of the bladder or the intestines, people can experience difficulties urinating and constipation. They may also experience difficulty getting pregnant or have painful sex.

Misconceptions

Fibroids are Cancerous

Sometimes, people refer to fibroids as “tumors”. Medically speaking, a tumor is technically just a mass, and a fibroid is just that – a mass. In American English, “tumor” makes people think of cancer. Fibroids, however, are not cancer. They’re just a collection of overgrown uterine muscle cells.

You Can’t Get Pregnant if You Have Fibroids

Fibroids make many people worry about their fertility. While it’s true that the location and size of fibroids can disrupt a pregnancy, this isn’t true of all fibroids. Additionally, there are certain treatments that can help people improve their chances of pregnancy.

Once Fibroids are Removed, They Can’t Come Back

It’s important to realize that fibroids can recur even if they’re removed. Fortunately, there are different treatment options for different situations.

Treatment

Choosing the best treatment option depends on the patient’s symptoms and health goals. If the patient isn’t having any symptoms, there’s no need to treat. There are some medications women can take to control symptoms. If they want to control bleeding, they can take oral contraception pills, otherwise known as birth control pills. These don’t treat the fibroids themselves but rather control the bleeding. Hormone pills called GnRH agonists can shrink the fibroids prior to surgery, but they’re not a good long-term solution due to side effects. There are more invasive and definitive treatments. If the woman wants to get pregnant in the future, she can get a myomectomy. This is a surgery in which the doctor just removes the fibroids themselves. This isn’t an option for everyone if the fibroids are too big or invade different layers of the uterus. If pregnancy isn’t a concern, the patient can get a uterine fibroid embolization or a hysterectomy. An embolization is less invasive and involves cutting off the blood flow to the fibroid. A hysterectomy is a surgery in which the uterus is removed. The disadvantage is that the patient can’t get pregnant once the uterus is removed, but the advantage is that it is the only 100% effective way to prevent future fibroids.

Update: I spoke with my physician on 3/27/2020 I have a scheduled procedure on 4/1/2020 for a colposcopy. Results from my pap came back, there were numerous atypical cells, this test determined that the atypical cells were not cancerous.

Public Health Note: Yearly physicals are covered as preventive care under the Affordable Care Act, which means if you have insurance you are able to see a physician once every 365 days free of charge.