Uterine fibroids: Another women’s health concern affecting quality of life
By Justine Roper / Photo by Kate Treick Photography
Fibroids, although non-cancerous, can significantly affect a woman’s quality of life. These benign uterine tumors are common in women, particularly African American women.
Regina McCutcheon, M.D., OB/GYN, and Kasha Williams, ARNP, have over 20 years of experience in women’s health and are well-versed in the challenges posed by fibroids. McCutcheon, inspired by “The Cosby Show” to pursue obstetrics and gynecology, trained at Tulane University School of Medicine and LSU OB/GYN residency. Williams, who began her career as a medical assistant before advancing to a nurse practitioner, has served the Gulf Coast community extensively. Her varied experience in women’s health has contributed to her success as a practitioner.
McCutcheon recalled her early experiences with fibroid patients.
“Oftentimes the patients that came to us looked like they were pregnant,” she said, and this was likely due to the lack of medical access within that population in Louisiana.
Approximately 25% to 50% of women with fibroids experience symptoms such as heavy menstrual bleeding, pelvic pain, constipation, bladder problems, fertility issues, increased urinary frequency and anemia. However, 50% to 75% of cases are asymptomatic. Both McCutcheon and Williams observe that many women are not devastated upon diagnosis, as fibroids are often part of their family history. Yet, many women still experience fibroids without familial connections.
Fibroids are classified based on their location, McCutcheon explained.
“Submucosal fibroids lie inside of the uterus,” she said. This type is most likely to cause abnormal bleeding.
“Intramural fibroids are most likely to cause pain symptoms because they lie inside of the muscle tissue of the uterus.”
Subserosal fibroids lie on the outside layer of the uterus. “Imagine something is right under the skin where you can feel it.”
“Pedunculated fibroids have a stalk on them,” Williams added. “They hang off of the uterus similar to a tree.”
McCutcheon also explained that pedunculated fibroids have a mass effect as if they are pressing down on something. This is when you see bladder and bowel symptoms.
African American women are disproportionately affected by fibroids, with studies showing they are three times more likely to develop them than Caucasian women. Their fibroids also tend to be larger and cause more severe symptoms. Low vitamin D levels, which are common among African Americans, may contribute to the growth of fibroids. Regardless of race, 20% to 80% of women develop fibroids by age 50, with most cases occurring in their 40s and early 50s.
Risk factors for fibroids include race, age, family history, the number of births a woman has had, obesity and hypertension.
McCutcheon explained the obesity link.
“The more fat cells a woman has, there is an enzyme called aromatase which converts these fat cells into estrogen. Excessive estrogen can feed fibroids. This is why one of the first lines of treatment is lifestyle changes and weight loss. And, it is not because of aesthetic reasons,” she said.
If a woman is concerned about fibroids, Williams recommends a pelvic ultrasound as the typical diagnostic approach. Depending on the fibroids’ size, they may be detected during a pelvic exam, but a transvaginal ultrasound provides a clearer picture. In some cases, a pelvic MRI is used for diagnosis.
McCutcheon cautions that other conditions, such as Crohn’s disease or diverticulosis, can mimic gynecological issues, making imaging crucial for accurate diagnosis.
Many women worry about fertility after a fibroid diagnosis. McCutcheon assures patients that fibroids do not equate to infertility, and women can still get pregnant. In fact, women who have given birth are less likely to experience rapid fibroid growth, while those who haven’t are at higher risk.
Several treatment options are available for fibroids. Williams mentioned UFE (uterine fibroid embolization) and UAE (uterine artery embolization) procedures, which slowly shrink fibroids, though this process may be less appealing to some. Medication is also an option, particularly for managing heavy bleeding or temporarily placing a woman into menopause to shrink fibroids.
Surgery is another common treatment for fibroids. A myomectomy, which removes fibroids from the uterus, can be performed either through an abdominal incision (open myomectomy) or vaginally (hysteroscopic myomectomy), the latter being the least invasive. However, women of reproductive age often experience fibroid recurrence, and multiple surgeries can increase the risk of adhesions and scar tissue over time.
McCutcheon advises caution when treating asymptomatic fibroids, as intervention should focus on improving quality of life rather than just addressing their presence. Williams encourages women to base treatment decisions on their personal goals, whether it’s managing symptoms or planning for pregnancy.
Ultimately, fibroids, though common, should not be a major roadblock in life. Experts like McCutcheon and Williams emphasize that there is no one-size-fits-all approach to treatment. The key is to stay informed, consider your options, and choose a treatment plan that aligns with your goals.
MY JOURNEY WITH FIBROIDS: A personal reflection by Justine Roper
Navigating the world of women’s health can often feel like uncharted territory, especially when faced with conditions like fibroids. My own experience with fibroids has been a journey of discovery, resilience and learning to listen to my body in ways I never imagined I would have to. In many ways these things were foreign in regards to my health. Like many women, I was initially unaware of what fibroids truly were or how they could impact my life. It wasn’t until I found myself grappling with unexplained symptoms well into my 30s — persistent discomfort, heavy periods and a general sense of unease — that I began to unravel the mystery behind this common yet often misunderstood condition. Although I don’t know what lies ahead, I am grateful for the resources that I have come across along my journey. From my surgeon and OB/GYN, to support groups on social media, having the comfort of knowing that options are out there that can only get better with time allows my hope for a life without fibroids to rise.
