A fibroid you can be proud of?

Does your menstrual cycle inspire you to investigate stock options in feminine products? Is your lifestyle dominated by your monthly cycle?

If you answered "yes," you may have a fibroid. Fibroids are muscular tumors that grow in the wall of the uterus (womb). Another medical term for fibroids is "leiomyoma" (leye-oh-meye-OH-muh) or just "myoma". Fibroids are almost always benign (not cancerous). Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.*

This blog entry was inspired by my daughter, Heather, who wrote this letter to me:

Dear Mom:

In February, I had a myosure procedure to remove a pretty large fibroid from my uterus.

Today was my three-month checkup appointment. Part one was finding that I was anemic – AGAIN. No surprise there, really, given the period I was still having. The second part was an ultrasound. The tech marked my cervix with a few mouse clicks, then the left and right side of my uterus, more mouse clicks, she marked my tubes, and then she took another picture and typed out:  F.I.B.R.O.I.D.?

LOL. Seriously, I couldn't help laughing. A few minutes later I'm dressed, and then undressed again for my yearly pap and a review of the ultrasound. My doctor comes in and says, "I don't know what to tell you. It's hard to believe and I've never seen anything like this, but another fibroid has grown back in the same place as the first, and is currently the same size as the one we removed. I can tell you what I would do if I were you – I'd have the hysterectomy."

 I've gone from thinking it's hilarious, in a very weird way (my fibroids are high achievers – if you've got to be a fibroid, be the best darn fibroid you can be), to feeling very sad.

I don't want to have a hysterectomy. I hate going to hospitals, being in hospitals.

Sharon – I'd like to get your professional and mom-based opinion.
To which I responded:
Take heart and don't hate on your uterus and its over-achieving fibroids.
Before I provide my mom-based professional opinion, I'd like to provide a brief anatomy lesson.
Think of your uterus as a pear-shaped, hollow organ. If you had never been pregnant your uterus would measure approximately 8 centimeters (3.1 inches) in length and 5 centimeters (2.0 inches) wide and about 2.5 centimeters (1 inch) thick. And, it would weigh about 40-50 grams (1.4 to 1.7 ounces). When you became pregnant, your uterus underwent a remarkable 10 to 20 fold increase in weight. After pregnancy, the size of your uterus is about 1.2 centimeters larger and about 20 to 30 grams heavier.
Your uterus has three layers, a thin external layer, the peritoneum, a thick muscular layer called the myometrium, and a thin inner layer, the endometrium. The inner layer responds to hormonal stimulation.
Then, knowing my daughter would want to know, I also offered the following in-depth information

 Leiomyoma Facts

Leiomyomas are benign smooth muscle growths that originate from the muscle of the uterus. The term fibroid stems from the fact that these benign growths contain collagen which creates a fibrous consistency. If you have been diagnosed with a leiomyoma, you represent the woman whose fibroids have become symptomatic. Most women with leiomyomas are asymptomatic. However, of the four most common symptoms women describe (bleeding, pain, pressure or infertility), bleeding is the most common symptom. Researchers have found that the bleeding associated with leiomyomas is likely due to pressure placed upon the uterine blood supply by the bulky nature of this benign growth.

Leiomyomas are classified based on their location and direction of growth:
  • Subserosal leiomyomas grow outward.
  • Intramural leiomyomas are centered within the muscular walls of the uterus.
  • Submucosal leiomyomas are near the endometrium and grow toward the endometrial cavity of the uterus.


Leiomyomas and Estrogen

Uterine leiomyomas are considered estrogen- and progesterone-sensitive tumors. They develop during your reproductive years. Some risk factors include early menarche (first menstrual cycle), elevated body mass index, family history of fibroids, African-American race, and a history of polycystic ovary syndrome.

Leiomyomas themselves create an increased estrogen environment which is needed for their growth and maintenance.
So what to do?
  • If your leiomyoma is small, you may be a candidate for a procedure called a "uterine artery embolization" in which the blood supply to the leiomyoma is blocked.
  • If you are interested in maintaining your fertility, a myomectomy may be an option.
  • There are also medications which aid in decreasing the size of the uterus.
  • The ultimate resolution for women with multiple leiomyomas is a hysterectomy.
The most important question to ask yourself is whether your quality of life will improve based on the outcome of your choice.
Love, Mom
I'm glad my daughter asked the questions that were on her mind. That's the only way to learn about our bodies and the options we face as women. Just as I counsel my daughter from time to time, I also counsel patients, and I'd love to answer your questions as well. Check out my Facebook page and leave me a private message if you wish, or post a question that you think others might have as well. Or, just comment here on this blog to get the conversation going. 

Additional resources:

The Centers for Disease Control and Prevention (CDC) – Heavy Menstrual Bleeding

The American College of Obstetricians and Gynecologists (ACOG) – Frequently Asked Questions: Uterine Fibroids

(Based on the Guiness Book of Records, the heaviest fibroid weighed 30 kilograms (66 lb. 2 oz.) and belonged to Mrs. Mahadevamma (India). The fibroid was removed by a team of surgeons and nurses, led by Dr. Pushpanjali Malipatil (India) at the Rajiv Gandhi Superspeciality Hospital in Raichur, Karnataka, India on Dec. 19, 2005).

*From Womenshealth.gov

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