Fibroids
Careful exams and being educated are the best ways to check and treat this disease

A doctor once told Greenville native Gail Parsons that anything in the body that is not being used is a breeding ground for problems. “I thought it was kind of harsh,” she said. “But now I understand.”

Last year, Parsons, 44, experienced heavy bleeding, cramping and spotting between menstrual cycles. After going to see her doctor, the diagnosis she received was uterine fibroid tumors, or benign — that is, noncancerous — tumors of the uterus. The tumors grow from the muscle cells of the uterus and may protrude from the inside or outside surface of the uterus, or they may be contained within the muscular wall.

“My doctor suggested I have an ultrasound, which I did,” said Parsons, who asked that her real name not be used. “Ten fibroids were found, and one was the size of a grapefruit.” According to Benjie B. Mills, a physician with the Center for Women’s Medicine at the Greenville Hospital System, 25 percent of all women will have fibroids at some point in their lives.

Dr. Mary Haddad, left, of Spartanburg Regional Health System discusses the symptoms and options for treating fibroids with a patient. “Patients should be educated about what makes women symptomatic,” Haddad says. “If they have fibroids, they should see their gynecologist … more frequently, like every six months.

“Fibroids typically grow very slowly and sneak up on women,” she said. “By far, most are about 1 centimeter in size to 1 inch — 2.5 centimeters — in diameter. The ones that gather our attention are 8, 12 or 20 centimeters.” Mills and Parsons know of patients whose fibroid growths have presented visible bodily protrusions.

“In some women, their bellies will protrude, along with their external symptoms,” Parsons said. “Some other patients I’ve known could feel the fibroids if they pressed their abdomens, and some actually looked pregnant.” Laura LeBel, a physician in practice with the Highlands Center for Women in Greenville, agreed.

“A woman can carry a fibroid for many years,” she said. “The mass can cause bleeding, which may be very heavy during menses. If it is compressing the bowels, it may cause flushing symptoms – like having to use the restroom immediately after eating – as well as abdominal pain and bloating. My mother had one that was the size of a 20-week fetus before she had it removed.”

While the exact cause of fibroids is not known, several risk factors — including the use of birth control pills at an early age and significant consumption of ham, beef or other red meats — have been recognized as increasing a woman’s susceptibility.

“Some women may be asymptomatic,” said Mary Haddad, a physician in practice with Spartanburg Regional Health System. “Many times fibroids are found during a routine pelvic exam, and it is noted that the patient’s uterus is a lot bigger than the previous visit. Otherwise, the most prevalent symptoms are abnormal bleeding between periods, heavy menstrual flow during the menses and increased abdominal pain.”

LeBel found out during a routine pregnancy ultrasound that she had a fibroid. She did not have any symptoms before or since it was found. Her pregnancy was successful, and she has no plans to remove the fibroid, as she said she would like to have more children. Mills said fibroids are more common in black women than in Hispanic, Asian or white women.

“A fibroid starts from one cell’s programmed death,” she said. “The genetic alterations are passed along through DNA, and, unfortunately, we don’t have any known preventive.”

The symptoms are related to the number, size, and location of the fibroids, which can embed themselves in the lining of the uterus and occasionally attach to the outside of the uterus or an ovary. Increased uterine bleeding, pelvic pressure and pain, and problems related to pregnancy and fertility have been linked to fibroids — which are 99 percent benign but should still be tested for cancer.

“I was surprised that I had so many fibroids,” Parsons said. “Then my surprise kind of turned into fear at the prospect of their being potentially cancerous. I didn’t know much about fibroids in the first place, and then finding out their possible link to cancer was overwhelming.” More information is reaching the public about fibroids, but not fast enough to quiet the fears of women who have been recently diagnosed.

“Fibroids are a growth where the cells are dividing abnormally,” LeBel said. “Less than 1 percent are cancerous. It’s probably the biggest fear in the women I’ve seen. They can grow inside or outside the uterus, and a woman can carry a baby and have a fibroid. If the fibroid is inside the uterus, the placenta can’t implant itself and may cause fertility problems. If the fibroid is located low in the uterus and blocks the cervical canal, that would be the only reason for recommending a delivery by Caesarean section. A fibroid that is a large size won’t allow the fetus into the birth canal.” LeBel said that removal of the fibroid, or myomectomy, would be recommended in such cases.

“It’s very different for different age groups,” she said. “We see more fibroids in older women, and as we see the population getting older, we’ll see more. For women in their 30s and 40s, fibroids are often hereditary. Obviously, you want to avoid surgery and the risks associated with surgery.”

Hysterectomy procedures, which involve the removal of the uterus, are most often recommended to women suffering from fibroids.

Women in their childbearing years are faced with difficult decisions if they still desire a family or wish to have more children. In some cases where the patient opts to forgo a hysterectomy, the fibroids have been found to make an inexplicable return.

“I opted to have them removed,” Parsons said. “I didn’t have the hysterectomy, as I still felt there was a possibility that I might want to have children. My recovery took eight weeks, and I had the bikini cut surgery, which leaves a pretty long scar. I spent five days in the hospital, and I recovered at home. You’re out of commission for a while. I took things slowly, and now I’m back to my old routine.” Parsons’ recovery time is just about in line with Haddad’s recommendations for her own patients.

“I like patients to take six weeks,” she said. “Any time you open the belly, you have to take the time to heal.”

Unfortunately, a recent ultrasound has shown that a new fibroid has grown within Parsons’ uterus.

“I had been told about the UAE procedure,” she said. “However, I also know that since my mother had fibroids, I’ll always have to go back to the possibility that they will come back. I’m planning to just go ahead with the hysterectomy.” Uterine artery embolation — also known as UAE — is a nonsurgical procedure, which involves cutting off the blood supply to the tumors. LeBel said some women must follow up with a hysterectomy anyway, but she said she always shares all the options with her patients. LeBel said hysterectomy is an option for older women.

“You can treat the fibroids before surgery with Lupron, which helps shrink their size,” Haddad said. “Patients usually spend the night in the hospital because their pain has to be managed. In about a week or two, they should be back on their feet. It’s a new procedure and it’s been very popular here at Spartanburg Regional.”

Parsons said she hopes women will learn from her experiences. “My advice is that every woman should go and get a thorough checkup,” Parsons said.

“You have to be very persistent if you have the symptoms and any discomfort. I had a male doctor who said that maybe it was PMS, and then I saw a female doctor and she paid attention to my symptoms. She recommended that I have the additional tests, and I’m glad I followed through with them.” Haddad agreed.

“Women should maintain their scheduled annual pelvic exams,” she said. “Patients should be educated about what makes a women symptomatic. If they have fibroids, they should see their gynecologist even more frequently, like every six months. If women are finding that they can’t get their skirts around their abdomens, they shouldn’t blame it on the holiday food that caused 15 pounds of weight gain. It could be that there is a fibroid present.”