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Menstrual Irregularities Could Signal the Presence of Uterine Fibroids

HIGHLIGHTS:

  • Abnormalities affecting a woman’s period may be a warning sign of uterine fibroids, which are most common among females aged between 30–40 years, with up to 20–25% of this group affected.
  • Uterine fibroids are generally not dangerous in themselves but are capable of causing other complications, such as anemia resulting from significant blood loss. A uterine fibroid during a pregnancy could also increase the risk of a premature birth, miscarriage or developmental issues affecting the unborn child.
  • In Thailand, there are currently oral drugs available that are capable of directly targeting and destroying uterine fibroids cells, thereby reducing their size, making this an extremely effective form of treatment for the disorder.

Menstrual Irregularities Could Signal the Presence of Uterine Fibroids

As women enter the reproductive stage of their lives, their bodies produce greater amounts of tissue for use in the uterine walls to ensure it is ready to support a pregnancy. However, if left unfertilized, the endometrial tissue will peel away, and be passed out through the vagina as blood or “the period”. The menstrual cycle usually lasts around 28 days (+/- 7 days), with the period lasting around 3–8 days. The first 2 days of a period is when most of the bleeding tend to occur, with the blood passed often dark red, brown or black in color. Some women will also experience symptoms prior to their period, such as headaches, indigestion, frustration, muscle and joint pain, enlarged breasts, and increase in appetite, while stomach pain may occur once the period has begun. In some cases, these symptoms are a result of hormonal changes that are occurring during ovulation, whereas other symptoms could be a signal of a potentially dangerous condition like uterine fibroids.


Normal periods vs. irregular periods

  1. Color: Normally, the blood passed during the first days of a period will be a little dark, often becoming brighter in the days following. Alternatively, some women may begin their period with bright red blood which then darkens as the period nears its end. However, if the color is extremely pale or is similar in color to lymphatic fluid, a doctor should be consulted at the earliest opportunity in order to undergo a thorough diagnosis.
  2. Amount: .Most of the bleeding usually occurs during the initial days of a woman’s period, before gradually reducing in amount and stopping altogether at the end. The blood passed in one bleed should not exceed 80 cc, with women able to observe the amount by checking the frequency with which they need to change their sanitary pads, including inspecting the pads they are changing. Changing pads every 2–3 hours is considered normal, but having to change a soaked pad hourly for the duration of a period or having a period lasting longer than 8 days is considered a sign that the body is behaving abnormally. Such abnormalities include anemia, hormonal imbalances, or the occurrence of uterine fibroids. Moreover, experiencing a slowly dripping period throughout the menstrual cycle is also a cause to attend a consultation with a doctor who will attempt to diagnose the cause.
  3. Stomach pain: Nearly all women (up to 70%) will encounter the problem of stomach pain during their periods, whether in the form of cramps or soreness. These period pains are caused by increased production of prostaglandin, a chemical that is similar to other hormones and produced in the endometrium during a woman’s period. This chemical results in muscles flexing and tensing, creating a pain similar to those caused by contractions during childbirth. In cases where the body produces large amounts of this chemical, the period pains will be more severe, sometimes occurring alongside symptoms of diarrhea and nausea. Nevertheless, if such pains occur with increasing frequency or arrive with every period, it could be due to endometriosis or uterine fibroids.
  4. The menstrual cycle: This cycle refers to vaginal bleeding that occurs once a month, with around 28 days (+/- 7 days) in between. Each cycle should come around the same time of the month, give or take 7–9 days, so frequently missing periods or experiencing 2–3 periods of irregular frequency may be an indicator of hormonal imbalances or sexually transmitted disease, meaning a specialist should be consulted.


Warning signs of uterine fibroids from period irregularities

Abnormalities affecting the period are not something to be ignored because they may be signaling the presence of uterine fibroids, which up to 20–25% of women aged between 30–40 suffer from.

Uterine fibroids refer to fibroids that occur in the uterus, which are usually completely normal and non-cancerous. They may be found anywhere within the uterus and can be of varying size. There may be one or more fibroids, some of which grow slowly and some of which grow rapidly.

Patients with small fibroids will not display any symptoms, and these may only be identified by chance during an annual health examination or when consulting a doctor about another health issue. Such fibroids may not require any treatment at all.

Larger fibroids, on the other hand, may be detected through the following forms of period abnormality:

  • Abnormally profuse and lengthy bleeding
  • Localized lower abdominal pain or chronic lower back pain
  • Pain during sex
  • Chronic constipation
  • Frequently urinating in dribs and drabs, or a stinging sensation when urinating
  • Feeling a lump in the lower abdomen or in the main abdomen similar to the lump formed during the early stages of a pregnancy.


Uterine fibroid risk factors

Those in the medical field are still unable to identify the true causes of uterine fibroids accurately. However, evidence indicates that the following factors can play a part:

  • Hormone levels: Changes in hormone levels that affect women, including varying levels of estrogen and progesterone, could result in the growth of uterine fibroids.
  • Side effects of medication: The use of hormonal drugs may lead to uterine fibroid growth, including those hormones found in the contraceptive pill.
  • Genetics: A family history of uterine fibroids is likely to increase a person’s risk of developing uterine fibroids.
  • Diet: A diet high in red meat and fats, as well as regularly drinking alcohol may place someone at a greater risk of developing uterine fibroids than those with a healthier diet.
  • Body state: Obese women, women who got their first period early in life, or women with various types of vitamin deficiency may all play a part in the occurrence of uterine fibroids.


Diagnosing uterine fibroids

Ultrasound scans enable medical staff to carefully analyze the state of a person’s internal organs. These scans take the following two main forms:

  1. A lower abdominal ultrasound provides doctors with a view of all the organs located in this area, especially the uterus. It is advised that women undergo such a procedure once they reach the age of 30, as well as women who belong to high risk groups, such as those who suffer chronic period pains or those suffering from other period abnormalities. The scan involves the use of high frequency radio waves aimed at the lower abdomen, and is usually most effective when patients have a slight urge to urinate, meaning women should drink plenty of water and refrain from using the bathroom prior to the scan taking place. This is because the urine stored in the bladder allows medical staff a clearer view of the uterus as it is more pronounced than other nearby organs. Women may make an appointment to undergo a scan during their annual health check-up.
  2. A transvaginal ultrasound (TVS) is another type of scan involving high frequency radio waves. A TVS provides analysis in terms of endometrium thickness, which can be a cause of uterine fibroids. The scan involves inserting a tiny device into the vagina in order to view the inside of the uterus, which means the scan may only offer analysis of a limited area. However, the images produced are of much greater clarity than those gleaned from a lower abdominal ultrasound, although patients are required to urinate fully before undergoing this type of scan.

In addition to ultrasounds, there are a number of other methods available, including MRI scans or endoscopic inspections of the uterus, which can provide clarity of the situation, enabling doctors to make the correct decisions regarding treatment thereafter.


Treating uterine fibroids

  • Medication: In less severe cases or cases where the fibroids are small in size, the doctor may consider the use of orally administered pain relief drugs or contraceptive pills as these can aid in reducing the pain caused by uterine fibroids. For women whose periods involve an abnormal amount of bleeding, doctors may prescribe iron supplement drugs to prevent against anemia.
  • Hormonal treatment: Gonadotropin releasing hormones not only reduce the size of fibroids but can also help relieve associated symptoms. Nevertheless, the use of such hormones could have an impact on estrogen production, which could leave patients suffering from hot flushes and vaginal dryness, and there is also a risk of new fibroids presenting themselves once treatment is halted.
  • Targeted therapy: The Thai medical industry now imports from Europe drugs that are the first and only form of medication containing selective progesterone receptor modulators (SPRM), which have been certified for use in the treatment of uterine fibroids. These drugs attack the fibroid cells directly, eradicating them and reducing their overall size, thereby making them highly effective. Targeted therapy may be used to reduce symptoms and fibroid size prior to surgery, or they may be prescribed as an independent course that can eliminate the need for surgery altogether. Moreover, these drugs can halt irregular period bleeding within just 5–10 days, reduce fibroids size and relieve painful symptoms.
  • Surgery: In cases of larger fibroids or cases of severe symptoms, doctors may consider surgery as the most effective form of treatment.

However, patients who have previously suffered from uterine fibroids are at risk of repeated fibroids developing, meaning there are some cases where doctors may consider surgically removing the uterus altogether in order to fully protect patients from repeat bouts of the condition. Such a procedure would render the patient’s ability to conceive, and may also have other long-term effects on their health, meaning careful analysis of the size and severity of the fibroids present must be carried out to ensure that whatever course of action taken is appropriate (https://www.samitivejhospitals.com/en/promotions/arthroscopic-surgery-svh/).


Complications arising from uterine fibroids

Uterine fibroids are not generally dangerous, however they may lead to anxiety in patients alongside other potential complications, such as anemia resulting from heavy blood loss. Moreover, if the fibroids occur during a pregnancy, it could increase the risks posed to mother and child,  including premature births, miscarriages and fetal developmental issues. Additionally, some types of uterine fibroid can result in women experiencing difficulties conceiving. (https://www.samitivejhospitals.com/samitivej-fertility-center/).


Uterine fibroid prevention

It is still not possible to identify the root causes of uterine fibroids accurately, making total prevention impossible. However, taking good care of health and maintaining a strong body is likely to reduce a woman’s risk significantly. This means eating a healthy diet that includes avoiding red meat, fatty foods and alcohol, while regulating appropriate body weight by exercising regularly. Such physical activity should total 7 or more hours per week as this will not only reduce stress and keep you feeling fresh, but can also protect against uterine fibroids developing.

In cases where uterine fibroids are asymptomatic or the fibroids are tiny in size, there may be no need for treatment. However, attending regular health screening is essential in order to allow doctors to monitor the situation, and take appropriate action where necessary.


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