This article originally appeared on Health.
Fact: Most women will get fibroids. By the age of 50, 80% of black women and 70% of white women develop these benign tumors that grow within the wall of the uterus, according to the National Institutes of Health. But if fibroids are so common, why do we hear so little about them?
The reality is that the growths can be so small, they don’t cause any problems—and many women never know they have them. But in certain cases, larger tumors can lead to unpleasant symptoms, fertility issues, and pregnancy complications.
To learn more about the signs of uterine fibroids, we spoke with Charles Ascher-Walsh, MD, associate professor of gynecology, obstetrics and reproductive medicine at the Icahn School of Medicine at Mount Sinai in New York City. “We don’t really understand why some women get them and some don’t,” he says. Doctors believe genetics play a role, but since fibroids are so prevalent, other factors are likely involved as well, he explains.
Fibroid symptoms to watch for
The tumors may develop at any point during a woman’s childbearing years, but tend to appear when she’s in her mid- to late-30s and 40s, says Dr. Ascher-Walsh. Because fibroids grow in the uterine wall, the most common symptoms are irregular bleeding and heavy periods.
For many women, fibroids remain small and slow-growing. But when they do grow larger, they can cause symptoms related to their size. For example, you might experience pressure in your abdomen, or feel like you have a mass in your pelvis, or that you’re in the early stages of a pregnancy, says Dr. Ascher-Walsh. Another symptom is frequent urination, since fibroids can sometimes press on the bladder. They can even cause kidney damage if they compress the tubes that carry urine from the kidneys to the bladder.
Larger tumors may also lead to discomfort, says Dr. Ascher-Walsh: “Sometimes as fibroids grow, they can outgrow their blood supply, called degeneration, and when that happens they can become painful.”
Tumors called submucosal fibroids—which bulge into the uterine cavity—may make it more difficult for a woman to get pregnant and stay pregnant, because they can interfere with an egg’s ability to implant in the womb. “The miscarriage rate is doubled in women who have those types of fibroids,” says Dr. Ascher-Walsh.
All types of fibroids raise the risk of cesarean section, preterm delivery, and placental abruption, which is when the placenta detaches from the womb prematurely, sometimes causing life-threatening bleeding. Fibroids also tend to become more painful during pregnancy, he adds.
How fibroids are treated
Your ob-gyn can tell from a routine pelvic exam if your uterus is enlarged, and her first guess will likely be fibroids, says Dr. Ascher-Walsh. She’ll use an ultrasound or MRI to confirm, and count how many tumors are present. (They often appear in multiples.)
Some women may not want or need treatment if they aren’t experiencing any bothersome symptoms and don’t plan to try to get pregnant. Still, says Dr. Ascher-Walsh, it’s important to monitor fibroids over time, as they can grow and cause issues with other organs later on.
Treatment options vary greatly. Birth control pills or a hormonal IUD may help with bleeding or painful periods. And drugs called gonadotropin-releasing hormone agonists can shrink the tumors, though they are linked to side effects similar to menopause, such as hot flashes. Another option is surgical removal of the fibroids, a procedure called a myomectomy. It may be preformed laparoscopically, or for smaller fibroids, through the vagina.
Even after fibroids are removed, more will likely develop over time, says Dr. Ascher-Walsh. He recommends asking your doc about taking vitamin D or green tea extract. Research suggests these supplements may actually suppress the growth of these tumors.