January 15, 2017 Liza Colimon, MD Have you noticed a change in your menstrual cycle? Perhaps you are having longer more frequent periods, heavier periods, or spotting. If menstrual cramps have been interfering with your routine, or if you've noticed you are carrying Motrin in your purse more often than lip gloss, hopefully your internal alarm is sounding. Maybe your jeans just haven't been fitting quite right... A little more bloated than usual no matter how hard you hit the gym? If you have been complaining to your primary physician about abdominal pressure, constipation or having pain with intercourse and feel vague complaints have you categorized in the office as "The Mystery Patient," then a date with your favorite gynecologist should be on your calendar. Chances are, you may have uterine fibroids. Although fibroids are not dangerous or cancerous, they can cause complications, impact quality of life, and even result in pre-term deliveries, miscarriages, and infertility. Uterine fibroids are smooth muscle tumors that grow in various locations on the uterus. They may be found inside the uterine lining, within the muscle wall, or on the outer surface of the uterus. The size, shape, location and number of fibroids can vary. Sizes may be smaller than a pea to larger than a grapefruit or large cantaloupe. They can grow as single tumors or in groups and their rate of growth can be unpredictable. Risk factors for developing uterine fibroids has also been associated with race. The incidence of uterine fibroids has been found to be two-to-three-fold greater in black women than in white. A classic study in 2003 published in the American Journal of Obstetrics and Gynecology found the incidence of fibroids in black women by age 50 was over 80%. Many studies quote over 60% of black women have uterine fibroids compared to 30-40% of white women. The cause of this increased risk is unknown. Black women often develop symptoms and complications related to fibroids at much younger ages than white women and may often present with symptoms even in their 20's that may require surgery. Compared to white women, black women often have more aggressive, fast growing tumors and are more likely to present to their doctors with anemia and severe symptoms. Many women ignore the need for surgery and find blood transfusions as the answer to their treatment plan, which is not without risk. Not all fibroids need to be removed, especially depending on your age, their size, and whether or not they are causing symptoms. However, they will continue to grow, small fibroids often become larger fibroids. Surveillance is key if you are not having symptoms. Your gynecologist can monitor your fibroids based on your symptoms, an exam, and by performing an ultrasound. Birth control pills and non-steroidal anti-inflammatory drugs may only help control abnormal bleeding and cramping. Other medications such as Lupron may shrink your fibroids in the short term but studies show this is only a temporary fix. Myomectomy (surgical removal of fibroid tumors) is often indicated. Various surgical options are available. Advocate for minimally invasive approaches if you are a candidate such as a hysteroscopic myomectomy, laparoscopic myomectomy, or a robotic-assisted approach. Minimally invasive surgical options offer smaller incisions, less pain, and faster recovery times. Remember, if you are having symptoms, don't delay. A surgery that could have been performed minimally invasive may require a larger abdominal incision and more recovery time if procrastination and fear get the best of you. If you suffer from many fibroids or large fibroids, than a laparotomy (open abdominal incision) will be required. If you have completed your childbearing years a hysterectomy (removal of the uterus which contains the fibroids) may be recommended or desired. Hysterectomies are more commonly performed minimally invasive as well. They key is not to panic or ignore your body. Educate yourself and advocate for favorable treatment options. Fear is not helpful and finding the right gynecologist who takes the time to educate and address your concerns early on is imperative.