The Problem You Are Told to "Just Deal With"
You have been soaking through a super tampon every hour during your period. You are doubling up with a pad underneath. You carry a change of clothes in your bag. You have cancelled vacations, skipped workouts, and called in sick because the cramping and bleeding were simply too much.
You are not weak. You likely have uterine fibroids.
Fibroids are non-cancerous growths of smooth muscle tissue in the wall of the uterus. They are staggeringly common: by age 50, up to 80% of women will have developed them [2]. Despite their prevalence, fibroids remain one of the most under-discussed conditions in women's health, and too many patients are told to "just deal with it" until they are ready for a hysterectomy.
At MomDoc, we reject that binary. A hysterectomy is just one option on a spectrum of effective treatments, and for many patients, it is not necessary at all.
What Fibroids Are (And Why They Form)
Fibroids (medically called leiomyomas) are firm, round growths composed of smooth muscle cells and connective tissue. They develop within the muscular wall of the uterus and can range from the size of a seed to larger than a grapefruit. Some women have a single fibroid; others have many.
Why some women develop fibroids and others do not remains incompletely understood. Known risk factors include:
- Family history: If your mother or sister has fibroids, your risk is significantly higher.
- Race: Black women are diagnosed with fibroids 2 to 3 times more frequently than white women, tend to develop them at a younger age, and often experience more severe symptoms [2].
- Hormonal factors: Estrogen and progesterone stimulate fibroid growth. They tend to shrink after menopause when hormone levels decline.
- Age: Most commonly diagnosed in the 30s and 40s.
The Symptom Spectrum
Many fibroids cause zero symptoms and are discovered incidentally during a routine pelvic exam or ultrasound. But when fibroids do cause symptoms, they can profoundly affect quality of life:
- Heavy menstrual bleeding (menorrhagia): The most common symptom. Bleeding that requires changing protection every 1 to 2 hours, lasts longer than 7 days, or includes large clots.
- Iron-deficiency anemia: A direct consequence of chronic heavy bleeding. Symptoms include fatigue, weakness, pallor, shortness of breath, and dizziness.
- Pelvic pressure and pain: A sensation of fullness, heaviness, or aching in the lower abdomen.
- Urinary frequency: Large fibroids can press on the bladder, creating a constant urge to urinate.
- Constipation: Fibroids pressing on the rectum can impair bowel function.
- Pain during intercourse: Particularly with certain fibroid locations.
- Abdominal distension: Large fibroids can visibly enlarge the abdomen, leading to the mortifying experience of being asked "when are you due?"
Diagnosis at MomDoc
Fibroid diagnosis is typically straightforward:
- Pelvic examination: We can often feel larger fibroids during a bimanual exam.
- Transvaginal ultrasound: The primary imaging tool. Clearly maps fibroid number, size, and location.
- Saline infusion sonography (SIS): Provides enhanced views of the uterine cavity to identify submucosal fibroids that may affect fertility or cause heavy bleeding.
- MRI: Ordered for complex cases, particularly before surgical planning or when multiple large fibroids are present.
Treatment: The Full Spectrum
ACOG Practice Bulletin 228 [1] emphasizes that treatment goals should be individually defined and all available options should be offered.
Medical Management
- Hormonal IUD (Mirena): Can dramatically reduce heavy bleeding in patients with smaller fibroids.
- Tranexamic acid (Lysteda): A non-hormonal medication taken only during your period that reduces blood loss by 30% to 50%.
- GnRH agonists/antagonists: Temporarily shrink fibroids by lowering estrogen. Often used as a bridge to surgery or to control symptoms near menopause.
- Oral GnRH antagonists with hormonal add-back (elagolix, relugolix): Newer medications that can be used for up to 2 years to manage bleeding and bulk symptoms [1].
Procedural and Surgical Options
- NovaSure endometrial ablation: Destroys the uterine lining to reduce or eliminate heavy bleeding. Only for patients done with childbearing.
- Myomectomy: Surgical removal of fibroids while preserving the uterus. The preferred option for patients who want to maintain fertility. MomDoc performs this via robotic-assisted (da Vinci) laparoscopy for faster recovery and smaller incisions.
- Uterine artery embolization (UAE): A radiological procedure that cuts off blood supply to fibroids, causing them to shrink. Performed by interventional radiology partners.
- Radiofrequency ablation (Lap-RFA): A newer minimally invasive option that shrinks fibroids using targeted heat energy.
- Hysterectomy: The definitive treatment. Recommended only for patients who have completed childbearing, failed conservative treatments, or have very large symptomatic fibroids causing significant quality-of-life impairment.
Myth Busting: "Fibroids Always Require Surgery"
False. Many fibroids require no treatment at all. For those that do, effective medical and procedural options exist that preserve the uterus. Surgery (myomectomy or hysterectomy) is reserved for cases where medical management has failed or is not appropriate. The decision is always yours, guided by your provider's expertise and your personal goals.
The MomDoc Approach
- We do not default to hysterectomy. We present the full menu of evidence-based options and help you choose the approach that aligns with your reproductive goals and quality-of-life priorities.
- We address racial health disparities head-on. Black women are disproportionately affected by fibroids and historically under-served. We provide equitable, proactive care for all patients.
- We offer advanced surgical capability. Our robotic-assisted myomectomy program provides precision surgery with faster recovery times.
Stop Suffering Through Your Period
If heavy bleeding, pelvic pressure, or anemia is controlling your life, call MomDoc at 480-821-3601 or book a gynecology appointment online. You have options beyond "just deal with it."
This content is for informational purposes only and does not replace professional medical advice. Always consult your MomDoc provider regarding your specific diagnosis and treatment plan.