Dr. Jessica Opoku-Anane is a gynecologist who specializes in the minimally invasive treatment of fibroids, abnormal uterine bleeding, chronic pelvic pain, endometriosis, intrauterine scarring (Asherman's syndrome), pelvic organ prolapse and ovarian pathology.
Opoku-Anane's research interests include making gynecologic surgery safer and improving treatments for endometriosis and fibroids.
What we Discuss
Difference between uterine fibroids vs. endometriosis vs. adenomyosis, including the symptoms for each
Uterine fibroid symptoms, diagnosis, and treatment
Quality of life and fertility impact for those with uterine fibroids
Questions to ask your doctor to ensure your uterine fibroids and diagnosed early and proactively treated
Jessica Opoku-Anane 03:12
Uterine fibroids are benign, meaning not cancerous growth of the muscle tissue inside the uterus. So you could do this is just a really big muscle that contracts and causes cramping that it causes with periods, if like one little muscle fibroids starts to grow, or one little muscle cell starts to grow really fast and replicate itself over and over again, it can make a little ball of tissue and that's what we call a fibroid. It's a tumor, but it is not a cancer tumor.
Why are these problematic? So they used to contain the uterus and a lot of times they're often not problematic. So if we look at all women 70 to 80% of all women will have uterine fibroids, but not all the time where they are problematic. They only cause problems if they grow into the wrong place or if they get really large as they're pushing on things in terms of the wrong place.
If they start to grow into your uterine cavity or your womb, they disrupt the normal fibroids that are there that allow you to menstruate once a month. And so if you can't if the uterus can't work in a coordinated manner to cramp and stop you from bleeding a whole lot, but you can end up with really heavy periods or hemorrhaging with your periods. If it's into the cavity can affect fertility because it's just not enough space for a pregnancy to implant or to grow. But if they grow on the outside of the uterus, or even in the muscle wall, the uterus and get really big, they start to push on things like your bowel or your bladder and cause pain and discomfort.
Georgie Kovacs 04:38
Now some of the things that you're talking about seem to be fairly similar to endometriosis as well. Maybe you can tell us a little bit about how endometriosis and uterine fibroids and even adenomyosis differ.
Jessica Opoku-Anane 04:52
Endometriosis. This is when the endometrial tissue, the cells that line the inside of the uterus, comes out once a month with the gooey stuff that comes with the blood. It goes back through the fallopian tubes and spills into the pelvis outside of the uterus. We call this endometriosis.
Fibroids are part of the uterus and endometriosis is when the lining cells, endometrial tissue go outside of the uterus, and they're very different disorders. So for fibroids, the mass is like the actual pressure or location of it that's causing problems. With endometriosis, it is the inflammation that causes pain and discomfort and scar tissue. So you don't tend to have as much inflammation with uterine fibroids.
Adenomyosis is something closer to endometriosis in most situations. So instead of the endometrial tissue with those periods, cells going back with fallopian tubes and spilling outside of the uterus, they go into the muscle wall of the uterus similar to a fibroid, but again, it causes inflammation. And so the inflammation causes pain. It's much more significant pain with endometriosis compared to fibroids. And it can still cause the same issues as fibroids disrupting the normal muscle fibroids can cause bleeding.
Georgie Kovacs 06:06
What are the symptoms for these conditions and how do they differ?
Jessica Opoku-Anane 06:51
For fibroids, the best way for me to describe it is our bulk symptoms and bleeding. Think of a pregnant woman, the uterus is designed and meant to grow up to the size of a full-term baby. And so the symptoms that happen with fibroids is the uterus is just growing. So you're going to feel the same symptoms as a pregnant woman - bulk symptoms, pressure is pushing against your bladder. You're gonna have to urinate more. If it's pushed against your bowels, you may have more constipation or difficulty with your bowel movements, but bloating, pressure discomfort, those are usually the bulk symptoms of uterine fibroids. And they're rare other symptoms, but they're so rare. I don't think that most women should think about those.
Then there are the bleeding symptoms. So the heavy periods that's the other really significant portion for uterine fibroids. Just because we brought this up for like adenomyosis or endometriosis is very different - those disorders tend to cause pain. It's not a pressure, it's not a bulk. It's literally severe pain with your periods.
And it can be difficult to distinguish between the two but more just thinking of bulk discomfort, bloating, that's more fibroids. Actual pain that's once a month, the same time every month - that's the most classic symptoms for endometriosis, although it can look like a lot of different things.
Georgie Kovacs 08:12
Yes, that is definitely true. Now, you mentioned heavy periods. So I must ask because, you know, we women aren't taught necessarily what a normal period is. Heavy to one woman may not actually be heavy, but then heavy to another woman actually is heavy. So what is considered a heavy period?
Jessica Opoku-Anane 08:34
Yeah, the technical term is more than 30 milliliters of blood. But I think that that's hard to quantify. The way that we will ask patients is, “Are you filling a tampon or a pad front to back the whole thing, within an hour to two hours?” That's heavy.
If you're saturating through your clothes and having accidents, that's too heavy.
If you're anemic, feeling lightheaded and dizzy with your periods, that's too much as well.
Georgie Kovacs 09:04
I know that sometimes when women start their period may be heavier on the first day or two and then it gets lighter and lighter. And when the flow first comes out, it could be heavier. So is this like, throughout a certain period of time? Because what if you know when that period first comes out, it may be heavier than throughout? So when you're saying that tampon in an hour is that over a certain time period, or even if it's that first tampon?
Jessica Opoku-Anane 09:31
Even if it's that first tampon, if this consistently even through that first tampon then it can be, but yes, for most women, it's heavier in the beginning, but some of it's a little bit subjective. It's what's heavy to you. But that's just a general way to gauge - Is this normal or not normal?
Georgie Kovacs 09:49
I wonder if the menstrual cups are starting to help with understanding the milliliters a little bit better? I've tried the menstrual cup and I don't even know if I know how many milliliters it fills,
You were also talking about not necessarily the pain but just the feeling that one may get if they do have uterine fibroids - that pressure feeling. Do you find that patients tend to wait too long?
In talking to so many women and experts, I hear women tend to grin and bear it because again, we aren't taught this is normal. So whatever we live with, and whatever our mothers and aunties and grandmothers and friends or the school nurse tell us is what we define as normal. It's not like we get this textbook handed to us when we're 14 years old that said, “This is how a woman's body should work.”
I'd love to hear if you have any perspective to add around that feeling of pressure, because I also understand, with uterine fibroids if you wait too long, that's when it's harder to actually help women.
Jessica Opoku-Anane 11:14
I think this is really important for all women's health, I think we suffer too much. You should not be suffering with your periods in any fashion, whether your periods are too heavy, and you're having embarrassing episodes, that's not necessary. That's not normal. We have lots of treatment options.