The ways women experience menstrual periods vary from person to person.
Symptoms vary and the intensity of those symptoms can vary month to month. Some women may experience heavy bleeding, significant cramping and discomfort, and/or bloating that impacts their quality of life and prevents them from doing the things they want and need to do in day-to-day life.
It's important that women talk to their doctor or midwife about their period symptoms at their annual visit and let them know of significant changes.
Providers can explain what is normal and identify symptoms that might be related to underlying conditions.
Keeping track of menstrual frequency, duration and flow amounts in a journal or on an app can be very helpful to track changes over time and to share with your provider to help determine what is normal.
Two of the most common causes of painful periods and heavy bleeding can be uterine fibroids and endometriosis.
Fibroids are non-cancerous tumors of muscular and fibrous tissues that can occur in other parts of the body, and can commonly develop in the wall of the uterus.
"Uterine fibroids are the most common tumor of the reproductive tract. Approximately 70 percent of women have fibroids before the onset of menopause. However, most are small, asymptomatic, and not concerning. Studies show black women are more likely to have fibroids at a younger age or have more severe cases," said Dr. Cassandra Foss, an OB/Gyn at Intermountain McKay Dee and Layton Hospitals in Utah.
Fibroids can occur in many locations, outside and inside the uterus. Medical imaging is necessary to diagnose them.
"Fibroids often appear during the childbearing years, and are most common between ages 40-50. Depending on location and size, fibroids can create different symptoms of varied severity. Certain sizes of fibroids and locations are not clinically concerning, while others need medical attention. Fibroids can range in size from 1 mm to more than 20 cm (8 inches) in diameter or even larger," added Dr. Foss.
Most fibroids are small and don't cause symptoms or require treatment, other than annual observation. Larger fibroids can cause a variety of symptoms, including:
• Longer, heavier, more frequent, and/or painful periods
• Painful abdominal cramps or periods
• Bleeding between periods
• Boating or feeling of fullness in lower abdomen or abdominal enlargement
• Pain during sex
• Low back pain
• Constipation
• Frequent urination, inability to urinate, or to completely empty the bladder
Side effects of fibroids
• Anemia from blood loss
• Miscarriage or infertility
"The causes of fibroids are unknown, but could be genetic or hormone-related, and specifically tied to estrogen and progesterone levels. Hormones are a big cause, and that's one reason why fibroids can change in size. Imaging results can also vary during monthly cycles and over longer periods of time, so seeing the same provider will help track results and streamline care," added Dr. Foss.
Dr. Foss says there are genetic and lifestyle factors that may put women at risk for fibroids.
Risk factors
• Obesity - defined as 20% over healthy body weight
• Heredity, or family history of fibroids
• Not having children
• Early onset of menstruation younger than age 11
• Late age for menopause
• Poor diet, high in red meat or not enough fresh fruits and green vegetables
• Alcohol use
• Race: Black women are more likely to have fibroids younger or more severe. Additional studies are needed in black and minority populations to understand all the risk factors more completely.
In her practice, Dr. Foss also sees a fair number of Hispanic patients affected by fibroids. In general, fibroids can't be completely prevented, but women can reduce their risk by maintaining a healthy body weight with a healthy diet and having annual exams.
Depending on location and size of the fibroid(s), treatment may or may not be needed. They are not usually dangerous, but it can vary from person to person. If women have fibroids, it's a good idea to make a plan for how often to monitor them by seeing your doctor to monitor their size and number.
"If fibroids become problematic, they may need medical management – an interventional procedure or efforts to manage bleeding with birth control or hormonal IUDs, which helps block the hormones that feed the fibroids. Those are temporary fixes," she added.
Some women are relieved to know symptoms of uterine fibroids can stabilize or go away completely after menopause, as hormone levels decline.
For further problematic fibroids a procedure called a uterine artery embolization is performed by an interventional radiologist. It involves going into the blood vessels in the leg, then traveling to the arteries that supply the uterus and blocking them off. When blood flow is cut off, then the fibroid dies. This reduces the size of the fibroids and reduces menstrual bleeding. It is an outpatient procedure that involves light sedation.
"Laparoscopic radiofrequency ablation is the least invasive surgical procedure and uses focused energy on the fibroid tumor. It's similar to microwaving and cauterizing. The process heats the tissue so hot, the fibroid cells are destroyed. Over time the body reabsorbs the fibroid cells and results in reduction in the size of the fibroids, menstrual bleeding, and pain," said Dr. Foss.
"It's a same day outpatient surgery, done under general anesthesia. Typically, three small laparoscopic incisions are made, depending on location, with the lower abdomen being most common. Recovery is short, from a few days to one week, depending on severity," she added.
More invasive surgical treatment for larger or more numerous uterine fibroids would be myomectomy which removes fibroid tissue, but preserves the uterus. Or in severe cases, a hysterectomy, which removes the uterus may be recommended. Either of these surgeries can be performed in a minimally-invasive manner with laparoscopic or robotic surgery, but with quite large fibroids an open incision may be required.
Treatment options may be individualized for each patient, depending on their symptoms, lifestyle, and preferences. Providers can help women understand the risks and benefits of various treatments based on a patient's medical history, and help identify which treatment may be right for them.
"It's ok for women to get pregnant if they have uterine fibroids, but they should be especially conscious to have regular prenatal care with proper imaging, as there are some risks of pregnancy complications, such as placenta abruption, fetal growth restriction or preterm birth," said Dr. Foss.
Dr. Cassandra Foss treats fibroids and practices in the Intermountain Wasatch OB/Gyn clinics located at the McKay Dee and Layton Hospital campuses. For more information about women's health or to find a provider visit intermountainhealthcare.org.
