Health Canada has released a new health warning about Allergan’s uterine fibroid medication, Esmya (also known as Fibristal.) According to the warning, the medication can cause a rare but serious liver injury.
Uterine fibroids are non-cancerous tumors that develop inside, on or in between the layers of a woman’s uterus. Esmya is an oral medication intended to manage some fibroid symptoms, particularly heavy bleeding during your period. Prior to this warning, Esmya was prescribed for women who were of child-bearing age and didn’t want to undergo surgery, or for women who were awaiting surgery and wanted to mitigate their symptoms. While the drug has been widely prescribed in Canada and Europe, the FDA here in the U.S. has declined approval of the drug for use in this country.
Because of the newly-discovered potential for liver injury, doctors are being told to change the ways in which they use the medication. Now, it’s only recommended for women who want to have children. Even for these women, doctors should only prescribe one course of the drug–refills aren’t recommended. And, of course, no woman with a history of liver problems should ever take the medication.
Other Alternatives to Fibroid Surgery
It’s not surprising that many women want to avoid fibroid surgery. Whether opting for a myomectomy (surgical removal of the tumor) or a hysterectomy (removal of the entire uterus), surgery is a big deal. It typically comes with a hospital stay and a considerable recovery time.
Given the potential for serious complications, however, medication shouldn’t necessarily be the solution for young women dealing with fibroid symptoms. In our Houston area office, we provide a minimally-invasive fibroid treatment with no down time and outpatient delivery. While it is not right for everyone, it is certainly a treatment option worth considering, since it offers a non-medicinal, non-surgical solution for fibroid sufferers. If you’re currently investigating fibroid treatment options, be sure to schedule a consultation with Dr. Fox or Dr. Hardee to learn whether Uterine Fibroid Embolization is the right option for you.
According to a new Mayo Clinic study, minimally invasive uterine fibroid treatments offer better results than surgical options. According to findings published in the American Journal of Obstetrics and Gynecology, women who treated fibroids with UAE (uterine artery embolization) were less likely to need a second procedure than women who were treated with MRI focused ultrasound surgery (MRgFUS).
The study found that, both treatments reduced women’s fibroid treatments, but UFE offered a greater symptom reduction.
Of course, the study proved that both procedures were minimally invasive, making them viable alternatives to hysterectomy (the complete removal of a woman’s uterus.) This is great news for all women, since fibroids lead to about 200,000 hysterectomies each year in this country. While hysterectomies can “cure” women of fibroids, removing a woman’s uterus has been shown to increase a woman’s risk of long term health complications, including weight gain and heart disease.
What’s important about this new study is that, finally, alternatives to hysterectomies are being compared to one another to see which is the best option. And in this study, called FIRSTT Fibroid Interventions: Reducing Symptoms Today and Tomorrow, Mayo Clinic, Duke University and University of California, San Francisco, researchers compared MRgFUS to UAE to determine effectiveness.
During the study, 83 participants were randomly assigned to receive one of the two treatments: UAE or MRgFUS. Over the next four years, researchers compared the outcomes of the two procedures in 70 women who underwent MRgFUS and 62 who were treated by UAE. Of the MRgFUS women, 30 percent underwent a second fibroid procedure; only 13 percent of the women who were treated with UAE needed a second procedure.
For interventional radiologists like Dr. Fox and Dr. Hardee, this study is heartening. What it proves to us, and to our patients, is the fact that not only are alternative hysterectomy treatments effective, some are more effective than others. It emphasizes the importance of considering all your options before deciding how to deal with your fibroid diagnosis.
Those non-cancerous tumors made up of cells and muscle known as fibroids can be a quirky lot. Many women with uterine fibroids have no symptoms whatsoever, and some never even know they have them. Others have painful and heavy periods and struggle with discomfort. With all these disparate situations you may be wondering if and how fibroids can affect your fertility.
Adenomyosis is a condition that causes many symptoms—like pelvic pain and heavy bleeding—that mimic fibroid symptoms. This condition is the result of endometrial cells (from the uterine inner lining) that migrate into the middle, muscular wall of the uterus, the myometrium, where they stay put. The newly lodged cells then increase the mass of your uterus.
What Causes Adenomyosis?
Unfortunately, we still don’t understand the exact cause of this condition, although different the
ories exist. One suggests that it’s caused by genetic changes in endometrial cells. Another proposes that, in fact, cells inside your myometrium actually convert into endometrial cells. We also believe that hormones like estrogen trigger the condition since its symptoms go away after menopause. Female levels of estrogen go down in the first year after menopause and the symptoms dissipate as well.
How is Adenomyosis Diagnosed?
This condition is sometimes diagnosed with an ultrasound scan, but it can be difficult to spot lodged cells, so an MRI is often needed for confirmation. Often, adenomyosis is detected while your doctor is screening for fibroid tumors.
What Are the Symptoms of Adenomyosis?
While a good portion of women—as many as 30%–won’t experience any symptoms, women with adenomyosis typically experience:
Intense pelvic pain and pressure
Pain that radiates to your legs and back
Blood clots in the pelvis and legs
Prolonged menstrual cycles
Spotting between cycles
How is Adenomyosis treated?
The only way to cure this condition is to undergo a hysterectomy. For many women, this will be too drastic an option—especially since we now know that hysterectomies leave women at risk for cardiac and metabolic problems.
So, while we can’t stop the problem without removing your uterus, we can help manage symptoms with less invasive treatment options. The best option for you will depend on the severity of your symptoms and your overall health:
Anti-inflammatory medications like ibuprofen can help with the pain and reduce the blood flow. For best results, start taking medication several days prior to the start of your cycle.
Taking birth control pills and other hormonal supplements can help manage the condition.
Endometrial Ablation is a minimally invasive procedure that destroys the uterine lining, so no cells can migrate into the muscle wall. The success of this option will depend on how deeply endometrial tissue has penetrated into the wall of your uterus.
UAE or Uterine Artery Embolization is a technique commonly used to treat uterine fibroids. When treating adenomyosis, particles are injected into the uterine artery to block the blood flow to the specific problem area. The goal is to deprive the tissue of both blood and oxygen so the condition will abate. Unlike UFE for fibroid treatments, UAE for adenomyosis involves an overnight stay in the hospital. As we evolve our technique, UAE has earned an 80% effectiveness rating in abating the symptoms of adenomyosis, making it an excellent short term solution to this painful condition.
Many women believe that undergoing a hysterectomy (the surgical removal of the uterus) will cure their fibroid problems. And while that may be true, a new study from the Mayo Clinic says that, in doing so, women set themselves up for more serious problems down the road.
In fact, according to the study, women who undergo hysterectomies–even if their ovaries are preserved–have a big increase in their risk of many metabolic and cardiovascular conditions. Dr. Shannon Laughlin-Tommaso, who authored the study, says, “This is the best data to date that shows women undergoing hysterectomy have a risk of long term disease…while women are increasingly aware that removing their ovaries poses health risks, this study suggests hysterectomy alone has risks, especially for women who undergo hysterectomy prior to age 35.”
To reach these conclusions, researchers followed 2094 women who’d undergone hysterectomies, with ovary preservation, between 1980 and 2002. Each of these women was then compared to a woman her same age, in her same county of residence, who had not undergone a hysterectomy. What they found was frightening: the women who’d had hysterectomies were 14% more likely to have lipid abnormalities, 18% more likely to be obese, 13% more likely to have high blood pressure, and had a 33% increase in risk of coronary artery disease. These risks increased in the women who’d had their hysterectomies before the age of 35.
For years, hysterectomy was thought of as the best way to treat fibroid tumors. Many women are still told that this is the right treatment choice, even though other, less invasive, options are now available. In the light of this research, however, the reasons for seeking alternative fibroid treatments is abundantly clear.
As Dr. Laughlin-Tommaso says, “Hysterectomy is the second most common gynecologic surgery, and most are done for benign reasons, because most physicians believe that this surgery has minimal long-term risks. With the results of this study, we encourage people to consider nonsurgical alternative therapies fro fibroids, endometriosis and prolapse, which are the leading causes of hysterectomy.”
Many times, we feature celebrity fibroid warriors as our Woman Crush Wednesday, but this week we get to draw from our own patient pool. We welcomed Raquel K. recently to our Houston area fibroid practice; as she explains, she came to us because she was, “looking for an alternative to having surgery due to fibroids.”
Like many African American women, Raquel was diagnosed with fibroids and was facing scary treatment options like surgical removal of her tumors or even of her uterus (hysterectomy.) When she discovered our practice and scheduled her first appointment, she says, “Dr. Fox and his team took time to explain the UFE procedure and made me feel very comfortable.” UFE (Uterine Fibroid Embolization) is an alternative treatment for fibroids that is minimally invasive and is performed as an out-patient procedure. Our doctors insert a catheter through our patient’s femoral artery, in your upper thigh. Next, we guide the catheter to the uterine artery until we get close to your fibroid tumor. Finally, we inject an embolic substance into the catheter. The embolic material is designed to block the vessels around the fibroid, depriving it of the blood and oxygen it needs to grow. The blood and oxygen deprivation results in the shrinking of your fibroids, and the embolic material remains permanently in the blood vessels at the fibroid site.
After Raquel successfully underwent her UFE procedure, she turned to our practice Facebook page to share her story, helping other patients learn about UFE. In telling her fellow fibroid patients, “My quality of life has improved greatly since my UFE and I am very happy with my results,” she’s helping spread the word about this alternative #FibroidFix. And, in our well-versed hashtag books, that earns her a spot on the #WCW list, as well!
Uterine fibroids are non-cancerous tumors that affect many women throughout their lifetime. Fibroids can develop in several different places in or on the uterus, and will be classified as as subserosal, intramural, or submucosal depending on where they develop. While no one knows exactly why these tumors develop, most doctors agree that their growth can be affected by the presence of estrogen, which may be why many women’s fibroids grow and develop during pregnancy. Because estrogen likely affects fibroid development, many women will wonder how taking birth control will impact their fibroid growth and development. Here are four things women with fibroids should know about their birth control:
Your Periods Will Probably get Lighter
A common side effect of fibroids is long, heavy periods; using birth control pills may help manage this symptom. Birth control typically gives women lighter, shorter periods because the estrogen in the medications can help improve blood clotting and reduce your menstrual flow.
You May Have Fewer Cramps
Pelvic pain and cramps are another typical fibroid side effect—and these cramps can be quite severe for women dealing with these tumors. Many women on birth control pills experience cramping relief because the medications can decrease a woman’s prostaglandin count (prostaglandins make the uterus contract, leading to cramps.)
Your Fibroids Could Get Bigger
While taking birth control may help you manage certain side effects of fibroids, there’s a caveat: fibroids are very responsive to estrogen, which means that taking birth control can actually make your tumors grow larger. For this reason, you’ll need to discuss your options with your doctors carefully. A larger fibroid tumor may cause you to experience a worsening of symptoms, canceling out the temporary relief delivered by the estrogen in your birth control pills.
Birth Control Can Help Prevent Fibroids
If you already have uterine fibroids, taking birth control could make your tumors increase in size. But if you haven’t yet been diagnosed, certain birth controls (especially those with lower doses of estrogen) may reduce your fibroid risk!
Choosing the right birth control when you have fibroids can be complicated, so it’s crucial to review all your options with your fibroid specialist. Feel free to reach out to Dr. Fox or Dr. Hardee to schedule a consultation on all your fibroid treatment options.
When you have fibroids, sex with your partner can hurt. This is especially true if you have large and or numerous fibroids. Not surprisingly, this pain may make you less excited about sex—you may want to stop having intercourse altogether. In other instances, pain may not be the only problem. Depending on the size or location of your fibroid, these tumors may make you appear to have gained weight, or even look slightly pregnant, possibly impacting your self-esteem and feelings of attractiveness.
If your partner feels personally rejected because he or she doesn’t understand what you’re going through, the change in intimacy may become a source of conflict, If, however, you are able to have an open, honest discussion about uterine fibroids and painful intercourse, you’ll help your partner understand what you’re experiencing, and hopefully become intimate together on an even deeper level.
Painful Intercourse with Uterine Fibroids
Every woman has different fibroid symptoms, but extremely painful sex is often associated with fibroids. That pain may be caused by pressure from the fibroids, vaginal dryness, or even hormonal changes. Even harder to explain to your partner? Your fibroid pain likely isn’t consistent. Certain positions, and certain times in the month, will affect the discomfort you experience, but this can also make it harder for your partner to know how best to approach intimacy.
4 Tips to Use When Discussing Fibroids and Sex with Your Partner
It’s important to remember: your partner might not understand what you’re dealing with or why you’re avoiding getting physical—that’s why open communication is crucial. Explain to your partner what you feel during sex, or if you’re just anxious about sex in general. Tell your partner how you are feeling, and make sure you discuss his or her feelings, too.
We know that talking about sex and intimacy can be uncomfortable, so we’re here to help. Here are a few suggestions for making this conversation a little less difficult to jump into:
Before you sit down to talk, do your research: Your partner will probably have lots of questions about your fibroid diagnosis and how it will continue to affect your body. To give the most effective and honest answers, be prepared with knowledge. Your fibroid specialists should be happy to help you with this portion of your experience.
Once you know enough about your condition, it’s time to get talking. You should:
Choose the ‘when’ wisely: Don’t start a conversation when either of you is upset or short on time. Make a date to sit down and talk, letting your partner know you want to discuss your health in a private, relaxed setting.
Open Up: Be as real as possible about all the symptoms you are experiencing. Then you and your partner can try to determine the best way to help manage your symptoms and support you through your experiences.
See the Other Side: Of course, you are the one dealing with a serious medical condition, but it’s important to recognize that your partner may be frightened as well. Make sure to really listen to what your partner is feeling or experiencing in the wake of your diagnosis. Moving forward: Fibroid Treatments
While there are several surgical treatments available for uterine fibroids, women who eventually wish to become pregnant may prefer a non-surgical treatment that won’t impact the uterus. While it’s important to review all treatment options with your doctor, make sure that you and your health care provider discuss Uterine Fibroid Embolization (UFE), one alternative to surgery.
During UFE, a thin catheter is threaded into the blood vessels that feed the fibroid. Then, tiny, medical-grade plastic particles are injected into the blood vessels, blocking the blood supply and causing the fibroid to shrink and die.
Ideal UFE candidates:
Have fibroids that are causing heavy bleeding.
Have fibroids that are causing pain or pressing on the bladder or rectum.
Don’t want to have a hysterectomy.
Don’t want to have children in the future
According to recent studies, one year after having UFE, women with painful uterine fibroids saw an improvement in their sex lives and significant symptom relief a year. To learn if you’re a candidate for UFE, we invite you to schedule a consultation at our Houston Fibroids office.
Many women with fibroids have questions: why did I get this kind of tumor? How fast will it grow? What can I do to slow down or stop the growth in my fibroids?
While we don’t know what causes women to develop fibroids, we do have an understanding of what these tumors are and what factors may increase your risk of developing fibroids. We also know certain factors that affect fibroid growth. To help you gain a better understanding, let’s start at the beginning, with a basic explanation of fibroids.
What are Fibroids?
Uterine fibroids are non-cancerous tumors that develop in the wall of your uterus. Fibroids can grow alone or in clusters; they vary in size, from microscopically small to rare cases where they grow to the size of fully-developed fetus.
Fibroid symptoms can include:
Heavy menstrual bleeding
Bloating in the pelvic region
Lower back pain
Frequent need to pee
What Can Speed Up Fibroid Growth? While your genes will play a role in how quickly fibroids grow, hormones like estrogen and progesterone also affect the growth of these tumors. Without these two hormones, fibroids are unable to grow which is why, in the past, causing a woman to experience menopause was considered the only cure for fibroids. Thankfully, we now know better and can offer women less dramatic treatment options.
How Big Will My Fibroids Become?
It’s difficult to know how big a fibroid tumor will become–growth varies from person to person, predict how big a fibroid will grow or what causes a fibroid to grow rapidly. In some cases, fibroids even disappear without treatment. This however, is not common: most fibroids will grow larger unless you opt for medical intervention.
So, just how big will your fibroids become? Honestly, the size limit is based only on your body’s ability to expand. Fibroids can stretch and enlarge your uterus to accommodate their own growth. In fact, some fibroids get so big that you appear to be in the second trimester of pregnancy!
In extreme cases, fibroids will grow so large that doctors can only treat them with surgery. For this reason, it’s important to begin researching fibroid treatment options as soon as you receive a diagnosis.
Can I Slow Down Fibroid Growth? Certain steps, like adopting a fibroid-friendly diet, may slow the growth of these tumors. Research suggests that dairy products like milk, cheese and ice cream may inhibit fibroid development. Green tea has also been shown to slow fibroid growth and, in some cases, even kill off existing fibroid cells.
For some women, the hormones in certain forms of birth control can help slow fibroid development.
When it comes to interventions that simply slow down fibroid development, there are no guarantees…that’s the bad news. The good news, however, is that we have better treatment options available. Instead of slowing fibroid growth, interventional radiologists like Dr. Fox and Dr. Hardee are able to use a method known as Uterine Fibroid Embolization to cut off the fibroid’s supply of blood and oxygen. This minimally invasive treatment causes fibroids to shrink and, eventually, die. Want to know if you’re a good candidate for UFE? Just reach out to our Houston area team and we’ll be happy to set you up with a comprehensive consultation.
Together with Acessa Health Inc., the White Dress Project has launched the Goodbye Fibroids initiative to unite women, doctors and political leaders in order to raise awareness of and improve care for women living with fibroids.
Recently, the two groups made a presentation at the Congressional Black Caucus’ Annual Legislative Conference to discuss how women of different races are not receiving the same quality of fibroid care. As Acessa Health CEO Kim Rodriguez pointed out, “Unfortunately, there is a well-established racial barrier to women receiving less invasive alternatives to hysterectomy.” In other words, though black women have a much higher risk of developing these non-cancerous uterine tumors, they are much less likely to receive information about the full range of fibroid treatment options, including minimally invasive procedures like Uterine Fibroid Embolization.
The facts are clear (and upsetting): among women who elected to have hysterectomies to treat their fibroids, African American women were less likely to receive a minimally invasive surgery compared to white women. They were also 40% more likely to develop complications, nearly three times as likely to have an extended hospital stay, and three times as likely to die after their procedures.
While these are statistics for hysterectomies, they don’t even begin to explore other fibroid treatment options—which likely means that women aren’t even being informed about hysterectomy alternatives.
Tanika Gray Valbrun, founder of The White Dress Project, told the Black Caucus, “As a community we need to begin to address and change the clear, systematic and structural defect within the US healthcare system that disproportionately pushes women of color toward the most invasive option, which is hysterectomy.”
As interventional radiologists in Houston, we could not agree more. We applaud the Goodbye Fibroids movement, and have ourselves been promoting #FibroidFix, a campaign to make all women aware of all the available treatment options for fibroids, particularly the ones that will preserve their fertility and minimize the risk of surgical complications. Will you join us in spreading the word? Please share this information with all your female friends and help us and the Goodbye Fibroids team make better healthcare accessible to every woman in this country.