Are your periods exceptionally heavy and keeping you from sticking to your exercise routine? Do you find yourself exhausted and weak for the entire duration of your period—sometimes as long as eight days?
Do you have to set an alarm each night to change your pad so you won’t wake up to a mess? And, do your legs ache to the point of distraction? When the bleeding finally stops, are you so tired you have no energy to run, or lift weights, or even take a brisk walk?
If you can relate to these scenarios, you may be suffering from uterine fibroids.
These noncancerous growths of the uterus are found in 35 percent of white women and 50 percent of black women at the time of menopause.
Fibroid tumors, also called myomas, are usually hard, similar to the inside of a golf ball, and they are made from a uterine muscle cell that starts growing out of control. The cells make a tight whirl of muscle cells and cause blood vessels to grow.
Fibroids are rarely cancerous, although in some cases it may be a possibility.
Many women who have fibroids do not have any symptoms. When symptoms do occur, they relate to the size and location of the fibroids.
Large fibroids can cause back pressure and aching legs and pelvis. Fibroids in the wall near the inside cavity, however, tend to cause heavier bleeding and low iron or anemia.
These annoying growths can increase in size and put pressure on the bladder and bowl, creating a constant urge to go to the bathroom. Even worse, they can cause pain and discomfort during sex.
A patient I’ll call Molly came to see me to figure out her fatigue.
She was 44 and done having children. Most days, it was all she could do to keep up with her kids.
At least 10 days each month, she’d get home from work and collapse onto the couch, finding it virtually impossible to get up. She was just too exhausted. Six of those 10 days, she’d complain of heavy bleeding and annoying cramps; the other four, she was exhausted from all the blood loss.
Her office was doing a “Biggest Loser” contest. While she knew she needed to lose 25 pounds, she was just too tired. She lacked motivation to start an exercise plan or make any attempt at eating healthy.
As if all that wasn’t enough, she had to leave a work meeting because she felt a large clot come out and was afraid she would make a mess.
Molly had seen her family doctor a few weeks before she came to see me, and her doctor had ordered blood work to see if they could find some answers.
The results showed her hemoglobin blood count was 9 and her iron (ferritin) was 5. Both numbers were well below normal, so Molly’s doctor insisted she visit a gynecologist.
She lost so much blood on a regular basis and she couldn’t take enough iron (or she kept forgetting) to keep up with what her body needed. She had an ultrasound done and made an appointment to see me for further help.
When I asked Molly for more details, she told me the pressure on her bladder had gotten worse. Sometimes, when struck by the urge to urinate, she found she simply could not make it to the bathroom fast enough.
She didn’t want to have sex, either—sometimes because of bleeding, sometimes because it became too uncomfortable. It was anything but enjoyable. While understanding, her husband seemed sad; she missed sex with him as well.
Fortunately, Molly didn’t have any other major health issues except for her weight. Her cholesterol and blood sugar levels hovered at borderline high, but we could get those under control.
She had been experiencing an occasional night sweat right before her period, meaning she was on the edge of menopause.
Both her mom and grandmother had experienced fibroids, and they both had hysterectomies by the age of 40. Molly hoped to avoid the same fate.
Her ultrasound revealed a large fibroid measuring nearly the size of a baseball on the front of her bladder. It also showed several plum-sized fibroids near the lining of her uterus.
Together they caused the pressure she felt, and the heavy bleeding.
Her age, weight gain, fatigue and borderline cholesterol levels told me she reached an important time in her life—she needed to make some changes that would affect her for years to come.
Back in control
If Molly didn’t make some healthy adjustments, the result could be difficulty reversing her weight gain, the start of heart disease, and increased stress at home because of not being involved with her kids and husband nearly half of every month.
We talked about Molly’s somewhat limited options because she had fibroids in two different places.
If the fibroid formed just on the outside of the uterus, an IUD with progesterone, such as Mirena, would at least help the bleeding.
If the fibroids formed just on the lining of the cavity of the uterus, they could be removed without removing the uterus. Unfortunately, because she had fibroids in both places, the best recommendation for permanent treatment was a hysterectomy.
But first we needed to get her healthy enough to undergo surgery.
After taking her vitamins and iron faithfully for eight weeks, and adding an oral progesterone medicine to slow the bleeding, Molly’s iron level rose high enough to proceed.
I performed a laparoscopic hysterectomy—removing her uterus by making only three or four small incisions in her abdomen. Molly went home the same day and returned to work at full speed in four weeks. She couldn’t have sex for eight weeks as she waited for everything to heal, but then we cleared her to return to life as usual.
At Molly’s post-op appointment, she told me she felt like she had her life back and had motivatation to lose weight, lower her cholesterol and enjoy her family again.
She felt like she had won the “Biggest Loser” contest after the fact, and she seemed content with having to lose her uterus in order to move forward with the rest of her life.
Fibroids had been taking control of Molly’s life.
Now she’s back in control.