I swore I was about to bleed to death.
I was at work, standing in a bathroom stall frantically scrubbing my pinstriped lavender pants, shamefully unaware of the stain on them when I walked into the restroom for the umpteenth time and mad that I didn't wear black.
I caught my reflection on my way back to my desk to retrieve my cell phone. I was beginning to look gaunt. My iron count was so dangerously low that I was prescribed supplements, and I lost over 10 pounds – weight I worked so hard for years to gain, mind you – plus muscle all in one month.
I was suffering from uterine fibroids--benign tumors that grow within the uterus and a condition that disproportionately impacts 80% of Black women. While most women are asymptomatic and can continue life as normal, my symptoms--including frequent restroom breaks, lower back pain, and a hard, slightly round stomach equivalent to a 12-week pregnancy, according to my doctor – were a little more severe because of the fibroids' location and size. Fibroids can be as small as the width of a pea and as large as a grapefruit. Judging from the amount of blood loss, mine might've been approaching the size of a lemon or tangerine. I called my doctor for an emergency appointment because the bleeding wouldn't relent, and I was on track to pass out somewhere.
“It's been over three weeks," I said to the receptionist at my doctor's office.
The next morning, my gynecologist and I sat down to finalize a treatment plan. I was nervous about the whole idea of undergoing surgery, but I was relieved that I didn't have to have a hysterectomy, or the removal of all or part of the uterus and cervix. Unless it was cancerous, I didn't see the point of sacrificing a functioning organ, and according to an article in the International Academy of Pelvic Surgery, more women are opting for uterine preservation for reasons other than fertility: Sexuality and body image issues and personal and cultural preferences are presiding factors.
So it's important to know that a hysterectomy isn't a woman's only choice for fibroid relief, although many women think so and doctors may push for one as a solution when it should be the absolute last resort. In fact, the American College of Obstetricians and Gynecologists says that 76% of all hysterectomies performed today were unnecessary. But some doctors aren't exactly familiar with the newer medical advances, or they find them too “time-consuming," as my doctor once pointed out. Hysterectomies are routine, but patients face longer recovery periods, instant menopause, and bladder and sexual dysfunction. But despite the fact that my symptoms may have fallen on the more severe side of the spectrum, my GYN and I agreed that another option would be ideal.
Initially I had previously picked up a pamphlet for uterine fibroid embolization (UFE), partly to duck surgery. UFE, also known as uterine artery embolization, is a minimally invasive procedure that works by injecting contrast material – which may cause an allergic reaction in some women – into a woman's upper thigh to block arterial flow to the fibroids. It takes 1-3 hours and the patient is sedated – but not asleep – so she can follow any directions given by the interventional radiologist. Women can expect bleeding and pain from the breakdown of fibroid tissue from anywhere between a few weeks to a few months, although my doctor mentioned that some patients end up in the emergency room for “excruciating pain from dying tissue." In a few of those cases, women face emergency hysterectomies because of infections. But in best case scenarios, most women can resume usual activities in about a week.
However UFE isn't recommended for patients like me who do wish to preserve fertility because it shuts off blood flow that would be necessary for a future fetus. So I was left with the pill, myomectomy, or a combination of the two.
“I see the pill didn't work," my GYN said as he opened my chart.
The pill was supposed to have been the first step in controlling the profuse bleeding, and usually it does work for most women. It did for me, until my fibroids grew rebellious. Since I was already on oral contraception, my doctor just prescribed a different variation with iron. But to be honest, that pill was brown and looked funny (as in chalky-funny), and after years of taking the same tablets with no side effects, I was too stubborn to switch to a new one, anyway. Plus I convinced myself that I didn't drink enough water for my body to properly process iron, so that was that.
Ultimately I chose the laparoscopic, or robotic, myomectomy to remove the fibroids and keep my uterus intact. During this procedure, the surgeon makes a series of 3-5 one-inch incisions preferably along the bikini line but sometimes nearer the belly button where mine are located. A tube with a camera and small surgical instruments are then inserted into the abdominal wall. With the use of a “robot" or a separate console, the surgeon controls the instruments to cut the fibroids into “strips" thin enough to remove through the incisions. The surgery should've taken a few hours, but mine was nearly three times as long because my doctor and his colleague discovered more fibroids than were on the MRI once they were inside. But they were determined to complete the surgery without making a full cut across my abdomen. Some patients can go home the same day, however, I spent the night at the hospital, probably because I woke up late evening. I also needed a blood transfusion midway surgery, which UFE patients don't have to worry about. Recovery is about 6-8 weeks.
Three years later, at least one fibroid returned, which is a risk with both the UFE and myomectomy. But I still have no physical symptoms including fatigue, heavy bleeding, and severe anemia. I do try to practice a bit of self-care (again) because that was one thing that changed post-surgery. Now I'm more mindful of what I eat because some experts say what we put in our bodies – and on our bodies, like hair relaxers – can encourage the (re)growth of fibroids. It's possible genetics play a part, too. But there's no definitive answer.
There's also no cure for fibroids, and the only surefire way to get rid of them once and for all is through a hysterectomy, but that should still be a woman's choice. We shouldn't be led to believe we have no other recourse to both manage fibroids and maintain our uterus when, in fact, we do. Of course, treatment options vary depending on the patient, her medical history, and reproductive choices among other factors. This list of treatments isn't exhaustive, and as with any medical procedure, you should always consult your doctor and perform your own thorough research before making a final decision.
Have you had fibroids? What are some tips that you've learned to help with managing them?