Understanding fibroids and what to know

I can tell Grace, a 35-year-old Jamaican woman, is scared and confused. She has been referred to the Gynaecology department where I am a junior doctor, with a scan showing she has multiple fibroids in her womb. She’s suffered years of chronic pain up to this point, with extremely heavy periods and even blood clots, and she doesn’t really know what the diagnosis means.  

I see patients like Grace a lot; fibroids, which are non-cancerous growths of the muscle lining of the womb, are common. About one in three women will develop them in their lives, according to NHS statistics, with Black women like Grace up to three times more likely to have often painful symptomatic fibroids. Why do Black women suffer more? We don’t know. But they are more likely to experience symptoms that lead to surgical intervention and more likely to suffer multiple fibroids. It’s a huge problem, but it’s not a life sentence – there are things we can do to help, and it’s of vital importance to spot symptoms early so you can get support.

WHAT ARE FIBROIDS?

Fibroids are actually really common: about 30 per cent of all women get fibroids by age 35 and almost 80 per cent of women will have fibroids by age 50. Some are as tiny as a few millimetres, whilst others might be several centimetres wide and can develop inside or outside the womb. Most women – two in three – will not experience any symptoms, and those women don’t need treatment, as eventually the fibroids should shrink and disappear.

But those who do can suffer from symptoms including heavy menstrual bleeding, abdominal bloating, urinary frequency and pelvic pain. Often these symptoms can cause psychological distress affecting lots of areas of women’s lives from sex to fertility struggles. Judging by the women I’ve met, living with the symptoms can be a very overwhelming experience. Often women with fibroids have been struggling for several months, or even years, with their symptoms before they seek professional help, because the issue is not talked about enough.

HORMONAL LINK

We don’t know the exact cause of fibroids, but they are linked to the hormone oestrogen: fibroids usually develop during a woman’s reproductive years, when oestrogen levels are at their highest. There are certain factors that can increase the amount of oestrogen you are exposed to, altering your risk of fibroids, such as being overweight and early menarche (when you first start menstruating). By contrast those who have children and fewer periods have a lower risk of developing fibroids, due to having less oestrogen exposure whilst they're pregnant and having fewer periods – although some women do experience fibroids during pregnancy, too. Many women’s fibroids will shrink following the menopause once oestrogen production falls. Presently, scientists are unclear on genetic factors that influence fibroid formation but there have been suggestions that they could be hereditary. If your mother or sister suffered from fibroids then you’re three times more likely to get them, too.

Sophia Forrester a medical herbalist, says, “Oestrogen is naturally metabolised and excreted by our body mechanism, but this process can be slowed down by several factors such as slow bowel movements and a poor working liver. Both magnesium and B6 help with the detoxification of oestrogen and can help to improve hormone balance. Making sure you have regular moving bowels is also key, which can be helped by a diet rich in fibre.”

MEDICAL TREATMENT

Most fibroids that are less than 3cm can be managed simply by taking tranexamic acid or by using hormonal contraception such as the combined oral contraceptive pill or Levonorgestrel releasing IUS (Mirena) to reduce problems such as heavy bleeding. But for bigger growths, or for women trying to get pregnant, there are options including uterine artery embolisation (blocking the blood supply so that the fibroid shrinks) or myomectomy (surgical removal of the fibroid) but these do have their own set of complications. For instance, in at least 10 to 50 per cent of cases in which fibroids are removed, new fibroids grow back. More recently drugs such as ulipristal acetate, which blocks oestrogen production, have been used to shrink fibroids however, its use in the UK has currently been suspended due to safety concerns.

LIFESTYLE INFLUENCES

“Fibroids can be a distressing chronic condition and should be approached holistically,” Lola Ross, Moody Month’s co-founder and clinical nutritionist, says. “Alongside any medical and complementary care, aim to support healing with a diet that promotes hormone health. Include plant-based organic foods to avoid endocrine disrupting compounds (EDCs) often found in non-organic meats and other foods.”

She also suggests finding ways to help reduce negative stress “which can interfere with normal cell signalling, which can in turn disrupt hormone balance and potentially mediate conditions like fibroids.”

In addition, it has been suggested that vitamin D has the ability to regulate the immune system and may limit the production of fibrous tissue by fibroid cells, thus preventing fibroids from developing. “A 2014 Black Women’s Health Study showed a relationship between vitamin D deficiency, genetic variations (SNPs) in vitamin D – related genes and fibroid incidence in black women. Vitamin D3 supplementation may be useful in the prevention and management of fibroids in black women.” People with darker skin tones have more melanin, which reduces the skin's ability to produce vitamin D from sunlight, so a supplement could be beneficial, but it’s important to seek professional and personalised advice.

Many women will have fibroids and will never experience any symptoms, whereas, for some it can be life-changing. It is vital that if you are struggling with some of the symptoms mentioned that you seek the right help and advice; nobody should suffer in silence.