Uterine Fibroids: Symptoms, Diagnosis, and Treatment Options

Uterine fibroids

I am currently 46 years and 5 months old, and my usual menstrual cycle is about 23 days, which is normal, but the blood flow has been extremely light.
Since October, I have noticed that my period has not come.
At the end of November, I was worried about pregnancy and sought medical attention, during which I also had a Pap smear.
The report indicated inflammation, and the doctor mentioned that irregular periods could be a sign of perimenopause.
During treatment, I underwent a transvaginal ultrasound, and the doctor pointed out that my uterus is filled with fibroids of various sizes.
This was my first time having a transvaginal ultrasound, and I have heard that those with uterine fibroids usually experience heavy menstrual bleeding and pain, but I do not experience either and have very light bleeding.
I had slight spotting on December 9 and December 24.

I have a few questions:
1.
Am I too young for menopause at under 47 years old?
2.
Are fibroids considered normal or abnormal growths, given that I have had no other symptoms?
3.
Can a Pap smear detect any abnormal changes or tumors? How should I seek further medical care? Thank you.

xin huang yi luan, 40~49 year old female. Ask Date: 2011/12/25

Dr. Cai Yonglong reply Obstetrics and Gynecology

Dear Dr.
Tsai Yong-long of the Department of Obstetrics and Gynecology at Tainan Hospital, Ministry of Health and Welfare,
Hello.
The average age of menopause in Taiwan is approximately 49.8 years.
It is possible that fibroids approaching menopause are mostly benign, so there is no need to panic.
However, please visit a gynecologist.
If the bleeding is minimal but the fibroids are too large, numerous, or adhered to other structures, surgery may be necessary.

Wishing you good health and all the best!
Sincerely,
Department of Obstetrics and Gynecology, Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2011/12/25

More Info

Uterine fibroids, also known as leiomyomas, are non-cancerous growths that develop in the uterus. They are quite common, especially in women of reproductive age, and can vary in size, number, and location. Understanding the symptoms, diagnosis, and treatment options for uterine fibroids is crucial for managing your health effectively.

Symptoms of Uterine Fibroids
Many women with uterine fibroids may not experience any symptoms at all. However, when symptoms do occur, they can include:
1. Heavy Menstrual Bleeding: This is one of the most common symptoms, often leading to anemia.

2. Menstrual Periods Lasting More Than a Week: Prolonged bleeding can be a sign of fibroids.

3. Pelvic Pain or Pressure: Larger fibroids can cause discomfort or a feeling of fullness in the pelvic area.

4. Frequent Urination: If fibroids press against the bladder, they can lead to increased urination.

5. Difficulty Emptying the Bladder: Some women may find it hard to fully empty their bladder.

6. Constipation: Fibroids can also press against the rectum, causing constipation.

7. Pain during Intercourse: Depending on the location of the fibroids, they can cause pain during sexual activity.

In your case, you mentioned that you have experienced a decrease in menstrual flow and occasional spotting, which can be atypical for fibroids. It's important to note that fibroids can behave differently in each individual.

Diagnosis of Uterine Fibroids
Diagnosis typically involves:
1. Pelvic Exam: A healthcare provider may feel for abnormalities in the uterus during a routine pelvic exam.

2. Ultrasound: This imaging test is commonly used to visualize fibroids and assess their size and location.

3. MRI: In some cases, an MRI may be recommended for a more detailed view of the fibroids.

4. Hysteroscopy: This procedure allows the doctor to look inside the uterus using a thin, lighted tube.

You mentioned that you had an ultrasound that revealed multiple fibroids. This is a common finding, and the absence of significant symptoms like heavy bleeding or pain can indicate that the fibroids are not currently problematic.

Treatment Options for Uterine Fibroids
Treatment for uterine fibroids depends on several factors, including the severity of symptoms, the size and location of the fibroids, and your overall health. Options include:
1. Watchful Waiting: If fibroids are small and not causing significant symptoms, your doctor may recommend monitoring them over time.

2. Medications: Hormonal treatments, such as birth control pills or hormonal IUDs, can help manage symptoms. GnRH agonists may also be used to shrink fibroids temporarily.

3. Minimally Invasive Procedures: Options such as uterine artery embolization (UAE) can reduce blood flow to the fibroids, causing them to shrink.

4. Surgical Options: If fibroids are causing severe symptoms, surgical options include myomectomy (removal of fibroids) or hysterectomy (removal of the uterus).

Regarding Your Questions
1. Early Menopause: While the average age for menopause is around 51, some women may experience perimenopause symptoms in their late 30s to early 40s. Factors such as genetics, health conditions, and lifestyle can influence this.

2. Fibroids: Uterine fibroids are considered benign tumors. They are not cancerous, but they can cause symptoms that may require treatment. The absence of symptoms does not mean they are not present; many women have fibroids without knowing it.

3. Pap Smear and Abnormalities: A Pap smear primarily screens for cervical cancer and does not directly detect uterine fibroids or other uterine abnormalities. However, it can indicate inflammation or other changes that may warrant further investigation.

Seeking Medical Care
If you have concerns about your fibroids or any symptoms you are experiencing, it is advisable to consult with a gynecologist. They can provide personalized advice based on your medical history and current health status. Regular check-ups and open communication with your healthcare provider are key to managing your reproductive health effectively.

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