What Are Fibroids

Dealing with fibroids and uterine polyps

QUESTION: I am a 53-year-old woman who has had fibroids for some time. Recently, I have had heavy menstrual bleeding. An ultrasound showed polyps. My doctor suggested treatment choices, including a new procedure that involves freezing the fibroids and polyps. I'm not sure what to do.

ANSWER: As you probably know, you're almost certainly in perimenopause, the four to eight years leading up to menopause (the complete cessation of menstruation). Each woman follows a different path to menopause, but it's very common for the menstrual cycle to be irregular and the amount of blood flow to vary.

Although perimenopause may contribute to your heavy bleeding, your fibroids and uterine polyps may also be responsible. Fibroids are growths of muscle and fibrous tissue in the wall of the uterus. They often develop in women between the ages of 35 and 50. They can make menstrual bleeding heavy and full of clots, before and during perimenopause.

Uterine polyps, on the other hand, are overgrowths of the endometrial tissue that lines the uterus. Fibroids and uterine polyps can be cancerous, but the chance of that is less than 1 in 1,000 for fibroids and about 1 in 100 for uterine polyps. Both are benign growths and, unlike cancerous tumors, they cannot spread to other parts of the body. In fact, neither problem increases a woman's risk for developing uterine cancer.

The blood loss from heavy menstrual bleeding can make women anemic. So you should have a blood test that measures your level of red blood cells, especially if you are feeling run down. Even though the chances of endometrial cancer are low, an endometrial biopsy should be done to rule out cancer. This is usually a quick office procedure that involves removing a very small piece of endometrial tissue.

Beyond these initial, precautionary steps, the question of how aggressively to treat heavy bleeding during perimenopause comes down to how much it's interfering with a woman's quality of life. Unless it is causing anemia, the bleeding itself is not harmful. And it rarely indicates a serious underlying problem.

So let's go through some of the choices. (There are many, so this isn't an exhaustive list by any means.)

• You could defer active treatment and just have your gynecologist continue to monitor you. You're not that far away from menopause, and any bleeding should stop once you are no longer having periods. The fibroids will shrink once you are menopausal.

What are fibroids and can they make you infertile?

I’m 36 and I’ve been trying for several years to get pregnant. I can’t afford fertility treatments and don’t have insurance. I do get bad PMS. One doctor suggested that I may have endometreosis and another suggested fibroids. How do they test to see if you have them? And how can you remove fibroids? And are the procedures costly and painful? THANKS!

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