“Fibroids” – with Dr. Michael Silverstein

Dr. Michael Silverstein discusses fibroids with Dr. Fox, explaining what they are, symptoms they may cause, and treatment options.  

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In this episode, Dr. Michael Silverstein returns to Healthful Woman to discuss fibroids. Dr. Silverstein explains that “fibroids are just small muscle masses, little swirls of muscle.” Fibroids in the uterus are extremely common and often go unnoticed; autopsy studies have found that between ¼ and 1/3 of women have fibroids. Dr. Silverstein says that “fibroids could be the size of marbles” or larger, and that often they are an “incidental finding” when a woman requires a CT scan or other imaging test for another issue.  

Symptoms of Fibroids 

Dr. Silverstein says that fibroids can be found “virtually anywhere” on the uterus, and Dr. Fox adds that “where the fibroid is and its size are going to determine whether [the patient] has symptoms.” Often, a fibroid will cause no symptoms at all.  

However, fibroids can cause painful periods, especially when located on the inside of the uterus. They may also lean on the bladder and cause frequent urination or on the rectum and cause constipation or difficulty with bowel movements. Dr. Fox explains that fibroids typically have to be “very large” to cause problems, and that smaller ones tend to have no symptoms unless they are located in places like the endometrium.  

Even if a patient is not experiencing symptoms, Dr. Silverstein explains that it’s important for gynecologists to take a look at fibroids every few years, as they grow over time. Dr. Fox adds that this is especially true during pregnancy, because “they love estrogen and they love blood.” 

Treating Fibroids 

Dr. Silverstein explains that only patients who are “having severely heavy bleeding so they’re dropping their blood count and becoming anemic” and “women that have debilitating pain with their periods” generally require treatment for fibroids. He adds that fibroids aren’t the only reasons for these problems, but if other causes have been eliminated, it might be necessary to treat fibroids.  

In Dr. Silverstein’s opinion, the simplest option for treating fibroids is stabilizing hormones using hormonal contraceptives. These help to both thin the lining of the uterus and stabilize estrogen, slowing the growth of the fibroid and easing symptoms.  

Dr. Silverstein adds that if a woman is interested in having children, “pregnancy offers a wonderful reprieve to much of the menstrual pain that women have if they’re not large or disruptive fibroids.”  

Finally, he states that “surgery remains the ultimate cure.” If the patient does not wish to have children in the future, hysterectomy is an option. A myomectomy, which removes the fibroids, is also possible, though this can sometimes disfigure the uterus, cause a significant amount of blood loss, and may cause scar tissue which can lead to pelvic pain. However, Dr. Fox explains that if the fibroid is attached to the outside of the uterus “by a little stalk, like an apple on a tree,” the myomectomy can be relatively simple. Finally, A hysteroscopy is an option, in which a camera and speculum are used to, as Dr. Silverstein explains, “Carve or shave out the fibroid.” He says this “tend[s] to be a very dramatic improvement in the bleeding problems and a dramatic improvement in fertility.”