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Debunking Myths About Fibroids

There are several prevailing myths about fibroids, the most common benign tumors of the uterus. The first is a great relief to debunk- the myth that fibroids lead to cancer.  In fact, 999 out of 1000 fibroids are not cancerous.  In the 1 out of 1000 cases that become malignant, women are generally over age 50 or their fibroids grow unusually rapidly.  In borderline cases, your doctor may recommend a hysterectomy even if you don't have bothersome symptoms.  Benign fibroids may also grow to be huge, however, sometimes as large as a pregnancy!

Myth:  Fibroids increase your chances of endometrial cancer.  Fibroids are associated with a fourfold increase in the risk of endometrial cancer (cancer of the lining of the womb), but fibroids don't cause this.  The current thinking is that the same factors increase your risk for fibroids that also increase your risk for endometrial cancer.

Myth:  If you have fibroids, you must have a hysterectomy.  This thinking was common in the 1970's when there were 4 times as many hysterectomies performed per year in the US as there are now.  Now we know that even those fibroids that cause bothersome symptoms can often be treated with medicine or a lesser surgical procedure than removing the uterus entirely.  We also know that fibroids generally shrink in size after menopause.  With the advent of uterine-sparing surgical techniques and the use of lasers, we have greater ability to remove just a fibroid without removing the entire uterus.  This is of great importance to women with fibroids who want to be able to become pregnant.

Myth:  If you have fibroids, you can't become pregnant.  Fibroids can prevent pregnancy in certain patients, but the majority of women with fibroids will never even know that they have them.  Most often, fibroids are incidental findings when a woman has an ultrasound test for another reason.  In some patients, however, fibroids may cause miscarriages or other obstetric complications, depending upon the fibroid's size and location, and whether the pregnancy is a singleton or a multiple.  Occasionally, doctors will recommend removing a fibroid during pregnancy (myomectomy).  More commonly, doctors will recommend a myomectomy to patients who have had previous complications of pregnancy as a result of their fibroids.

Myth:  Birth control pills can "treat" fibroids or reduce fibroid size.  There is no evidence that this occurs.  Some patients with heavy bleeding, however, may notice a decreased amount of menstrual blood loss when on birth control pills.  The theory behind the use of low dose birth control pills in the treatment of fibroids, especially among perimenopausal women, is that they decrease hormonal fluctuations during the menstrual cycle, and this may decrease their stimulatory effect on fibroid growth.  Birth control pills are quite useful in the treatment of endometriosis, another very common condition causing pain and bleeding and stemming from the lining of the uterus, but quite different from fibroids.

Myth:  Birth control pills are bad for women with fibroids.  There is no association between birth control pills and fibroid growth or recurrence, despite the fact that they contain estrogen.  There is reason to believe that women entering menopause who have large or symptomatic fibroids should defer estrogen replacement therapy or use only the smallest doses.  This must be discussed with your physician on a case by case basis, considering all risks and benefits.

Myth:  There is a "miracle diet" that can cause fibroids to "vanish".  This is a wholly unsubstantiated claim.  There are no dietary supplements or practices that can reduce fibroid size, nor are there any magical therapies. 

Myth:  You are more likely to have fibroids if you have fibrocystic breasts.  While the words "fibrocystic" and "fibroids" are similar, there is no relationship between the two conditions other than that they are both very common in premenopausal women and they both regress in menopause.

Myth:  You don't need your uterus after you've had your children, so just remove it if it gives you any problems.  This was the prevailing medical approach until recently.  We considered that once it bore our children, the womb's job was done and it became as unnecessary-and dispensable-as the appendix.  Recent research, however, suggests that the uterus is a biologically active organ that may interact with other organs such as the ovaries in ways that have yet to be understood.  For example, even when a woman has only her uterus removed, her ovaries stop functioning prematurely in about half of premenopausal women without any surgical complicating factors.  This may explain some of the recent surprises in studies of menopausal women on hormone replacement and their risk for various diseases.  This may also explain the observation that many women who have had a hysterectomy report decreased libido and decreased sexual satisfaction, although many researchers attribute this to lost uterine contractions and cervical stimulation, which heighten the sexual response in many women.

Created: 12/11/2003  -  Donnica Moore, M.D.

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