Recently, we learned that WWE star Naomi had a myomectomy, and we wish she could have found an alternative to fibroid surgery. The fierce wrestler announced on her Instagram: “In the midst of hurricane Sally and COVID I also underwent an unexpected 6 hour surgery to finally remove a massive fibroid that’s caused me severe anemia fatigue horrible abdominal pains and more problems I don’t even want to mention over the past year and a half. I’m recovering well. I’m relieved and already feeling so much better. So family and fans don’t worry, I’m ok. Lol, miss ya.”
First, let’s be clear: we’re happy Naomi found relief. And we applaud her as our Woman Crush of the week for bravely sharing her story. But we also wish she’d learned about other options before her fibroid got so large. Because we believe that there need to be more alternatives to fibroid surgery in this country. Too many women with fibroids—non-cancerous tumors of the uterus—get hysterectomies (complete uterus removal). In fact, fibroids are the top reason women in the U.S. get hysterectomies. Because it’s such a serious surgery, many women opt for less invasive fibroid treatments. In our office, we offer Uterine Fibroid Embolization, a non-surgical treatment that shrinks your fibroids.
Oral and Minimally Invasive Alternatives to Fibroid Surgery
Recently, the FDA approved a new oral medication for women with fibroids, that’s expected to be available later this month. Called Oriahnn, the pill combines estrogen, progestin, and elagolix (a gonadotropin-releasing hormone). It’s important to note that this pill doesn’t shrink your fibroids. Instead, it decreases fibroid symptoms like heavy bleeding.
How effective is this pill? A recent study highlights the effects of elagolix, just one piece of the new drug’s puzzle. Over the course of two and a half years, they followed 433 women who had fibroids and heavy menstrual bleeding. 67% of participating women were African American, since black women are disproportionately affected by fibroids.
Women who took elagolix did get relief from heavy periods, but they also suffered hot flashes, night sweats, and bone loss. In contrast, 90% of the women who took a mix of elagolix, estradiol and norethindrone acetate (“add-back therapy”) experienced reduced blood loss, but with fewer side effects. The “Add-back” therapy combatted effects of stopping estrogen and progestin, as Oriahnn does. Some of these women saw their uterus size decrease. But their fibroids did not shrink.
Also, this pill won’t prevent pregnancy, even though it’s hormonal. And, studies note that taking the medication can cause long-term bone loss. Which means that you can’t take the pill for more than two years. That leads us to the question: what next? Unfortunately, once you stop taking this pill, your fibroid symptoms would return, sending you back to the start of your treatment journey. And, since they don’t want that journey to end in a hysterectomy, researchers at Michigan State University are trying to figure out why fibroids form in the first place. Because, in doing so, they hope to keep every woman from being pushed towards hysterectomy because of fibroid tumors.
Genes and Fibroids: The Newly Discovered Connection
In the course of this study, researchers at MSU’s College of Human Medicine discovered that HOXA13, a gene associated with fibroids, was connected to a process, known as homeotic transformation, that causes uterine muscle cells to turn into cells more typically found inside your cervix.
“It’s a cell type in a position where it doesn’t belong,” explained lead researcher Dr. Jose Teixeira said. “This was a surprise.”
But this discovery isn’t just informative: it could change the way we treat fibroids. Specifically, new treatments could target the chain of events that causes your cells to change. That way, you could treat existing tumors with less invasive treatments, such as Uterine Fibroid Embolization. Then, you could use molecular therapy to prevent any new tumors from forming.
As Teixeira explains, “The discovery that fibroid tumors have characteristics of cervical cells could be a key to better treatments. For example, among pregnant women, the cervix typically softens just before delivery. Figuring out what causes the cervix to soften could suggest new therapies that soften the fibroid tumors and prevent or inhibit their growth.” And, if that works out, you could eliminate any hysterectomy discussions!
What’s Next for Fibroid Research?
While new therapies are still going to take a while, this research is already changing the way scientists study fibroids. Now, the National Institutes of Health (NIH) is funding a follow-up fibroid study. It’s focus? Texeira says he wants to discover: “Is there a place where we can intervene? That’s the follow-up. If we can find out what’s causing the cervical softening, then we might be able to investigate treatment.” And that could stop fibroid growth before a tumor ever forms.