Uterine fibroids are common, non-cancerous growths that develop in or on the wall of the uterus. They consist of muscle and tissue and vary significantly in size, from as small as a pea to as large as a melon. While many individuals experience no symptoms, their presence does not always require immediate medical treatment. This article explores the potential outcomes when fibroids are not actively treated.
How Fibroids Can Change Over Time
Fibroids can change over time without direct intervention. Some fibroids may grow slowly or rapidly, while others remain stable in size for extended periods. Studies indicate fibroid growth rates can vary. Smaller fibroids might grow faster than larger ones in some cases.
Fibroids often shrink naturally, particularly after menopause, when estrogen levels decrease. However, some fibroids can undergo degeneration when they outgrow their blood supply. This can lead to acute pain as the fibroid tissue breaks down. Over time, some fibroids may also calcify, a hardening process due to calcium deposits, typically occurring after menopause.
Impact on Daily Life and Health
Untreated fibroids can cause symptoms affecting daily life and overall well-being. Heavy and prolonged menstrual bleeding (menorrhagia) is a frequent symptom, sometimes lasting longer than seven days. This excessive blood loss can disrupt daily activities.
Pelvic pain and pressure are also common, manifesting as chronic discomfort, a feeling of fullness, bloating, or cramping in the lower abdomen. The size and location of fibroids can lead to pressure on surrounding organs, causing increased urinary frequency or difficulty emptying the bladder. Similarly, fibroids pressing on the rectum can result in bowel issues like constipation or difficulty with bowel movements.
Some individuals may also experience painful intercourse (dyspareunia). This pain can range from mild discomfort to severe, particularly if fibroids are located near the cervix or if deep penetration causes pressure. These symptoms can significantly affect one’s quality of life, impacting work, sleep, and physical activity.
Serious Health Consequences
Beyond daily discomfort, untreated fibroids can lead to serious medical complications. Chronic heavy menstrual bleeding can result in iron-deficiency anemia, a condition where the body lacks sufficient healthy red blood cells to carry oxygen. Symptoms of anemia include fatigue, weakness, and shortness of breath.
Fibroids can also affect fertility and pregnancy, although they do not always prevent conception. Large or numerous fibroids may make it harder to conceive, or they could increase the risk of complications such as miscarriage, preterm labor, or issues during delivery.
In rare instances, very large fibroids can compress the ureters, tubes that carry urine from the kidneys to the bladder, potentially leading to a condition called hydronephrosis, which involves kidney swelling. Malignant transformation into a cancerous form called leiomyosarcoma is a very rare possibility, occurring in less than 1% of cases.
Understanding “Watchful Waiting”
“Leaving fibroids untreated” does not always imply neglect; often, it is a deliberate medical strategy known as “watchful waiting” or “expectant management.” This approach is recommended for individuals with asymptomatic fibroids or those with mild, manageable symptoms. Watchful waiting involves regular monitoring by a healthcare provider to track fibroid size and symptom progression. This management strategy includes periodic evaluations, such as follow-up appointments and imaging tests like ultrasounds. The decision to pursue watchful waiting is made when the potential risks or burdens of active treatment are considered to outweigh the fibroids’ current impact on health.