They can be as small as a grape or as large as a cantaloupe, and in some cases even bigger.
Uterine fibroids — non-cancerous tumours that grow spontaneously inside the wall of the uterus — are also profoundly common, with about 70 per cent of women developing them before the age of 50, according to the Journal of Obstetrics and Gynaecology Canada.
About one-third of those people will develop symptoms such as heavy menstrual bleeding and pain that can be debilitating and have major impacts on all aspects of their life.
But new technology is providing more treatment options that are promising less pain, a faster recovery and the potential to preserve fertility.
“Fibroids are a significant source of health burden, discomfort and they have an impact on quality of life for so many people” said Dr. Cindy Maxwell, an obstetrician and gynecologist and vice-president of medical affairs at Women’s College Hospital in Toronto.
Symptoms can vary, but heavy menstrual bleeding, pain, urinary problems, pelvic pressure, pressure on the bladder, anemia and bloating are some of the key issues patients often deal with.
“We don’t tend to find out about the fibroids until people have reached a stage where they have such symptoms that they require medical attention,” said Maxwell.
Fibroids also can affect fertility and cause issues getting pregnant or threaten the ability to carry a pregnancy, especially in the early stages, she said.
Options to treat fibroids have ranged from hormonal medications to stop heavy menstrual bleeding to intrauterine devices and pain medications. Depending on the size of the fibroids, their location or the severity of symptoms, surgical options are often considered next.
Procedures like a myomectomy remove fibroids while keeping the uterus. Uterine fibroid embolization aims to shrink fibroids by cutting off the blood supply. A catheter is usually inserted into an artery that feeds the fibroid and particles are injected into it that help form a clot.
More invasive procedures
If the fibroids are too large or numerous, then more invasive procedures like a hysterectomy, which removes the uterus, may be recommended, said Maxwell. Recovery time for surgical procedures can take anywhere from two to eight weeks or longer.
Fibroids can grow back, so younger patients in particular may have to endure multiple procedures.
Data from the Canadian Institute for Health Information shows that between 2022 and 2023, there were a total of 10,094 hysterectomies, 6,032 myomectomies and 561 embolizations in Canada (excluding Quebec).
But newer procedures on the horizon in Canada are aiming to provide more minimally invasive options to patients to help them recover more quickly, with fewer risks and an increased likelihood of preserving fertility.
Evolution of fibroid treatment
Humber River Hospital in Toronto is currently the only hospital in Ontario to offer one of the newest less invasive surgical options for fibroid treatment in Canada, says Hologic, the company behind the device used for the procedure.
“Traditionally we would have to do some form of larger cut typically to get fibroids out, either removing the fibroids or removing the whole uterus,” said Dr. Andre LaRoche, chief of obstetrics and gynecology at Humber River Hospital.
Dr. Andre LaRoche, chief of obstetrics and gynecology at Humber River Hospital in Toronto, explains how a less invasive treatment for fibroids works.
Through a couple of small incisions, the technology, called Acessa, includes a laparoscopic ultrasound to view the fibroid.
Another device delivers radio waves and heat directly into the fibroid and destroys the tissue, turning it from a hard muscle to a soft consistency. While it doesn’t remove the fibroid, over time the fibroid shrinks, alleviating symptoms and patients experience less pain.
“This allows people to also preserve their uterus, and have a minimally invasive approach that improves their symptoms pretty quickly,” said LaRoche.
“Typically within a week, they’re back to work doing their normal activities.”
Available in U.S. for several years
Humber River Hospital was the first medical centre in Ontario to offer the treatment starting in 2022, despite it being available in the U.S. market for many years.
Since then, LaRoche has done about 100 procedures and has been helping train other surgeons at Humber River and other medical centres outside Ontario. The company behind Acessa says the technology is available in eight other hospitals and outpatient clinics across the country — most recently arriving in Moncton, N.B.
While the procedure isn’t an option for extremely large fibroids, La Roche said ideal candidates are women closer to menopause, when fibroids tend to shrink and get smaller on their own, or people concerned about preserving fertility.
At another hospital in Toronto, a potential future treatment is in development. A team at Sunnybrook Health Sciences Centre is working on a non-surgical option using a high intensity focused ultrasound.
Researchers there completed a double-blinded, randomized controlled trial involving 50 women that ended last summer. The majority of the participants were in their 40s and 50s and had a range of fibroid symptoms. They were treated and monitored for one year.
“We did find in this trial that their quality of life and symptoms severity score did decrease over that period and that the effect was quite durable,” said Dr. Elizabeth David, a vascular interventional radiologist and principal investigator of the trial.
The findings are under review by Health Canada. If approval comes through, Sunnybrook scientists say it would be the first MRI-guided focused ultrasound device for the treatment of uterine fibroids in Canada.
David said she hopes it will be another option for treating uterine fibroids in Canada, a condition she says has major societal impacts.
“If someone is so hindered or so disabled by their menses every month that they can’t go to work or they can’t function properly, that is an enormous societal cost,” she said.
“Not only for the women, [but] their family and their employer.”
In the U.S., fibroids are the leading cause of hysterectomy surgeries — and it’s estimated the health issue accounts for up to $34 billion annually in direct and indirect costs, according to the Journal of the American Medical Association.
‘Scared that I would die’
Nam Kiwanuka knows about the personal cost of fibroids.
Kiwanuka, a journalist and host for TVO in Toronto, began experiencing pain and heavy bleeding in her 40s. After tests and ultrasounds, she discovered it was due to fibroids.
As the months went on, her symptoms worsened. At one point, she said, she bled for 52 days straight, often bleeding through her clothes while on the way to work. At night, she would wake up every few hours to change her pads.
“I was actually really scared that I would die from this because I would sit on the toilet at night and blood would just come out of my body and I didn’t know how to stop it.”
Host and producer for TVO in Ontario, Nam Kiwanuka shares how uterine fibroids impacted her life.
She said she endured visits to the ER, became anemic, experienced hair loss and had to pay out of pocket for iron transfusions. She spent thousands of dollars on menstrual products and medications to help stop the bleeding. While some medications eased her symptoms, she said they often came with unbearable side-effects, such as migraines, night sweats and nausea.
Ultimately her doctor advised her she would need a hysterectomy.
“I didn’t exactly want to have a hysterectomy, but there wasn’t really any way to work around it.”
Complications after surgery
After waiting almost a year, she had the surgery in December 2023. She was scheduled for a laparoscopic hysterectomy, but during the procedure, the doctor had to cut her open because her fibroids were too numerous and large — one measured 10 centimetres.
Months later, because of complications, she is still recovering and dealing with pain.
Kiwanuka said ultimately she wants to bring awareness to the issue in the hope that treatment options will be better for her daughter, and other women, if they ever had to deal with fibroids.
“It just feels like there’s so much silence around it, but then there’s so much harm.”
So many questions, few answers
As to why fibroids occur, that’s another mystery.
“We don’t really know what causes fibroids,” said Maxwell.
Researchers have some theories, exploring potential links between chronic stress, Vitamin D deficiency, obesity and the role of genetics.
There are also racial disparities, with the risk of fibroids higher for Black women. Research has shown they are more likely to develop fibroids at a younger age, develop larger fibroids and experience more severe symptoms. They also have higher rates of invasive surgery.
Maxwell and other medical experts have advocated for more research on fibroids and racial disparities in Canada.
“I think it would be helpful if we could get down to some of the root causes as to why fibroids grow and what makes them grow larger and more numerous, in order to also target treatments in the future,” said Maxwell.
Fibroids are non-cancerous tumours that develop in an estimated 70 per cent of women in their lifetime and can cause ongoing pain, infertility and bleeding for weeks on end. Medication and invasive surgery has long been the main solution, but CBC’s Tashauna Reid goes into the operating room to see how two new high-tech treatments could make a difference.