Candid Consult: New Approaches to Treating Fibroids

Fibroids are a common condition affecting up to 70% of women. In decades past, removing your uterus (also known as a hysterectomy) was the only option for treating them. But, today’s era of medicine brings new treatments that are minimally invasive, offer a quicker recovery, and can help preserve your fertility. Of course, determining the right treatment for you depends on your symptoms and your personal reproductive plans. In this edition of Candid Consult, we spoke with an Axia Women’s Health provider, Dr. Geoffrey Bowers of the Center for Gynecologic Surgery, to learn more about what causes fibroids, how to identify them, and the range of new treatment options available.

Dr. Bowers explains all this and more in our interview below.

Dr. Bowers, can you help us understand what exactly are fibroids?

Sure. Uterine fibroids are benign tumors that grow in the muscle in the uterus. Essentially, this means that fibroids are normal tissue that grows out of control. Imagine fibroids like freckles on your skin. They’re new growths that are very common, and most of the time don’t cause any major issues.

How common are fibroids?

Fibroids are very common and occur in about 40-70% of women. Some women may not experience symptoms at all. But, for the women who do experience symptoms, these usually present during their late 20s to late 40s. We also see that African American women are more likely to develop fibroids, though we don’t know exactly why. We do know that genetics play a role. So, if your mother had fibroids, you are about twice as likely to develop them.

What are some symptoms associated with fibroids?

The symptoms a woman may experience are dependent on a few factors: the size, the location, and the quantity of fibroids.

By and large, the most common symptom associated with fibroids is heavy bleeding or painful periods. You may be wondering what is considered “heavy bleeding.” This is difficult to answer, because no woman’s experience is the same. I advise women to consider how their period is affecting their day-to-day lives. If their periods are affecting their quality of life, no matter the “textbook definition” of heavy bleeding, it’s important to seek help.

Additional symptoms may include pelvic pressure, urinary frequency, abdominal bloating, or pain with sex. Lesser-known symptoms can include constipation, lower back pain, or leg pain.

How does a provider diagnose fibroids?

A pelvic ultrasound is the best way to diagnose what’s going on. If you’re experiencing heavy bleeding, I would advise asking your provider about an ultrasound. This type of imaging can provide a greater understanding of what’s going on inside, so we can better determine next steps for treatment.

Are there other conditions that may present with similar symptoms to fibroids?

Yes, heavy bleeding can also be a symptom associated with conditions like adenomyosis, endometriosis, thyroid disorder, or endometrial polyps. In the worst and rarest cases, it can indicate the potential of cancer. An ultrasound is the best way to diagnose the root cause of your symptoms.

What can happen if fibroids are left untreated?

In the worst cases, fibroids can lead to excessive loss of blood that can require a blood transfusion. In this case, they can be life-threatening. Fibroids can also pose risk to fertility and pregnancy. Fibroids can limit the ability for a pregnancy to implant and grow within the uterus. If fibroids are located near or are obstructing the fallopian tubes, they can prevent fertilization from occurring. If fibroids develop in the cervix or in front of the uterus, they can make delivery more complicated. Overall, any fibroid that alters blood supply to the uterus can affect gestation.

How are fibroids treated?

How we approach treating fibroids is based on a few main factors. Namely, we consider what are the primary symptoms we need to address and what are the patient’s goals for conception and future childbearing. In the last five years many new treatments have been developed, allowing us more options to meet a patient’s specific needs.

When we think of the scope of type treatments, there are really two ends of the spectrum from birth control to hysterectomy. I’ll break down what to consider with each treatment here.

Medications

Birth control: Birth control pills work by regulating the menstrual cycle, so they may lessen bleeding and reduce pain. Similarly, an intrauterine device (IUD) may provide symptom relief by relieving heavy bleeding and pain. However, neither option will reduce the size of the fibroid. So, if bulk symptoms are your main concern, I wouldn’t recommend this option.
Gonadotropin-releasing hormone (GnRH) Agonist: GnRH medications work at the pituitary level to block the brain from producing the hormones estrogen and progesterone. Without estrogen stimulation, fibroids shrink, and symptoms of bleeding and pain are decreased. Because these medications can only be used for two months, they are typically only prescribed prior to a fibroid surgery.

Procedures

Uterine fibroid embolization (UFE): UFE is a non-surgical, minimally invasive treatment option for uterine fibroids. During the procedure, a small catheter is inserted into the artery at your groin or your wrist and releases small particles, like a grain of sand, that block the blood vessels and deprive the fibroid of nutrients, causing it to shrink. This treatment is not recommended for patients with large fibroids.
Myomectomy: Myomectomy is a surgical procedure that can be performed in several ways, dependent on the size, number, and location of fibroids. Abdominal myomectomy is done through an incision in the belly, laparoscopic myomectomy is done through a small incision in the belly and with the assistance of a small lighted telescope called a laparoscope, and hysteroscopic myomectomy is done through the cervix, leaving no scar. Myomectomy can be used to treat many different types of fibroids. It’s important to seek out a physician who is specifically trained in myomectomy as it is a complex procedure, but can be an excellent option for many women. Expect recovery to be about 3-5 weeks.
Radiofrequency ablation (Acessa): The Acessa procedure, or radiofrequency ablation, is a newer form of treatment that has been shown to help with both bleeding and bulk symptoms of fibroids. It is designed to heat the fibroid tissue to the point that it dies, shrinks, and shrivels over time. Imagine a grape being shrunk down to the size of a raisin. Ablation offers a fast recovery within 3-5 days. While it will not remove fibroids completely, it will significantly shrink them. It is less invasive than myomectomy as it requires no cutting or suturing of the uterine tissue and leaves less scarring. However, because it is a relatively new procedure, it is not offered everywhere. It’s important to seek out a highly qualified physician who is trained and skilled in this specialized procedure.
Hysterectomy: Hysterectomy is the surgical removal of the uterus. It is a permanent solution for fibroids, and is typically only considered if other less invasive options aren’t viable. It is a major operation that requires careful consideration and discussion with your provider.

If you’re experiencing heavy bleeding, don’t be afraid to speak up. This could be a sign of an underlying health condition like fibroids. Booking an appointment with your Axia Women’s Health provider can help you take the next step towards finding relief.