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What Fibroid symptoms should you look out for?

Although 50% of all women may have fibroids, only 30% have pain due to fibroids. For this reason, it’s important to look out for other symptoms.

Fibroid symptoms include:

Many fibroids are slow-growing, so symptoms may not develop until a woman is over 35, especially when the fibroids have enlarged to the same size as a three-month pregnancy enough to interfere with menstruation and fertility.


Fibroids and Leiomyosarcoma

Only 1 woman in 1,000 who has fibroids develops Leiomyosarcoma, which is cancer of the muscle layer of the uterus. Affected women average 58 years old. It is extremely rare for younger women to develop cancer in conjunction with fibroids.

Clues that you may have Leiomyosarcoma are very quickly growing fibroids and postmenopausal bleeding. If you were diagnosed with fibroids before menopause and experience vaginal bleeding after your periods have stopped for at least 12 consecutive months, then see your doctor as soon as possible.


Who develops Fibroids?

Fibroid tumors occur in approximately 30% of all women, and in 40% of women over 35 years of age.

Fibroids are more prevalent among Black women, affecting up to 50% of them. Women who have had at least two live births have half the risk of developing fibroids than women who have no children or one child.

The incidence of fibroids is 65% greater in women who have polycystic ovary syndrome (PCOS). Fibroids often co-occur with aggressive kidney tumors in women of European descent who have a mutated Fumarate Hydratase Gene.


How are Fibroids classified?

Fibroids are named for their location in the uterus: Intramural, subserosal, or submucosal. The classification of fibroids is important because each has its own inherent dangers.

Intramural fibroids appear within the wall of the uterus, where they replace the muscle layer (myometrium). These are the most common form of fibroid tumors. Intramural fibroids are often associated with a bulky abdomen, excessive bleeding, back and pelvic pain. Large intramural fibroids can rupture during childbirth, necessitating a Caesarian section because of blood loss.

Subserosal fibroids appear under the outer lining of the uterus, making it bulbous. They can cause chronic lower back and pelvic pain, which can radiate to the legs if they press on the lumbar and sacral nerves in the back. Some subserosal fibroids grow on stalks. These are called pedunculated fibroids. A pedunculated fibroid can twist on its stalk and cause severe pelvic pain.

Large subserosal fibroids can crowd the bladder and bowel, causing frequent urination, constipation, or piles (haemorrhoids).

Submucosal fibroids appear beneath the mucous membrane lining the uterus (endometrium). These are the rarest form of fibroid tumors, but are often the most aggravating because they increase the surface area of the lining. A bigger surface area is often associated with dysfunctional uterine bleeding (DUB). The first symptom is usually excessive bleeding, called menorrhagia, which means soaking more than one sanitary pad per hour or more than 16 soaked sanitary pads per period.

You may experience flooding, a sudden gush of blood for no apparent reason, especially when you stand up from a sitting position. Eventually, submucosal fibroids produce iron deficiency anaemia (lack of blood) from prolonged bleeding (longer than six days). Submucosal fibroids often produce severe abdominal cramping during menstruation (dysmenorrhea).

Submucosal fibroids produce infertility because they act similarly to an IUD (intrauterine contraceptive device) to prevent implantation of a fertilized egg in the lining of the uterus. The cavity of the uterus may become distorted with submucosal or intramural fibroids, increasing miscarriage rates. Submucosal fibroids tend to cause the placenta to detach from the uterus during childbirth. This condition is called ‘abruptio placenta’ and it can cause death or brain damage in the baby due to lack of oxygen. Caesarian delivery is required in approximately 2% of submucosal fibroid patients to avoid these complications.


How are fibroids diagnosed?

Your doctor will probably find large fibroids through a routine pelvic examination, or small fibroids if you have a pelvic ultrasound for some other reason. If your doctor suspects fibroids, he or she will order a transvaginal ultrasound to confirm the finding. An MRI scan may be required to view subserosal fibroids.

Submucous fibroid detection may require either sonohysterogram or hysterosalpingogram x-rays.
It is important for you to have these tests performed to get a definitive diagnosis. Many diseases mimic the symptoms of fibroid tumors, including adenomyosis, polyps, endometrial hyperplasia, and cervical cancer.

These more serious diseases must be ruled out to ensure correct treatment.


Here is a brief overview of the most common initial tests used to diagnose Fibroids:

Transvaginal Ultrasound
A transvaginal scan takes about 30 minutes and is painless. You do not need to fast or book the whole day off work. It is performed either at an out-patient lab or Diagnostic Imaging at a hospital.

Prepare for the ultrasound by drinking eight glasses (32 ounces or 2 lites) of water one hour before you go to the Diagnostic Imaging Lab. Retain your urine until after the initial scan has been completed. Drinking liquid provides contrast between the uterus and the nearby bladder. Remove your clothing from the waist down. Wear the johnny gown provided.

The radiology technologist first coats your abdomen with electrolyte gel and moves a transducer across your pelvis to view your ovaries, fallopian tubes, and uterus on a monitor. The technologist may use a Doppler ‘gun’ to determine if any blood vessels are blocked. The technologist asks you to urinate into the toilet before the transvaginal ultrasound.

The technologist covers a small probe with a condom, coats it with lubricating gel, and inserts two or three inches of it into your vagina.

He or she measures the thickness of your endometrium. An endometrium more than 5 mm is too thick. It causes heavy bleeding (menorrhagia) and predisposes you to cancer. The radiology technologist sends your readings to the radiologist, a specialized medical doctor, for interpretation.
The radiologist reports the final results directly to the doctor who ordered your test.


If a radiologist is available at the time of your transvaginal ultrasound, then he or she may instill salt water (saline) into your uterus to make small growths easier to detect. Take ibuprofen before a sonohysterogram to minimize cramping. The radiologist may suction (aspirate) tissue from inside your uterus and send it to a pathologist for microscopic examination.

A sonohysterogram is often an easier biopsy collection method to tolerate than a hysteroscopy.



If the radiology technologist detects fibroids or another abnormality through the ultrasound, your doctor will follow up with a hysteroscopy.

A hysteroscopy is an invasive procedure where the doctor looks inside the uterus with a tiny telescope and a thin, flexible ‘straw’ called a hysteroscope. It is usually performed as an out-patient procedure at a hospital or gynecology clinic.

Schedule the day off work. Shower the night before your procedure. Do not eat or drink from midnight until your procedure is completed.

In addition to the technologist, a hysteroscopy requires the presence of a radiologist, a doctor specially trained to interpret the images. A doctor is absolutely required because there is a slight chance (0.012%) you could develop complications, such as:

You will receive a local anesthetic in your cervix so you will feel no pain. Ask for an epidural or general anesthetic if the procedure makes you very apprehensive. Your cervix may be gently dilated before introducing the ‘straw’. Gas or liquid is piped through the hysteroscope to widen the uterus and make its interior visible.

If the radiologist discovers a problem, he or she will take a small tissue sample (biopsy) for the pathologist to examine. Unfortunately, a small fibroid is easily missed in a blind biopsy.


Blood Test & Biopsy

If you know you have fibroids and have bleeding after menopause, then your doctor will perform a thorough pelvic exam and order an LDH blood test and an MRI to rule out leiomyosarcoma, a rare cancer of the uterine muscle that affects mostly women in their late 50’s and 60’s.

If your blood and imaging results indicate cancer, your doctor will perform a biopsy to confirm it. He or she will remove tiny slivers of tissue from your uterus and give it to a pathologist for a definitive diagnosis.


Dilatation & Curettage (D&C)

A dilatation and curettage allows your doctor to remove your built-up endometrium and collect a tissue sample for Pathology at one fell swoop. However, it is only a temporary solution. A D&C does not cure fibroids. Shaving the top off a fibroid during a D&C could worsen your condition.

D&C has fallen from favor as a method of diagnosing and treating fibroid tumors because it is a blind procedure and is traumatic to the reproductive system. It takes a month to recover from a D&C, whereas a woman recovers from an aspiration biopsy in about a week.

The risks are higher for D&C than other diagnostic methods. Your cervix could be lacerated, your uterus could be perforated, or you might develop a pelvic infection that leads to scarring. If your doctor suggests a D&C, ask about more modern, less invasive methods.


What can I do to decrease my Fibroid symptoms?

Fat is a repository for estrone, a weak form of estrogen, which encourages the rapid growth of fibroids. If you maintain a normal weight, exercise regularly, and eat plenty of fruits and vegetables, you can keep your estrone levels low and avoid stimulating your fibroids to increase in size.

If you are exposed to environmental estrogens at work (xenoestrogens), then talk to your shop steward/employer or consider switching jobs. This free booklet on Estrogen Dominance will help you understand more about how Estrogen affects you.

Two days before you start menstruating, start taking one ibuprofen (Advil® or Motrin®) every four hours. Ibuprofen inhibits pain and bleeding by reducing prostaglandins.

If your fibroids are very tiny and you are perimenopausal, you may opt for a Mirena IUD. The progestin in this intrauterine device significantly reduces bleeding and prevents pregnancy. However, most women have fibroids that are too large for an IUD. Mirena® is unsuitable to control fibroids in postmenopausal women.

Without doubt the safest and most effective treatment for small to medium sized fibroids is natural progesterone cream. Progesterone addresses the underlying estrogen dominance that has caused the fibroids to develop and can keep your endometrial lining from thickening, which prevents heavy bleeding, and limits future growth of fibroids by opposing the growth instigated by high estradiol levels. With time most fibroids will regress in size.


Understand more on Fibroids:

What are Fibroids?

Treating Fibroids

What is natural progesterone?

Progesterone treatment and side effects

 The information in this article has been taken with permission from the official Lawley booklet on Understanding Fibroids.