By Dr. allyson Shrikhande, md

While 1 in 3 women have fibroids at some point in their lives, only a small percentage have symptoms. At PRM, we believe that even when something is “common” it should not be normalized. Which is why I want to take some time to share everything you need to know about uterine fibroids. 

What are uterine fibroids?  

Fibroids are benign tumors comprised of the uterine muscle and connective tissue in the uterus. Uterine fibroids refer to the overgrowth of muscle cells within the uterine wall. 

What are the symptoms of fibroids? 

A common symptom associated with uterine fibroids includes excessive menstrual bleeding (menorrhagia) which can often cause anemia. Fibroids can cause symptoms such as:  

  • Pelvic pressure or pelvic pain
  • Bowel dysfunction,  
  • Urinary frequency and urgency 
  • Urinary retention
  • Low back pain 
  • Constipation
  • Painful intercourse

Fibroids are associated with infertility as well. 

Uterine fibroids can cause pelvic pain from pressure on surrounding structures such as the bladder, pelvic nerves and pelvic floor muscles. 

What are the causes and risk factors for developing fibroids? 

There is a genetic predisposition to having fibroids. Estrogen predominance is usually a common cause and risk factor for uterine fibroid pain. Risk factors, both modifiable and non-modifiable, are associated with the development of fibroids include age, race, endogenous and exogenous hormonal factors, obesity, uterine infection, and lifestyle factors. 

Lifestyle factors for the development of fibroids include a diet low in fruit, vegetables, and vitamin D, increased pollutants in food, and caffeine and alcohol consumption. A lifestyle with low physical activity, high stress, and smoking are also risk factors for developing fibroids. 

Why are fibroid symptoms commonly misdiagnosed or normalized?  

Fibroids are quite common, and the symptoms are often dismissed as “normal period pain” or “it must be in your head”. Ultrasound is typically the initial imaging used to diagnose Fibroids, and depending on the location and size they may be missed on ultrasound. 

What are the treatment options for fibroids? 

There are many ways to manage and treat fibroids, which include medication (hormonal contraceptives, tranexamic acid, Gonadotropin-releasing hormone agonists or selective progesterone receptor modulators, non-steroidal anti-inflammatories), surgery (including hysterectomy, myomectomy, magnetic resonance-guided focused ultrasound surgery), and embolization methods.  

Pelvic floor muscle dysfunction and chronic pelvic pain syndrome can be triggered by uterine fibroids and contribute to fibroid symptoms of pelvic pain and pelvic pressure. 

At PRM, sometimes our office-based treatment to the nerves and muscles of the pelvis is combined with a hormonal approach and sometimes it is not. It depends on the location, size and number of fibroids and the patient preference and stage of life. Some of our patients are actively trying to get pregnant so they cannot be on a birth control, some cannot tolerate the side effects of birth control. 

At PRM, our non-operative approach does not include hormones since we are treating the pelvic floor dysfunction that comes with fibroids and can cause the symptoms of fibroids. As fibroids often cause the pelvic floor muscles to go into a spastic and guarded state, this in turn will lead to abdominal pelvic pressure and pain, pain with intercourse, urinary symptoms and bowel symptoms. We directly treat the pelvic floor muscles and nerves and reduce the pain and pelvic pressure associated with fibroids. We do this as an in-office, ultrasound-guided approach to the pelvis- targeting the pelvic nerves and muscles that are irritated and inflamed due to persistent pelvic pain from conditions such as fibroids. Essentially, the treatment works to increase blood flow to help heal the nerves and muscles of the pelvis.

How effective are non-surgical treatments for fibroids and what is recovery like? 

Our office-based treatments have been shown to decrease pelvic pain and pressure symptoms by 50%, improve sexual, bladder and bowel function by 35%. This is without the use of any hormonal methods. As the needle used is so small, safety is not an issue and there is no downtime, patients go on with their day. They go right to work, lunch, dinner and even the gym. 

Why should women with fibroids seek non-surgical fibroid treatments as opposed to hysterectomies? 

We believe that often, a hysterectomy is a jump, when fibroids can be treated non-surgically in a method that is non-invasive and requires no downtime and better results. 

Additionally, patients who are closer to menopause tend to do well with PRM’s non-operative care as fibroids tend to get smaller and maybe even go away with menopause. 

What questions should women be asking their doctors about their fibroids?  

Patients should ask their doctors about all potential treatment options and combination of treatment options. If patients are interested in a non-surgical approach, we make sure to address not only the hormonal options but also the options for treating the pelvic floor muscles and nerves. If patients are considering a surgical option, please ask about all the different surgical options.