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    Uterine Fibroids – Revisited

    by Ngozi Osuagwu, MD | April 7th, 2024

    Uterine Fibroids – Revisited

    I am always a little surprised when I have to tell a patient they have uterine fibroids, and they look puzzled. I then ask the question—do you know what fibroids are? No. Have you ever heard of fibroids? Not really. Sometimes, as a physician, because you see something often, you assume everyone knows what it is.

    The last time I wrote about fibroids in depth was in 2017. It was time to revisit fibroids and discuss the options available. The purpose is to make sure those who have been diagnosed with fibroids are fully aware. 

    What are uterine fibroids? They are benign (not cancerous) growths of the uterus muscle. You might hear it called leiomyomas or myomas. They vary in size, number, shape, and location in the uterus. Some women may have one fibroid, and some may have multiple fibroids. Fibroids can occasionally have ‘growth spurts, ’ which means they can be one size now and become very large in a few months.

    How did I get it? We do not quite understand why some women get it and others do not, but we know that there are factors that put you at increased risk of getting it. It occurs in women after puberty and before menopause because it is dependent on the hormone estrogen that is produced in the ovary. Most women will be diagnosed by the age of 50. It is more common in black women. We know that if you start birth control pills before age 16, that would put you at increased risk of getting fibroids. Other risk factors include getting your period early, having low vitamin D levels, and eating high-fat foods.

    What are the symptoms of uterine fibroids? The symptoms can be generalized into two categories – heavy menstrual flow and pelvic pressure. With the heavy bleeding, you can become anemic and feel tired all the time. You can bleed so heavily that you have accidents (bleeding through your underwear and clothing). The pelvic pressure occurs because the uterus can be so large, making you look like you are pregnant when you are not. You might have urinary frequency, meaning you urinate a lot. You might have painful menstrual cramps and back pain and feel very uncomfortable.

    Some women do not have symptoms. In their case, fibroids are found when the doctor is performing a pelvic exam and notices that the uterus is more significant than usual.

    How do you make the diagnosis? The diagnosis is usually based on your history (the story you tell the doctor) and your physical exam. The doctor will suspect that you have fibroids and then order a pelvic ultrasound to confirm the diagnosis. Sometimes, the uterus is so large that the ultrasound cannot show everything, and an MRI will need to be ordered.

    What other test do you need to order? A complete blood count (CBC) is ordered to see if you are anemic. Some women have had heavy bleeding all their life and have thought that was normal and never knew they had fibroids. It can take up to 5 years of actual heavy bleeding before the diagnosis of uterine fibroids is made because we have ignored our symptoms. A thyroid screening test and maybe vitamin D levels may be ordered.

    Will I be able to have children? Yes, you may be able to have children, but it depends on the location and size of the fibroids in the uterus. You have to start trying to have a child for us to know if the fibroids will cause a problem. It is hard to know who will have a problem. After six months of trying without getting pregnant with known uterine fibroids, the doctor will start an infertility workup. Once you are pregnant, you may be at risk for miscarriage or preterm labor, but the majority of women with uterine fibroids who become pregnant will have healthy babies that go to full term without problems.

    Check out next week’s blog for more questions and answers regarding uterine fibroids.

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    With her trademark wit and straightforward communication, Dr. Osuagwu continues to dole out valuable medical advice using the letter form and addressing women’s health conditions and issues in a method that was praised for its innovative approach in her earlier award-winning book, Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist. In this book, each letter is paired with reference sources and statistics about the condition that is the subject of the letter.

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    Secure Your Copy of Letters to My Sisters by Dr. Ngozi Osuagwu.
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    The book discusses common gynecological and women’s health issues in a series of witty and entertaining letters. These letters, all educational, offer suggestions on what approaches to take in tackling the medical problems that typically bring women to an ob/gynecologist. The letters are spiced with art, a poem and quotes. Although its emphasis is on gynecology and women’s health, it touches on some other medical issues that make women visit their doctors.

    The second half of the book briefly discusses the most common gynecological conditions and also provides an overview of sexually transmitted infections. A list of annotated websites dealing with the different topics in the book is provided for the reader who wants to pursue each subject in depth.




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