Here's what else you need to know about uterine fibroids.

1. Uterine fibroids are often symptom-free and require no treatment.
Although some fibroids are large enough to fill the uterine cavity and weigh several pounds, many are as small as a pinhead. Only about one-quarter of women who have fibroids develop symptoms.

But when symptoms do develop, the most common is heavy or prolonged bleeding during the menstrual cycle. Fibroids may also cause cramps, and large ones can produce a sensation of fullness or pressure in the lower abdomen. If they press against the bladder, they can cause frequent urination.

2. Fibroids can affect fertility.
Fibroids can block the fallopian tubes and prevent sperm from reaching and fertilizing an egg. After conception, fibroids may impair the ability of the embryo to implant in the uterus. A woman who brings her baby to full term may have fibroids blocking her vagina, possibly making natural birth difficult; cesarean section rates are higher among women with fibroids, notes Dr. George Vilos, a professor of obstetrics and gynecology at the University of Western Ontario in London. Fibroids are also associated with higher rates of miscarriage and premature labour.

However, there's a 20 per cent reduction in the prevalence of fibroids after each pregnancy, says Vilos. This is because the uterus continues to contract, compressing blood vessels in the area where the placenta was attached and cutting off the blood supply to fibroids. “Fibroids cannot tolerate the lack of blood supply,” notes Vilos.

Click here for a tour through your postpartum body.

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3. Treatment options depend on a woman's desire to remain fertile.
These options include:
• Medications (including Zoladex, an injectable drug, and Nafarelin, a nasal spray) that block the production of female hormones. They're relatively expensive and fibroids tend to regrow when they're discontinued. Side-effects are similar to those of menopause (hot flashes, night sweats, etc.). Male hormones (androgen) may also be used but may cause facial hair growth, changes in voice, weight gain and acne.

• Surgical alternatives to hysterectomy (removal of the entire uterus) including:
a) Uterine artery embolization (UAE).
This procedure shrinks fibroids by blocking the blood supply to the uterus. In a small percentage of women, menstruation is suspended and fertility compromised.

b) Myomectomy
This procedure involves surgical removal of fibroids but, unlike a hysterectomy, leaves the uterus intact, therefore preserving reproductive potential. Surgeons may use a laparoscope to access the fibroids.

c) Flostat clamp
Pioneered by Vilos, this procedure involves inserting a clamp through the vagina and placing it on the cervix for up to six hours, during which time the blood supply to the fibroids is blocked. This temporary procedure can be performed by a gynecologist and is less invasive than UAE. Early study results suggest that fibroids are reduced in size by about 25 per cent. Fertility does not appear to be affected.

d) MRI-guided ultrasound
This experimental procedure uses tiny heat pellets to cut off blood supply and destroy over half of a fibroid, providing significant symptom relief to 80 to 85 per cent of patients, says Dr. David Gianfelice, an associate professor of abdominal and interventional radiology at University Health Network in Toronto. .

Pump up the iron
Women may become anemic from blood loss caused by fibroids. Here are some tips to maintain iron stores:
• Eat foods that contain readily absorbable iron; for example, clams, oysters, beef, pork, poultry and fish.
• Choose dairy products, eggs and certain vegetables that contain a less-absorbable type of iron.
• Eat cooked vegetables. The cooking process increases the release of stored iron.
• Increase vitamin C intake (from foods such as broccoli, cabbage and citrus fruit) to enhance iron absorption.
• Eat foods rich in riboflavin (vitamin B2), such as liver and fortified cereals, to increase your body's ability to use iron.
• Avoid tannin (found in tea) and phytic acid (found in seeds and bran). These impair iron absorption.

Search the Canadian Living recipe database for iron-rich and healthy meals.

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