80% of you have fibroids!
And of course it’s complicated by perimenopause.
Eighty percent of cisgender women will develop uterine fibroids before the age of 50. Eighty percent!
And of those, anywhere between 20 and 50 percent will experience symptoms including abnormal bleeding, intense pelvic and abdominal pain, urinary frequency, constipation and even infertility.
Of course it’s underresearched. Of course there is misinformation. And of course (of course!) it all becomes more complicated when your hormones start acting up in perimenopause.
Simply, fibroids are non-cancerous growths that occur in the uterus. They can vary in size and the number and severity of symptoms they cause (most commonly, abnormal bleeding and pain).
The numbers are even more staggering in Black women, 90 percent of whom will develop fibroids before the age of 50. They often develop fibroids starting at younger ages and have larger and faster-growing fibroids, too.
Because of all of this, they also experience more severe symptoms than other demographics, often grappling with pain and bleeding so intense that it can become disruptive to their daily lives: They are three times more likely to be hospitalized for fibroid-related issues, seven times more likely to undergo surgical removal of their fibroids, and twice as likely to have a hysterectomy to remove their uterus, and fibroids, altogether.
Even if you haven’t had symptoms before, sometimes perimenopause can lead them to rear their ugly head. And since 80 percent of us have them — across all races and ethnicities — I wanted to dig into what we should all know.
Cue the expert
I called Dr. Taraneh Shirazian, the director of the Center for Fibroid Care at NYU Langone Health (yes, you probably heard about it from Venus Williams) and the director of the division of women’s global and community health in the department of obstetrics and gynecology at NYU Grossman School of Medicine. She said that every single day, she fields questions about perimenopause and fibroids.
Fibroids feed on estrogen, so it makes sense that the big hormonal fluctuations that come with perimenopause would make them worse.
“Fibroids have a definite growth spurt or growth increase in these key years with all this hormonal fluctuation. This doesn’t happen for every woman, but it does for many,” Shirazian said. “All of a sudden, their fibroids weren’t bothering them and now they’ve reached age 45 and they’re bleeding all the time, they feel more pressure, they feel more pain, they feel more urinary frequency and other symptoms of fibroids.”
And then on top of that, they’re also experiencing all the classic symptoms of perimenopause, like hot flashes and night sweats, brain fog, and mood swings. And many are being told that hormone therapy isn’t right for them because of the fibroids. But Shirazian said that’s not true — it’s just a matter of finding the right hormone therapy, and fibroid treatment, for them.
“What I think is very important for women to know is that they can treat their perimenopausal symptoms and also treat their fibroids.”
So, what about hormone therapy?
Shirazian said there are a lot of myths about hormone therapy, or hormone replacement therapy (HRT) — a prominent one is that people with fibroids can’t be on hormone therapy because it will grow their fibroids. But, she said, there’s no proof of that — and actually, the fact that hormone therapy keeps estrogen steady means it’s less likely to make the fibroids bigger, compared with the fluctuations that come with perimenopause.
“We don’t need for women to suffer unnecessarily. If you are symptomatic for perimenopause, you should treat the perimenopausal symptoms and we’ll figure out how to manage the fibroids,” she said. “The key teaching point that I would like women to know is that they do not have to sacrifice their HRT.”
‘A whole other way of thinking about screening’
Shirazian said she also hopes that more women will feel more empowered to be proactive in their health care — and that when it comes to fibroids, she would love to see a cultural and institutional shift on screening.
She feels that this is especially true for Black women, who so disproportionately experience symptomatic fibroid disease. Too often, they are left without treatment until their symptoms become so significant that their daily lives are being disrupted and they need more invasive treatment. It doesn’t have to be this way.
“We should be screening differently for fibroids disease. If you have family history — and you should talk to your family, if your mom had fibroids, if your aunts had fibroids, you have sisters with fibroids — you should start screening early. You should get an ultrasound. You should keep an eye out for those symptoms,” Shirazian said.
So, about those fibroids …
The other main point Shirazian wants people with fibroids to know? That there are a lot of avenues for treatment outside of a hysterectomy.
“We can treat the category of abnormal bleeding in so many ways, even without treating the fibroids themselves sometimes,” she said.
For instance, if a person has very small fibroids that might be causing a heavy amount of bleeding, a doctor can freeze the endometrium so it doesn’t bleed so much. For others, placing an IUD might treat irregular bleeding, while radio frequency ablation (a minimally invasive procedure that uses heat from radio waves to destroy targeted tissue) might be utilized in other cases.
And at some point, she said, menopause will mean the fibroids go away. But it’s just not always as speedy as we might hope.
“Once you enter menopause and have a full year of no periods, you should know that your fibroids will slowly shrink, so they will get better — but if they’re very big to start with, it will be a slow process. It will be years of them shrinking if they’re very large,” Shirazian said. “I think sometimes women wait until menopause only to be disappointed by the fact that the fibroids don’t just go away.”
From stigma to treatment
Too many people are scared off from seeking evaluation and treatment because they don’t want a hysterectomy, Shirazian said.
“The only bad option probably is to do nothing if you’re suffering. Any other option could at least make your quality of life better,” she said. And more often than not, that treatment is not going to be a hysterectomy.
“Even if you choose a medication, an IUD, a minor procedure to help your bleeding, coming in and being evaluated and choosing something — anything is probably the right choice. I want women to have the permission to choose other choices, to have other choices and know that they can make those decisions. That’s important.”
And for those who do end up needing a hysterectomy, there are some myths she would like to dispel there, too.
“A hysterectomy doesn’t have to involve removing your ovaries. If they don’t remove your ovaries, you will not go into surgical menopause,” she explained. She added that studies show that people who have hysterectomies without ovary removal typically experience menopause about six months earlier than the average onset of natural menopause, but not much earlier than that. “You can leave your ovaries if you don’t have family history, if you’re an age that you prefer to keep them, or we think they would benefit you for longer.”
Likewise, not removing the cervix is also an option for some patients and can mean fewer changes in terms of the onset of menopause, as well.
But regardless, Shirazian wants people with fibroid disease to know one thing most of all when it comes to treatment.
“No option is a bad option.”
This and that
I really loved this very honest, very thoughtful essay on aging and beauty (and aptly titled “Aging Out of Beauty”) by Mindy Isser, over at Gloria.
Speaking of thinking about my own face, I’m grateful that the New York Times explained who is and who is not a narcissist for me.
Speaking of self-indulgence, I also enjoyed this take in The Cut on the sex scenes in the new “Lolita”-adjacent novel “Half His Age” by former child star Jeanette McCurdy.
Speaking of icons of the small screen, my 19th colleague Marissa Martinez was there to watch “Real Housewives of Salt Lake City’s” very own Angie “You do french fries, I do franchise” Katsanevas testify before Congress in favor of a rule that defines the relationship between franchisors and employees.
Speaking of french fries, what would you do if you found a beach covered in french fries and onions, as discussed in the latest Food News podcast at The Ringer?
Would you eat a beach onion? Write me.