Though the majority of Canadian women are likely not familiar with uterine fibroids, these non-cancerous tumours will appear in up to 70 percent of women by the age of 50. While the fibroids will not impact the health of most women, unfortunately, for about 20 to 50 percent, the condition can lead to symptoms such as heavy menstrual bleeding, pain, pelvic pressure, difficult or frequent urination, and even fertility issues.

For women suffering from the ill effects of these uterine growths, if medications and radiologic intervention don’t work, it may be necessary to undergo surgery. Surgery, however, is not without potential complications because women with uterine fibroids may also be anemic, potentially due to prolonged heavy menstrual bleeding.

“Approximately 24 percent or one in four women having gynaecological surgery have perioperative anemia,” says Dr. Sony S. Singh, a gynaecologist from The Ottawa Hospital, who emphasizes the importance of reducing anemia before surgery to ensure a successful procedure. “The bottom line is we want to make surgery as safe as possible and give the patient the best outcome. Doing surgery on a patient with anemia — a low blood count — can lead to all sorts of problems, such as blood transfusion risks or impaired healing. Additionally, if somebody comes in with a low blood count, their energy is low, and they also won’t heal as well after surgery.”

Reducing anemia

There are several medications and iron replacement options that can help reduce the risk of anemia before surgery. These options include various medications that reduce or stop menstrual bleeding, such as gonadotropin-releasing hormone (GnRH) agonist therapy, which is now indicated to improve anemia prior to fibroids surgery. “GnRH agonists work by reducing the amount of estrogen and progesterone that feed the fibroids, and therefore they help control bleeding. They also shrink the fibroids, along with the uterus, which may actually make the surgery easier,” says Dr. Singh.

“For example, if I had a patient who was 30 years old with heavy menstrual bleeding and many uterine fibroids who wants to have a baby, but she has low energy because of a low blood count… before surgery, we would give her iron and want to stop her bleeding. Giving GnRH agonists will help stop bleeding as we await the operation. GnRH agonists may also make the surgery easier to do and allow for less risk of blood transfusion and other issues.” Other medications (hormonal and non-hormonal) working through separate methods may also be offered and may benefit patients.

Talk to your doctor

For patients with uterine fibroids undergoing surgery, communication is key, says Dr. Singh. “If women are going to have surgery, it’s very important they look into or discuss with their physician options to reduce the harm of being anemic, because anemia is a condition that needs to be treated and addressed prior to surgery.”