More Treatments for Fibroids

Although women of any age can experience fibroids, they become more common as women get older, especially from their 30s and 40s through menopause.

Who’s at Risk?

For African-American women and those with a family history, the risks are higher. In fact, a national survey published in the October 2013 Journal of Women’s Health revealed African-American women are three times more likely to get fibroids than Caucasian women. In this population, fibroids also seem to occur at a younger age, grow more quickly and are more likely to cause severe symptoms that interfere with daily life.

What Causes Fibroids?

No one knows for sure why African-American women are disproportionately affected, because no one knows what causes fibroids or what makes them grow or shrink, says gynecologist Rafael Perez, M.D., medical director of the Fibroid Center at South Miami Hospital. They can grow as a single tumor, or there can be many. They can be as small as an apple seed, or as big as a grapefruit. While they are not cancerous, fibroids can cause symptoms such as excessive menstrual bleeding, bloating, abdominal swelling, pelvic and lower back pain, constipation, frequent urination or even pregnancy complications and infertility.

Uterine fibroids are frequently found incidentally during a routine pelvic exam and diagnosed using MRI, says interventional radiologist James Benenati, M.D., medical director of the Peripheral Vascular Lab at Miami Cardiac & Vascular Institute. Some women have no symptoms, but those who do experience symptoms often find living with fibroids difficult. Many find the most commonly recommended fibroid treatment – hysterectomy, or the surgical removal of the uterus – hard to live with as well. The Society of Interventional Radiology reports of the estimated 600,000 hysterectomies performed in the United States each year, one-third are due to problematic fibroids.

Treatment Options

It’s important to note, however, that hysterectomy is not the only option or the best option in many cases, says Dr. Perez. The Fibroid Center’s specialists, he says, diagnose and treat uterine fibroids using a team approach. The team consists of gynecologists, interventional radiologists and fertility specialists. Because more women are choosing to delay childbirth, some may learn they have fibroids before they have had children.

The good news, according to Dr. Perez and his associate medical director Adam Geronemus, M.D., an interventional radiologist, is that women have alternatives. The following treatment options preserve a woman’s uterus and fertility:

• Watchful waiting can be coupled with pain relievers or anti-inflammatory medications taken for pain.

• Birth control pills help regulate the menstrual cycle, control heavy bleeding and alleviate some of the pain and pressure.

• Hormone treatment aids in shrinking fibroids and stopping bleeding.

• Uterine fibroid embolization (UFE), a nonsurgical procedure performed by an interventional radiologist, destroys the blood supply to the fibroids, causing them to shrink.

• Endometrial ablation uses heat, microwave energy, or electric current to destroy the lining of the uterus, either ending menstruation or reducing menstrual flow.

• Myomectomy, a surgical, laparoscopic or robotic procedure, removes uterine fibroids while leaving the healthy tissues of the uterus intact.

• MRI-guided focused ultrasound uses ultrasound waves to destroy the fibroids.

Maintaining Fertility

“For many women, the loss of fertility after a hysterectomy is an unacceptable tradeoff for the relief of fibroid symptoms,” Dr. Perez said. “Even if they’re no longer concerned about fertility, preservation of the uterus is an important goal for some patients.”

Treatment options vary based on the size, number and location of fibroids and a woman’s symptoms, age and desire to conceive.

Dr. Perez performs minimally invasive laparoscopic and robotic myomectomy to remove uterine fibroids. The procedure is a good choice for women whose doctor suspects uterine fibroids might be interfering with fertility, those who want to have children after fibroid treatment and women who simply wish to keep their uterus, says Dr. Perez.

Uterine Fibroid Embolization

As interventional radiologists, Dr. Benanti and Dr. Geronemus perform UFE as an alternative to hysterectomy.

“UFE is a successful option for 75 to 80 percent of women seeking treatment for uterine fibroids,” Dr. Benenati said, adding that studies released by the National Institutes of Health concluded that fibroid embolization is just as effective as hysterectomy as a treatment for uterine fibroids.

Seek Opinions

“It’s very important that women are aware of all their treatment options,” Dr. Benenati said. “Women should do their research and ask questions. Patients who are told hysterectomy is their only option should seek a second opinion from a specialist who performs minimally invasive procedures to treat uterine fibroids.”

“Our doctors work together with women and their referring gynecologists to determine the very best treatment plan,” Dr. Perez added.

All three doctors say there’s no need for women who are diagnosed with fibroids to suffer with them to protect their fertility. They recommend discussing options with their gynecologist and finding local specialists who can help initiate the best treatment.