Regina Goulder, FNP-C, APN, on the Risk Factors and Symptoms Associated With Uterine Fibroids
In this podcast, Regina Gouder, FNP-C, APN, speaks about uterine fibroids, including the different types, the causes, the risk factors, and the symptoms associated with uterine fibroids.
Regina Goulder, FNP-C, APN, is a family nurse practitioner at Methodist Medical Group in Atoka, Tennessee.
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Jessica Bard: Hello, everyone, and welcome to another installment of "Podcast360," your go‑to resource for medical news and clinical updates. I'm your moderator, Jessica Bard, with Consultant360 Specialty Network. Uterine fibroids are the most common benign tumors in women of childbearing age.
Regina Goulder is here to speak with us about the cause, the symptoms, and the risk factors associated with uterine fibroids. Regina is a nurse practitioner at Methodist Medical Group in Atoka, Tennessee. Thank you for joining us on the podcast today. What are uterine fibroids, and are there different types?
Regina Goulder: Sure. Uterine fibroids, they're typically non‑cancerous. I will start with that. They're muscular tumors of the uterus. Medically, we call them leiomyomas. At times, you can get single fibroids. You can get multiple fibroids. They range in sizes from seedlings all the way up to ones that may enlarge or distort the uterus.
We do classify them in different types. One would be an intramural fibroid. That's within the muscular wall of the uterus. Another type would be submucosal. These are typically more common. They bulge into the uterine cavity, so we can see them better on the ultrasound. Then you have subserosal ones that project outside the uterus. They're not quite as common.
Then the last type, which are hardly ever seen, are pedunculated fibroids. As I say, they're very uncommon. They grow outside the uterus. We use the ultrasound to detect the different types of fibroids, and that guides treatment plan.
Jessica: How common are uterine fibroids in the United States?
Regina: They are very common, but they're not always symptomatic. A lot of women remain asymptomatic. When we get into the range of how common are they, we have a big percentage, 40 to 80 percent of women will develop these before age 50.
We ask, how is it such a big percentage? It's because we don't always know because women are not always symptomatic with them. They are a lot more common than you would ever think, for sure.
Jessica: What causes uterine fibroids?
Regina: We don't know, to be honest. Research points more towards genetic changes and hormones. We know they're linked to hormones, and increase in estrogen and progesterone, in particular. This is why we usually get more uterine fibroids before the age of 50.
With menopause, our progesterone and estrogen decrease, which causes fibroids to shrink. With decreased hormone production, we have less fibroid. We know they're related to the hormones, but we don't know what causes them. I will say, which we'll probably get into this later, a risk factor is genetics. If we have a family history, you're going to be more likely to have the uterine fibroids.
Jessica: That's a great segue into the next question. I was going to talk about risk factors. In addition to genetics, what are risk factors that are associated with uterine fibroids?
Regina: To go back with genetics, I do want to pinpoint that a woman is 3 times more likely to have uterine fibroids if her mother did. That's a huge risk factor in itself. Of course, our most common risk factor is age, age, age. Women of reproductive age are the most likely to have them, anywhere from 30 to about 50.
Once again, that goes back with hormone production. When they start decreasing hormone production, we don't see them as often. We don't see them as much in early reproductive age, either. Your most common are going to be your 30 to 40‑year‑olds.
Another risk factor is race. African American women are more likely to have fibroids than Caucasian women. Also of note, African American women are more likely to have severe problems from the fibroids over Caucasian women. That's an extra note of risk factors.
Lastly, I usually like to preach about obesity. You're 2 to 3 times more likely to develop uterine fibroids in the obese population with a BMI of 40‑plus.
Jessica: I know that we've touched on symptoms a little bit before. What are the clinical features of uterine fibroids, and might patients present with symptoms?
Regina: Many have no symptoms. As we talked about earlier, they come in asymptomatic. If they do come in with symptoms, the most common symptom you're going to see is menorrhagia. This leads to anemia. You may get somebody complaining of menorrhagia and fatigue, which would make you want to draw an anemia panel. Then it'll all play out as to why they're having the fatigue.
Long cycles, pelvic pressure pain, low back pain, some people will complain of that. Occasionally, you'll get some constipation. That's not very common. You'll see a lot of painful intercourse. They'll come in complaining of painful intercourse. In my field, that's what I see.
In the gynecologist realm, they may see more of the pregnancy complications and reproductive problems, like fertility. Usually, when that comes out, it's not a primary care setting. It's more when they've been referred to a specialist. In primary care, we're definitely going to see the menorrhagia, the painful intercourse and the pelvic pain.
Jessica: Is there anything else that you'd like to add in regards to an overview of uterine fibroids?
Regina: No, I don't guess. It's mainly in the primary care realm. We want to do our best on education, education about what the risk factors are, when to be seen. Don't let this prolonged menorrhagia happen for 3 to 4 months before you're seen.
Also, education with the older population, although they're typically non‑cancerous, when these uterine fibroids develop at that age group of around 50, that's when we're more concerned about the cancerous fibroids. It's education and primary care about when to seek help, when to ask questions, when to come in and make sure your blood counts are OK.
Jessica: Thank you so much for joining us today on the podcast. We really appreciate your time.