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Women can experience pelvic pain and bleeding for a number of reasons, from a harmless menstrual cycle to more serious infections and, in some cases, uterine fibroids. Fibroids —benign growths of the uterus that most commonly appear in women during childbearing years — can also be considered harmless, with many cases never showing symptoms or causing pain.
Fibroid growths are driven by ovarian production of estrogen and progesterone, according to Dr. Steven McCarus, MD. While there’s no way to prevent or predict the appearance of these growths, the symptoms can present themselves in a range of ways:
- Abdominal pressure
- Extreme fatigue stemming from anemia
- Heavy bleeding
- Pelvic pain
- Weight gain
Of the 30% of reproductive-aged women who will experience fibroids, 20% of them don’t experience any symptoms at all.
Those who do show symptoms should contact their doctor immediately. At AdventHealth, our specialists will determine which medical or surgical strategies are needed, if any, to relieve the symptoms.
The method of treatment for a patient depends on whether or not that patient sees childbearing in her future, says Dr. McCarus, adding, “Uterine fibroids can be treated medically or surgically.” A physical examination and imaging will allow the medical professional to recommend the best type of care. Dr. McCarus describes three types of treatment.
If the patient doesn’t have symptoms:
Watchful waiting. Here, the physician and patient will continue to monitor fibroid development with regular visits.
If the patient does have symptoms:
Medical treatments. These can include oral contraceptive, non-steroidal anti-inflammatory medications, or Gonadotropin-releasing hormone (GnRH).
Minimally invasive surgeries like uterine artery embolization (UAE) and endometrial ablation.
UAE is a procedure in which the blood supply to the uterine fibroids is cut off, causing the fibroids to shrink. During this one three-hour procedure, the patient is typically awake and receives a sedative. Some types of endometrial ablation can also be done under conscious sedation, but can sometimes require general anesthesia. During the ablation, the lining of the uterus is removed, usually ending menstruation. Most women who undergo ablation are back to their normal routine within a week.
More invasive surgeries, such as myomectomy or hysterectomy, may be necessary in more serious cases.
A myomectomy is performed to remove symptom-causing fibroids and reconstruct the uterus. This procedure removes only the fibroids, whereas a hysterectomy removes the entire uterus. Both myomectomy and hysterectomy procedures are usually done while the patient is under anesthesia and will require a longer recovery time than UAE or endometrial ablation.
As a patient gets older, in their 40s and 50s, the risk of fibroids becoming cancerous increases. Dr. McCarus emphasized how important it is to continue monitoring fibroids at regular visits to the doctor’s office.
While a third of all patients (reproductive-aged women) will experience uterine fibroids, it’s important to know what factors put women at greater risk. African-American women have a three times greater risk of fibroid development, while those who have obesity, hypertension and diabetes are also at risk.
Women who have not been pregnant, as well as women who begin menstruating early on in their life, are also at a higher risk for developing uterine fibroids.
Learn more about women’s specialty care and find an AdventHealth for Women specialist who can help.