What Causes Fibroids?
Asking questions about fibroids is a lot easier than getting answers. They’re the most common tumor of the female reproductive system: It’s estimated that 75 percent of all women have them. But doctors simply don’t know why fibroids develop in the first place or why they recur, nor do physicians agree on what the best treatment is.
These hard knots of muscle fiber and collagen grow within the walls of the uterus, sometimes protruding from it or even growing on stalks outside the womb. (See "Fibroid Types and Symptoms" on page 4.) Fibroids can range in size from the head of a pin to a grapefruit. Not all fibroids are troublesome, but when they are, the symptoms they can cause — heavy bleeding, an abnormally enlarged abdomen, pressure in the pelvic area, urinary incontinence and/or frequency, pain during sex, constipation, bloating, or sciatica (because of fibroids pressing on the bowel or a nerve) — depend on their size and location.
Risk factors for the tumors run the gamut from genes to body weight. "Research is showing that at least some fibroids arise from a genetic susceptibility," says Elizabeth A. Stewart, MD, director, Center for Uterine Fibroids at Brigham and Women’s Hospital, in Boston. "Having a first-degree relative with the condition increases your risk." But so do a host of other factors: excess weight, elevated blood pressure, alcohol intake, not having children, stress, excess exposure to estrogens in the environment — and just getting older. Race plays a role: African-American women are about three times more likely to get fibroids than Caucasians are.
Hormones are yet another factor. "Estrogen makes fibroids grow, which could explain why they tend to act up with the irregular hormonal surges in perimenopause, then shrink and become asymptomatic after menopause," says Wendy Wilcox, MD, assistant professor of ob-gyn at Montefiore Medical Center, in New York. "Conversely, progesterone may shrink them."
To diagnose fibroids, your gynecologist will do a pelvic exam to feel for masses in the uterine wall. The next step may be a pelvic ultrasound. Occasionally, she may also use a hysteroscope, a thin telescope inserted through the cervix, or MRI scans to reveal the number and location of fibroids.
Because fibroids are rarely malignant or fatal, they have not been considered an urgent health problem. Until about 10 years ago, there was no major funding for fibroid research. Hysterectomy — removal of the uterus — was the primary treatment. But in the past five years, new, minimally invasive surgical treatments have become available, and doctors now predict that fibroids will eventually be treatable without surgery. "I fully expect that the number of women who need fibroid procedures in the future will drop considerably, just as it has for men with prostate problems, who now take drugs such as Proscar, which shrinks the gland," says Richard S. Guido, MD, associate professor of ob-gyn at Magee-Women’s Hospital, in Pittsburgh. Drugs that reduce the production or action of estrogen and progesterone are being tested in clinical trials. Also under consideration are drugs that target collagen, the fibrous tissue that is a major component of fibroids.
Until drug treatments become available (at least a year or two more), you have to choose a treatment based on the size, number, and location of the fibroids, the invasiveness of the treatment, recovery time, and what your insurer will pay for. One treatment may not be the end of it, however, because fibroids can recur, either because old ones were not adequately treated or because new ones form. But as the six women profiled here prove, you can find relief.
Removing the Uterus & Blocking Circulation
The Fix: Removing the uterus
The Deciding Factor: "I needed to be able to work without discomfort."
The Woman: Deni Hodges, 52