Uterine fibroids are non-cancerous myomas, or growths, that attach themselves to the inside of the uterine wall. These benign growths can cause a woman to have lower abdominal swelling and pressure, prolonged periods of bleeding during menstruation, pelvic and/or lower back pain, pain during intercourse and increased urination. These growths can be as small as a pea and virtually unnoticeable or a large mass that distends the uterus.
Why do Fibroids Develop?
Fibroids typically develop in women of childbearing age, and most of the time over the age of 30. They are stimulated by the same female hormones (estrogen and progesterone) that prompt the uterine lining to develop each month in anticipation of hosting a pregnancy. Doctors believe that the growths are birthed from a stem cell in the myometrium, i.e. the smooth uterine muscle. After rapid cell division, a firm and pliable myoma, unlike the muscle it is born from, takes residence in the uterus. The rate of growth can vary from woman to woman, with risk factors including family history, being over the age of 30, outside influences such as birth control pills, vitamin D deficiency, diet (high in red meat, fruit, dairy and alcohol), as well as pregnancy and obesity.
Hormones Play a Key Role
The two hormones implicated in triggering fibroid growth are estrogen and progesterone. Although they are the force behind fibroid growth, these hormones are necessary for developing into a woman and reproduction.
- Estrogen: Responsible for the development of female sexual characteristics and the same hormone that triggers the egg release each month from the ovaries.
- Progesterone: The other major female hormone produced by the ovaries aids in thickening and preparing the uterine lining for the fertilized egg by secreting particular proteins during the second half of the menstrual cycle.
Perimenopause Versus Menopause
The time in a woman’s life when the ovaries stop producing eggs and the production of female hormones of estrogen and progesterone begins to decline marks a time of physical change. Women can reach this stage of reproductive cessation as early as in their 40s and even into their 60s with an average age of complete termination of about 51 years old.
However, before full menopause sets in, a woman will experience perimenopause as the body prepares for the end of its monthly cycle. During the time of perimenopause (which can take place as early as 30 years of age, but typically begins from 40 to 44 years of age), estrogen levels can fluctuate from extreme highs to very low levels. These hormonal surges can induce the growth of fibroids. Because of this, in addition to the common symptoms associated with this life transition such as hot flashes, sleeplessness and menstrual irregularity, women may experience worsening of menstrual symptoms such as longer periods, heavier flow and severe pelvic cramping.
Once reaching the menopausal state as levels of estrogen and progesterone decline, uterine fibroids and the discomfort associated with them may lessen. Although the growths will still remain present in the uterus, the size will often dissipate and new fibroid growth may be stunted. With that being said, there are some risk factors that can increase fibroid development after the end of menstrual cycles. They include:
- High blood pressure
- Low vitamin D levels
- Family history
- No history of pregnancy
- Excessive stress
- Hormone replacement therapy
Treatment for fibroids can vary from pain management with non-steroidal anti-inflammatory medications to introducing birth control pills in premenopausal women. However, once postmenopausal, introducing any type of hormone therapy can have an adverse effect on fibroid growth. Procedures such as myomectomy (removal of myoma) or embolization (cutting off blood supply to the fibroids) have been found to benefit some women. In severe cases, doctors may even recommend a hysterectomy, i.e. removal of the uterus and/or ovaries.
With many variants of risk factors and severity of fibroids, the best course of action is to consult your physician and discuss the pros and cons of the treatment that is best for you.