Fibroids 101 for Midlife Women — OB-GYN Explains

Dr. Jill Liss: Hi, I'm Dr. Jill Liss. I'm a Board-Certified OB-GYN and an advisor to Versalie. I specialize in complex gynecology and menopause care. Today, we're going to talk about a very common gynecologic issue, which is fibroids. Up to 80% of people will have them, but only about half of those people will be symptomatic. But let's talk a little bit more and dive in.

Ambassador: I was wondering, what are fibroids?

Dr. Liss: Fibroids are an extremely common growth that occurs in the uterus, and these fibroids grow in different areas of the uterus and can vary tremendously in size. And they're made out of the same muscle cells that are made by the uterus. They can be dynamic and respond to hormones, but they are generally slow growing and, in many people, may not even cause symptoms.

We don't exactly know why people get them, but we do believe that things that contribute to them developing include hormones, age, genetics, and environmental factors.

Ambassador: What symptoms do fibroids cause? And how would I know if I have them?

Dr. Liss: Fibroids can cause a range of symptoms based primarily on their size and location within the uterus. Some people may have fibroids and never know it and be completely asymptomatic. But if somebody does have symptoms, the most common things we see are heavy or prolonged bleeding, and pain, cramping, pressure, and even some urinary symptoms like urinary frequency.

How symptomatic someone will be from fibroids depends a lot on their size and location. We have three major types of fibroids based on their location.

The first type is called a submucosal fibroid. These types of fibroids are pushing or indenting on the uterine lining where bleeding comes from and can create an unstable bleeding environment leading to heavier periods and sometimes irregular bleeding.

The second type of fibroid is an intramural fibroid. These are clusters of growth that happen within the uterine wall and don't have as much of an impact on bleeding.

The third type is a subserosal fibroid. These fibroids are growing on the outside of the uterus, and they don't typically have any impact on bleeding. They can get large though and impact things like pressure or bulk symptoms just by virtue of being large.

If you are experiencing symptoms of fibroids, it's recommended to be seen by a gynecologist. On an exam, we can often feel an enlarged uterus and sometimes the fibroids themselves. The next step, if there's any uncertainty or even if they're felt on exam, would be to obtain a pelvic ultrasound. Pelvic ultrasound is a great imaging modality where we can see fibroids quite well, including their size and location.

Ambassador: So, I'm curious, does fibroids affect some groups of women more than others?

Dr. Liss: Yes. Fibroids are more common in certain groups, but we do see that certain racial and ethnic groups, particularly Black women, are more impacted by fibroids. They have them more frequently; they may present earlier, and they may have more significant symptoms.

The reason for this is not super well understood, but we do believe it's a coming together of several factors, including hormonal factors, environmental factors, and genetic factors. There's lots of research happening and more research happening every day to try to better understand why this might be the case and how we might do better to prevent fibroids in differences amongst groups as well as provide novel therapies.

Ambassador: So, I'm curious, how does fibroids relate to perimenopause and menopause?

Dr. Liss: Fibroids are not directly caused or related to menopause, but they do tend to run together for a few reasons. Fibroids tend to show up in the late 30s or 40s, which is when perimenopause is happening. Additionally, they may be influenced by the hormonal changes in perimenopause when there are actually extra hormones around, which may spur some fibroid growth.

The good news is though, is that when someone enters into menopause and there's permanent hormone decline, they tend to shrink and become asymptomatic.

Ambassador: For someone that has fibroids, what can they do about them? How can they get rid of them?

Dr. Liss: For somebody who has fibroids, there's a great range of treatment options ranging anywhere from doing nothing or observing, to intervening with surgery. The approaches we take really go after treating the symptoms of fibroids.

So, when we talk about over-the-counter or hormonal or other medications, those are treating symptoms like bleeding, rather than taking away the fibroid itself. In the over-the-counter department, things like anti-inflammatories can reduce heaviness of bleeding associated with fibroids. There are also some hormonal medications that are progestin-only that are available over the counter that can also significantly decrease the heaviness of bleeding associated with fibroids.

In the prescription category, there are several hormonal medications like oral contraceptive pills, as well as the hormonal IUD, that are highly effective in reducing the quantity of bleeding.

If symptoms are more severe or the symptoms are more related to the mass effect, meaning bulk, pressure, heaviness, there are more invasive options that are surgical that are highly effective in treating fibroids. Those options range from ablating the fibroids so that it shrinks with radiofrequency, to surgically removing the fibroids, but leaving the uterus intact, all the way to performing a hysterectomy that removes the uterus and the fibroids together.

The right treatment option is complex and nuanced and should be based on you as an individual. The best way to figure out what's right for you is to talk to a gynecologist about your options.

Ambassador: Do fibroids go away on their own? Can they shrink?

Dr. Liss: Fibroids don't go away on their own, but the dynamic shifts of menopause when hormones drop and stay low often lead to improvement of symptoms, and they may actually shrink up to about 30%. When they get smaller, that might mean that you don't feel bulk symptoms or pressure anymore. And in menopause, bleeding is also resolved.

If you are suffering from symptoms of fibroids like heavy bleeding or pressure, make sure to reach out to your gynecologist to explore diagnosis as well as treatment options to improve your quality of life. This is not something you need to suffer through, and it's important to get the help that you need.