Overview

Uterine Fibroids (UF), also known as leiomyomas, are the most common type of pelvic and gynaecologically benign tumours; they affect more than 70% of women of reproductive age worldwide.¹ It is one of the main reasons that can cause you to get a hysterectomy, and is more likely to occur in black women (80% risk) than white (70% risk) women.² 

Having a lot of oestrogen in the blood can cause fibroids to grow in the smooth muscle cells of the uterus. A lot more information about how these fibroids grow is not well known. You can have fibroids and either be asymptomatic or symptomatic. Symptomatic individuals may present with abnormal vaginal bleeding, pelvic pain, problems with your bowels, bladder, back and infertility issues. Sometimes it leads to a low quality of life. 

One of the most debilitating events that can occur when diagnosed with UF is the negative impact on one's mental health. Studies have discovered that the prevalence of depression and anxiety is high amongst those diagnosed with UF and even higher in those women who had very severe pain or had to get a hysterectomy.³  So, aside from battling with the terrible physical effects of the condition, mental health problems due to UF are a serious issue that needs to be addressed. 

In this article, you will understand more about UF, its effects on mental health, the physiological processes involved, and how it can be managed. 

Firstly, let us dive a little deeper into understanding the basics.

Understanding uterine fibroids

You should know that UFs are of different types, mainly three, based on location; they are intramural(inside the uterine wall), submucosal(inside the uterine cavity), and subserosal(outside the uterus).⁴ It is important to know this because presenting symptoms, diagnosis, and treatment can be altered and differ due to the positioning of the fibroids. 

Submucosal and intramural fibroids will disrupt blood flow in the womb, and this can lead to the inability of a foetus to implant in the womb and thus infertility. Subserosal fibroids are often asymptomatic unless they are huge.⁵    

The fibroids can grow in different places, sizes, and ways, they can even get big enough to change the shape of the uterine cavity and endometrial surface and stop the flow of the menstrual blood.⁶ It may also affect reproduction and be linked to pregnancy loss, early birth, dystocia, and situations where the baby in utero is not in the proper position, which can lead to numerous complications. All these factors can contribute to the toll it can take on one's mental health, which will be talked about more below.

For its diagnosis, history, physical exams, laboratory, and radiologic investigations are incorporated, such as blood and hormonal tests (HCG & Prolactin), MRI, hysteroscopy, and transvaginal ultrasound, which is the gold standard. While treatment options are individualised according to symptoms, severity, and size, most of which will be surveillance, pharmacologic intervention, and surgery.³ 

Please consult your physician, who will provide the best option to match your needs.

How does having fibroids affect one's mental health?

In a particular study that evaluated 200 women with fibroids in London, it was found that 35% of them were depressed or borderline depressed, and 61% were depressed or borderline depressed with anxiety.⁷

It is the different symptoms associated with UF that can cause you to be in very low spirits, anxious, and depressed. These symptoms and effects on the body that can cause your mental health to decline will be explained under four main constructs below:

Psychological and emotional stress

Studies have shown that women suffering from fibroids, as a result of how their conditions changed their lives so drastically, felt sad, depressed, angry, helpless, and frustrated.

The psychological and emotional stress can occur due to several things you may experience as an individual with UF, some of which are :

Heavy bleeding and anxiety

Fibroid-associated menorrhagia (heavy menstrual bleeding) brings about a burden that cannot be overlooked. It has been shown that women experience the fear of bleeding heavily, or just how erratic their periods may be, due to the fibroids.⁸ This fear and constant worry cause a significant toll on them, leaving them frustrated and anxious all the time.

There are also reported cases of:^{6, 9}

• Having sleepless nights 
• Restrictions on doing normal daily activities: cooking, shopping, cleaning, and childcare 
• Constant fatigue and tiredness 

All of which negatively affect their moods and contribute to the feeling of anxiety and sadness.

Critics of body image and poor self-esteem

Fibroids can cause noticeable changes to your body, like bloating or weight gain in the abdomen, even if your general weight stays the same. This leads to a lot of the affected individuals experiencing issues with body image and sexuality. A study showed that 37% of the individuals with UF were conscious about the sizes of their stomachs and abdomen, while 20% believed that having UF impacted their sex lives negatively, most of the time with their partners/spouses.¹⁰

Even after treatment, like in those who ended up getting hysterectomies, their beliefs and perceptions of their body image, as well as physical pain experienced during intimacy (dyspareunia), significantly affected their ability to become intimate with their partners.¹¹  Also faced with, in some cases, the stigma of reproductive issues or feeling different, many suffer psychologically and feel alone and helpless.

Chronic pain and mood changes

We all know how terrible it is to be in a little bit of pain or discomfort for a short time. In UF symptomatic cases, individuals are faced with persistent discomfort, from lower back and pelvic pains to migraines. It was shown that for individuals who had pain-related symptoms, there was a relationship between UF and later mental health outcomes.⁴ Suggesting that poorly managed pain is a key factor in the link between UF and mental health outcomes.

Fertility and reproductive anxiety

As said earlier, knowing the types of fibroids you have and consulting your physician is important. Fibroids can make it harder to get pregnant, especially the submucosal ones that grow into the uterine canal. Up to 27% of individuals assigned female at birth who seek help for infertility have fibroids, with fibroids being the sole cause of infertility in between 1-3% of cases.¹²

What these types do is make it harder for embryos to implant, which lowers the chance of getting pregnant and having miscarriages. 

The thought of not being able to have children or having a miscarriage can cause a lot of sadness, hopelessness, or depression, especially in places where having children is a sign of social status. 

The role of hormones and neurobiology

Oestrogen and progesterone are the primary ovarian hormones that influence both your reproductive and neurological functions. Uterine fibroids are very sensitive to these hormones. When you have fibroids, your hormones get heightened, and this causes many physiological changes that affect your body and brain.¹³

In the uterus:^13,14

• Increase in circulating levels of oestrogen 
• Oestrogen increases progesterone's affinity for the fibroids
• In turn, progesterone encourages the growth of fibroid cells and stops them from dying, which causes the tumour to grow
• Increase in size of the tumours 
• Spreading of tumours to different sites in the uterus 

In the brain, hormonal imbalances like estrogen dominance, caused by fibroids, can lead to:¹⁵

• Mood disturbances 
• Memory impairment 
• Increased levels of stress hormones
• Anxiety 
• Depression  
• Stimulation of growth factors, like NGF and BDNF, contributes to pain and the maintenance of the fibroids 

All these can contribute significantly to mood changes, depressive feelings, and overall mental health state in individuals with UF.

What are the mental health support and coping strategies?

To address the mental health challenges associated with UF, options include:

• Psychological counselling and therapy
• Support groups and community
• Stress management techniques

Summary

• In addition to affecting the uterus, fibroid tumours have an impact on the entire individual
• The provision of emotional and psychological support ought to be a standard component of care for people who have fibroids
• A greater awareness can assist in the reduction of stigma and the improvement of quality of life