In November, actress Sharon Stone, 64, announced on Instagram that she had been diagnosed with a large uterine fibroid that had to be removed. She said that she had previously been "misdiagnosed and undergone an incorrect procedure," although she did not give specific details. Stone noted that she suffered from severe pain and had received a "double epidural" to relieve the pain. When her pain continued to increase, she decided to seek a second opinion, and the correct diagnosis was made.
True to her history of advocacy, Stone said she came forward about her health condition to spread this message: "Ladies in particular: Don't get blown off. GET A SECOND OPINION. It can save your life."
This is not the first time Stone has spoken up about her experiences with women's healthcare. In another message posted to Instagram in June, she said that she had had nine miscarriages prior to adopting her three sons. "We, as females don't have a forum to discuss the profundity of this loss. I lost nine children by miscarriage. It is no small thing, physically nor emotionally yet we are made to feel it is something to bear alone and secretly with some kind of sense of failure."
"Instead of receiving the much-needed compassion and empathy and healing which we so need, female health and wellness left to the care of the male ideology has become lax at best, ignorant in fact, and violently oppressive in effort," she added.
What Are Uterine Fibroids?
Uterine fibroids, or leiomyomas, are tumors or growths made of smooth muscle cells, fibroblasts, and other material that grow in or on the wall of the uterus. They are almost always benign. In fact, they are the most common non-cancerous tumors in women of childbearing age.
Fibroids can grow as a single tumor, or there can be many of them. They can be as small as an apple seed or as big as a grapefruit. In unusual cases, they can become very large, and can grow, shrink, or remain a constant size over time.
Fibroids are categorized based on where they grow:
- Submucosal fibroids grow just underneath the uterine lining and into the endometrial cavity
- Intramural fibroids grow in between the muscles of the uterus
- Subserosal fibroids grow on the outside of the uterus
- Pedunculated fibroids grow on stalks that protrude from the surface of the uterus or into the uterine cavity
Uterine fibroids are clonal in origin, appear after menarche, typically grow during the reproductive years, and then stabilize or regress after menopause. They are most common in women in their 40s and early 50s; about 20% to 80% of women develop them by age 50.
Symptoms
Many women have no symptoms with fibroids. However, they can cause uncomfortable or sometimes painful symptoms, such as:
- Heavy bleeding or painful periods
- Anemia
- Bleeding between periods
- Feeling "full" in the lower abdomen (pelvic pressure)
- Frequent urination (caused by a fibroid pressing on the bladder)
- Pain during sex (dyspareunia)
- Lower back pain
- Reproductive problems, such as infertility, multiple miscarriages, and early onset of labor during pregnancy
- Obstetrical problems, such as increased likelihood of cesarean section
Causes
Currently, the exact causes of urine fibroids are unknown. that any or all of these factors might play a role in the growth of uterine fibroids:
- Genetics (e.g., genetic mutations in the MED12, HMGA2, COL4A5/COL4A6, or FH genes)
- Estrogen and progesterone
- Growth hormones
- Micronutrients, such as iron, which the body needs only small amounts of in the blood -- for instance, a deficiency of vitamin D may be associated with uterine fibroids
It is likely that fibroids are caused by many factors interacting with one another.
Risk Factors
Several factors may affect a woman's risk of developing uterine fibroids, including:
- Age
- African-American race
- Obesity
- Family history of uterine fibroids
- High blood pressure
- No history of pregnancy
- Vitamin D deficiency
- Food additive consumption
- Use of soybean milk
Factors that may lower the risk of fibroids include pregnancy (risk decreases with an increasing number of pregnancies) and long-term use of oral or injectable contraceptives.
Treatment
may provide only temporary relief from symptoms of fibroids. When medications are stopped, fibroids can grow back, and symptoms can return.
Common medical treatments for fibroids include over-the-counter or prescription pain medications; birth control pills or other types of hormonal birth control; progestin-releasing intrauterine devices (IUDs); gonadotropin-releasing hormone agonists; and anti-hormonal agents or hormone modulators.
Birth control pills can help control heavy bleeding and painful periods; however, they can sometimes cause fibroids to grow larger. Hormonal IUDs reduce heavy and painful bleeding, but do not treat the fibroids themselves. They are not recommended for women who have very large fibroids, which can block the uterine cavity.
Gonadotropin-releasing hormone agonists block the body from making the hormones that cause ovulation, and also reduce the size of fibroids. Because they can cause side effects that mimic the symptoms of menopause (such as hot flashes, night sweats, and vaginal dryness) and bone loss, they are not meant for long-term use. Most of the time, they are used for a short time to reduce the size of fibroids before surgery or to treat anemia.
Anti-hormonal agents or hormone modulators, such as selective progesterone receptor modulators, including (Mifeprex) and , have been studied with varying results. In May 2021, the FDA approved relugolix/estradiol/norethisterone acetate (Myfembree) as a once-daily treatment for heavy menstrual bleeding associated with uterine fibroids.
Hysterectomy
is the only sure way to cure uterine fibroids completely. It may be an option for women who are close to or past menopause or those for whom childbearing is no longer desired. It may also be used for women with very large fibroids or very heavy bleeding.
Endometrial ablation
, which destroys the lining of the uterus, is used to treat small fibroids. Ablations can be performed in a variety of ways, including using electric currents, microwave energy, high-energy radio waves, hydrothermal energy, and freezing.
Although pregnancy is unlikely after this procedure, it can occur. Women who get pregnant after endometrial ablation are at higher risk for miscarriage and other problems.
Uterine artery embolization
In , also called uterine fibroid embolization, a physician makes a small cut in the groin area, inserts a catheter into the large blood vessel there, and slides the tube until it reaches the arteries that supply blood to the uterus. The doctor then injects tiny plastic or gel particles through the tube into the arteries. The particles block blood flow to the fibroids, so they eventually shrink, and symptoms may be relieved.
Research has shown that this procedure successfully treats fibroids, but about one-third of women need treatment again .
Because this procedure stops blood flow to parts of the uterus, it can affect how the uterus functions. It can also affect how the ovaries function if the inserted particles drift into other areas of the pelvis, such as the ovarian artery. The effect on pregnancy is not clear, but an increased risk of miscarriage has been reported. For this reason, most healthcare providers do not recommend uterine artery embolization for women who want to have children.
MRI-guided focused ultrasound
This treatment destroys fibroids by using . The healthcare provider uses an MRI scanner to see the fibroids and then directs focused ultrasound waves through the skin to destroy the fibroids. This option is usually recommended for women who have only a few large fibroids.
Scientists are still studying the long-term effects of this procedure. Studies show that although symptoms improve up to a year after having MRI-guided focused ultrasound, within 2 years about one in three women will need another surgery or another procedure to treat fibroids.
Myomectomy
Myomectomy is a surgical procedure that removes only the fibroids and leaves the healthy areas of the uterus intact. It can preserve the ability to get pregnant.
Myomectomy can be performed in one of three ways: hysteroscopy, laparotomy, or laparoscopy.
Studies show that myomectomy can relieve fibroid-related symptoms in 80% to 90% of women. The original fibroids do not regrow after surgery, but new fibroids may develop.
Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children's Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.