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Rapper and Actor Eve’s Uterine Fibroids

Rapper, former “The Talk” co-host, and actress Eve, 43, announced that she is taking maternity leave from her ABC show “Queens.” She and her husband, Maximillion Cooper, are expecting their first child in February. On a recent “Tamron Hall Show,” Eve revealed that her path to this birth has been long and rocky:

“We went through our fertility journey, we went through doctors first and just checking things out, and we did do IVF [in vitro fertilization], so we did go through that journey as well,” she told Hall. “But … something said to me that something was not right within my body. And I ended up going to a specialist. They told me, ‘I don’t care: you can do 20 rounds [of IVF], you can have all the sex you want — you’re never going to get pregnant because you have so many fibroids that your uterus actually already thinks it’s already pregnant.'”

Eve said that she had always had excruciatingly painful menstrual cycles and she learned that the fibroids were probably contributing to this. In 2020, she underwent surgery to remove the fibroids and improve her chances of becoming pregnant. She told Hall she cried when she had her first painless period after her myomectomy.

Eve said she feels it’s important for women like her to share their stories publicly, and that she hopes to educate women to pay attention to what is happening in their bodies, and to advocate for themselves when working with the medical system.

What are Uterine Fibroids?

Uterine fibroids, or leiomyomas, are tumors or growths made of smooth muscle cells, fibroblasts, and other material that grow in or on the wall of the uterus. They are almost always benign. In fact, they are the most common non-cancerous tumors in women of childbearing age.

Fibroids can grow as a single tumor, or there can be many of them in the uterus. They can be as small as an apple seed or as big as a grapefruit. In unusual cases they can become very large.

Fibroids can be different sizes or shapes. Bunches or clusters of fibroids are often of different sizes. Fibroids can grow, shrink, or remain a constant size over time.

Fibroids are categorized based on where they grow:

  • Submucosal fibroids grow just underneath the uterine lining and into the endometrial cavity
  • Intramural fibroids grow in between the muscles of the uterus
  • Subserosal fibroids grow on the outside of the uterus

Some fibroids grow on stalks that grow out from the surface of the uterus or into the uterine cavity. These are called pedunculated fibroids.

Uterine fibroids are clonal in origin, appear after menarche, typically grow during the reproductive years, and then stabilize or regress after menopause. About 20-80% of women develop fibroids by age 50. Fibroids are most common in women in their 40s and early 50s.

What are the Symptoms of Uterine Fibroids?

Many women have no symptoms of fibroids. However, uterine fibroids can cause uncomfortable or sometimes painful symptoms, such as the following:

  • Heavy bleeding or painful periods
  • Feeling “full” in the lower abdomen (pelvic pressure)
  • Frequent urination (caused by a fibroid pressing on the bladder)
  • Pain during sex (dyspareunia)
  • Reproductive problems, such as infertility, multiple miscarriages, and early onset of labor during pregnancy
  • Obstetrical problems, such as increased likelihood of cesarean section

What Causes Uterine Fibroids?

Currently, the exact causes of urine fibroids are unknown. Research evidence suggests that any or all of these factors might play a role in the growth of uterine fibroids: (See Segars et al.)

  • Genetics (e.g., genetic mutations in the MED12, HMGA2, COL4A5/COL4A6, or FH genes)
  • Estrogen and progesterone
  • Micronutrients, such as iron, that the body needs only small amounts of in the blood — for instance, a deficiency of vitamin D may be associated with uterine fibroids

It is likely that fibroids are caused by many factors interacting with one another.

What are the Risk Factors for Uterine Fibroids?

Several factors may affect a woman’s risk for having uterine fibroids, including the following:

  • Age (older women are at higher risk than younger women)
  • Family history of uterine fibroids
  • Food additive consumption

Factors that may lower the risk of fibroids:

  • Pregnancy (the risk decreases with an increasing number of pregnancies)
  • Long-term use of oral or injectable contraceptives

How are Uterine Fibroids Treated? (According to NICHD)

Medical Treatments

Medical treatments may give only temporary relief from the symptoms of fibroids. When medications are stopped, fibroids can grow back, and symptoms can return.

Common medical treatments for fibroids include:

  • Pain medicine: Over-the-counter or prescription medicine is often used for mild or occasional pain from fibroids
  • Birth control pills or other types of hormonal birth control: These medicines help control heavy bleeding and painful periods; however, this therapy can sometimes cause fibroids to grow larger
  • Progestin-releasing intrauterine device (IUD): The hormonal IUD, also called intrauterine contraception, reduces heavy and painful bleeding, but does not treat the fibroids themselves. It is not recommended for women who have very large fibroids, which can block the uterine cavity
  • Gonadotropin-releasing hormone agonists: These medicines block the body from making the hormones that cause ovulation, and also reduce the size of fibroids. Because this treatment can cause side effects that mimic the symptoms of menopause (such as hot flashes, night sweats, and vaginal dryness) and bone loss, it is not meant for long-term use. Most of the time, these medicines are used for a short time to reduce the size of fibroids before surgery or to treat anemia
  • Antihormonal agents or hormone modulators (such as selective progesterone receptor modulators): These drugs, which include mifepristone, and letrozole, have been studied with varying results. In May 2021, the FDA approved Myfembree (relugolix 40 mg, estradiol 1 mg, and norethindrone acetate 0.5 mg) as a once-a-day treatment for heavy menstrual bleeding associated with uterine fibroids

Hysterectomy

Hysterectomy is the only sure way to cure uterine fibroids completely. It may be an option for women who are close to or past menopause or those for whom childbearing is no longer desired. It may also be used for women with very large fibroids or very heavy bleeding.

Endometrial Ablation

Endometrial ablation, which destroys the lining of the uterus, is used to treat small fibroids inside the uterus. Ablations can be performed in a variety of ways, including using electric currents, microwave energy, high-energy radio waves, hydrothermal, and freezing.

Although pregnancy is unlikely after this procedure, it can happen. Women who get pregnant after endometrial ablation are at higher risk for miscarriage and other problems.

Uterine Artery Embolization

In uterine artery embolization (UAE), also called uterine fibroid embolization, a physician makes a small cut in the groin area, inserts a catheter into the large blood vessel there, and slides the tube until it reaches the arteries that supply blood to the uterus. The doctor then injects tiny plastic or gel particles through the tube into the arteries. The particles block blood flow to the fibroids, so they eventually shrink, and symptoms may be relieved.

Some research has shown that UAE successfully treats fibroids but that about one-third of women need treatment again within 5 years (see Agency for Healthcare Research and Quality [AHRQ]).

Because this procedure stops blood flow to parts of the uterus, it can affect how the uterus functions. It can also affect how the ovaries function if the inserted particles drift into other areas of the pelvis, such as the ovarian artery. The effect on pregnancy is not clear, but an increased risk of miscarriage has been reported. For this reason, most healthcare providers do not recommend UAE for women who want to have children.

MRI-Guided Focused Ultrasound

This treatment destroys fibroids by using high-intensity ultrasound. The healthcare provider uses an MRI scanner to see the fibroids and then directs focused ultrasound waves through the skin to destroy the fibroids. This option is usually recommended for women who have only a few large fibroids. (See Jacoby et al.)

Scientists are still studying the long-term effects of this procedure. Studies show that although symptoms improve up to a year after having MRI-guided focused ultrasound, within 2 years about one in three women will need another surgery or another procedure to treat fibroids.

Myomectomy

Myomectomy is a surgical procedure that removes only the fibroids and leaves the healthy areas of the uterus intact. It can preserve the ability to get pregnant.

Myomectomy can be performed in one of three ways: hysteroscopy, laparotomy, or laparoscopy.

Studies show that myomectomy can relieve fibroid-related symptoms in 80-90% of women. (See AHRQ). The original fibroids do not regrow after surgery, but new fibroids may develop.

Clinical trials dealing with various aspects of uterine fibroids can be found at clinicaltrials.gov.

Michele R. Berman, MD, is a pediatrician-turned-medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Her mission is both journalistic and educational: to report on common diseases affecting uncommon people and summarize the evidence-based medicine behind the headlines.

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