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Do’s And Don’ts For Talking To Your Doctor About Fibroids

 

Knowledge is power. When it comes to your health, your doctor has a lot of it – and a lot of empowering knowledge to share. At the same time, you know your body best. You know if things are “off”, and – in order for your doctor to effectively do his/her job – you need to share what you know about your state of health.

If you’ve been diagnosed with (or suspect) fibroids, you have a lot of options. Your visit with your gynecologist is an opportunity to learn about and discuss those options, as well as to gather information that will help you better understand your condition. To get maximum benefit from your appointment, observe these “do’s and don’ts”.

THE “DO” LIST

DO EXPLAIN YOUR SYMPTOMS – ALL YOUR SYMPTOMS

Being forthcoming about your symptoms will help both you and your doctor to better understand the nature of your condition. Among the estimated 25%-30% of women who have symptomatic fibroids, the nature and severity of symptoms can vary, depending on the size and location of fibroids. For example, urinary urgency often results when a large fibroid is growing next to – and pressing against – the bladder. In the initial phase of diagnosing your condition, gathering information about symptoms like this will give your gynecologist a clearer idea about the nature and location of your fibroids. In turn, he or she can help you understand how the symptoms you describe are impacted by your fibroids.

DO ASK YOUR BURNING QUESTIONS

If you’ve been newly diagnosed with fibroids, you probably have a number of pressing concerns and questions.  Bring them up! No matter how strange, gross, or personal you may consider a question to be, you’re probably not the first woman to ask it. In a 2012 survey of women aged 29–59 with symptomatic uterine fibroids that was conducted by Harris Interactive, concerns frequently cited by participants included:

  • Physical concerns, including: the potential for physical impairment, worsening of symptoms, future fibroid growth, health complications such as cancer, and impact on fertility
  • Employment-related concerns, including concerns about the ability to perform job-related duties and fear of missing work
  • Relationship concerns, including how fibroids will impact personal relationships, sex life, and home life

Your concerns are valid, and your doctor’s visit is the best time to get them addressed. Don’t be shy: whatever the question, chances are, you’re not the first fibroid patient to ask it!

 DO ARTICULATE YOUR PRIORITIES

Numerous treatment options are available to women with uterine fibroids, including pharmacological treatments, surgical and minimally-invasive options, and complementary and alternative therapies. In order for your doctor to recommend a course of treatment that fits your needs, he or she has to know what those needs are.

Perhaps the most important piece of information in this regard would be whether or not you want to get pregnant at some point in the future. Hysterectomy is notoriously overprescribed as a treatment for fibroids, yet it is obviously a poor option for women who desire to eventually get pregnant: a uterine-conserving procedure is usually a more suitable option in such cases.

DO EDUCATE YOURSELF

Too often, we hear women who have undergone hysterectomy saying they “wish they had known” about less invasive options for treating fibroids. While your gynecologist should – in theory – inform you about all of your treatment options, the best way to ensure the decision you make is an informed one is to inform yourself. Do some research in advance of your appointment, so you can use the visit as an opportunity to ask questions about the treatments you’ve investigated. There are numerous reputable websites that are loaded with information about uterine fibroids and new treatment options: a couple of good places to start are www.womenshealth.gov (published by the NIH) and www.reproductivefacts.org (published by the American Society for Reproductive Medicine. A hysterectomy is not for everyone, so get to know what other treatments are available to you; your subsequent discussion with your doctor will likely be more productive, as a result.

DO WRITE DOWN YOUR QUESTIONS IN ADVANCE

Most of us have, at some point, left a doctor’s office thinking “oh no, I forgot to ask about (insert pressing concern)”. It’s hard to remember everything you mean to ask when you’re in the midst of an exam or office discussion. Do yourself a favor and write those questions down. If you’re not sure what you want to ask, print out our handy list of “Questions To Ask Your Doctor” and bring it to your appointment.

 

THE “DON’T” LIST

DON’T SKIP THE GORY DETAILS

It’s not unusual to hear a woman with symptomatic fibroids share an anecdote about “sitting in the tub and just bleeding out” or describing how her bathroom regularly “looked like a warzone”. Sure, these are not dinner-table conversations, but the “colorful” details about symptoms like blood loss can actually be helpful to your doctor in diagnosing fibroids. Heavy menstrual bleeding is generally considered the definitive symptom of fibroids; but what constitutes “heavy” can be somewhat subjective for women experiencing the symptom. For this reason, describing gross realities like this can actually clarify the severity of your symptoms.

DON’T BE AFRAID TO SEEK A SECOND OPINION

If you don’t think that you have all the answers to your questions or you are not satisfied with the options that have been presented, you may want to get a second opinion.  It’s great to trust your physician; what’s more important, however, is that you feel comfortable with the decision you and he/she reach together. There’s no harm in seeking further information through a second opinion, even if you completely trust your doctor.

 

>> SEE ALSO:  Where Can I Learn More About Fibroid Treatment Options?

 

SOURCES:

Stewart, E. et al. “The Burden of Uterine Fibroids for African-American Women: Results of a National Survey”, Journal of Women’s Health. 2013; 22(10):807-16

 

 

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Fibroids After 50 (Why They Don’t Always Disappear!)

 

Fibroids, also known as leiomyomas, are estrogen-dependent. As a result, they typically grow and present symptoms during a woman’s reproductive years, when the ovaries are active. Once the ovaries stop naturally producing estradiol (estrogen)—usually in her mid-50’s— a woman is said to have entered menopause. Logically, the drop in estrogen production that occurs in menopause would cause any uterine fibroids to gradually shrink, and this is typically the case. Fibroids and their accompanying symptoms often diminish after menopause. But what if they don’t?

There are a number of reasons why a woman would continue to have difficulty with a fibroid tumor during this stage of her life: stimulation from exogenous estrogen production (i.e. hormone replacement therapy), cancerous tumors, or malignant uterine/fibroid changes are a few possible causes.

Hormone replacement is commonly prescribed for menopausal women to reduce the uncomfortable symptoms that result from estrogen-deficiency, including hot flushes, vaginal dryness, mood fluctuations, and reduced desire for sex. Estrogen deficiency can also compromise bone health, increasing the risk of fractures; adding supplemental estrogens back into the body can help maintain a woman’s bone strength after menopause.

Replacing estrogen with hormone therapy can drastically increase the quality of life for many women in menopause. However, the risks of hormone replacement can sometimes outweigh the benefits, the recurrence or worsening of fibroid symptoms being one example. Dr. Donald Galen, OB-GYN and former Surgical Director at the Reproductive Science Center of the San Francisco Bay Area explains, “if fibroids are present, the addition of estrogens will generally stimulate fibroid growth, or minimize fibroid regression which otherwise would occur during natural menopause.” A study by Lamminen et al. that compared the activity of fibroids in pre- and post-menopausal women found just that: proliferative activity was low in the post-menopausal subjects who weren’t receiving hormone replacement, whereas those women who were receiving hormones had “fibroid proliferative activity equal to premenopausal women”. Dr. Galen also advises patients of other risks related to hormone therapy, as well. He explains, “estrogen can increase health risks, such as an increased risk of blood clots, increased risk of breast hyperplasia/cancer, and increased risk of endometrial hyperplasia and/or endometrial cancer.”

Hormone replacement therapy isn’t the only reason women see a persistence in fibroid symptoms after menopause. Malignant changes in existing fibroids or the emergence of new, cancerous tumors (“neoplasia”) on the uterus or reproductive organs can produce symptoms like those of benign leiomyomas.  Dr. Galen advises, “as a precaution, any woman with an increase in uterine growth/size and/or post-menopausal uterine bleeding should be evaluated to rule-out malignant uterine/fibroid changes.”

 

 

SOURCES:

Burbank, Fred. Fibroids, Menstruation, Childbirth and Evolution: The Fascinating Story of Uterine Blood Vessels. Tucson, AZ: Wheatmark, 2009. 93. Print.

Lamminen, S. et al.”Proliferative activity of human uterine leiomyomacells as measured by automatic image analysis”,Gynecologic and Obstetetric Investigation. 1992; 34:111-114

 

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The 5 Biggest Myths Surrounding Uterine Fibroids

 

shutterstock_325530068Fibroids are the most common type of pelvic tumor among women of reproductive age. Despite their prevalence, however, fibroids are widely misunderstood. A number of popular misconceptions, in particular, create confusion for women with fibroids who are trying to understand their condition and treatment options. To clear up some of this confusion, we’re breaking down five of the most common myths surrounding fibroids.

 

MYTH: If you have fibroids, you will experience symptoms like heavy menstrual bleeding and pain.
As common as the condition is, researchers estimate that between 50-80% of women with fibroids will experience no fibroid symptoms at all. Many women with asymptomatic fibroids never even know that they have the condition. And, because fibroid tumors are almost always benign, women who aren’t experiencing symptoms may opt to forgo treating their fibroids.

MYTH: A routine ultrasound will detect any uterine fibroids that are present.
If fibroids are suspected, the first diagnostic tool gynecologists employ to confirm the suspicion is transvaginal ultrasound. However, this imaging method doesn’t always reveal all existing fibroids. The size and location of uterine fibroids varies greatly, and extremely small fibroids, submucosal fibroids, and small fibroids that are hidden behind larger tumors, aren’t always detectable through a routine pelvic ultrasound. For clearer visualization of the tumors, physicians frequently rely on laparoscopic ultrasound, which requires inserting a scope through the vagina and into the abdominal cavity provides. Research has shown that laparoscopic ultrasound can detect up to twice as many fibroids as transvaginal ultrasound.

MYTH: Fibroid tumors will become cancerous.
Uterine fibroids, also known as leiomyomas, are almost always benign: in women of reproductive age, less than 0.01% of (removed) fibroids become cancerous. While fibroids typically shrink after menopause, those that do appear in post-menopausal women may be the cancerous type, called leiosarcomas. It’s important to note, however, that – regardless of age – simply having fibroids does not increase a woman’s chances of developing cancer in her reproductive organs.

MYTH: Endometrial ablation is a method of treating fibroids
Endometrial ablation (EA) is a commonly used to treat abnormal uterine bleeding. The technique entails destroying the layer of tissue that lines the uterus known as the endometrium, preventing new tissue from growing and thereby reducing or eliminating menstrual bleeding. While you may have heard EA discussed in the context of fibroids, it is not, in fact a fibroid treatment. The destruction of fibroids that can occur with EA is incidental, and is not likely complete. In such cases, the ablated fibroids will often regrow, since subserosal fibroids – the type that grow inside the uterus and are therefore subject to destruction during EA – often originate below the endometrium layer.

MYTH: If left untreated, fibroids will continue to grow throughout a woman’s lifetime.
Fibroid growth is fueled by estrogen. Accordingly, fibroids will grow and shrink in response to the body’s hormone fluctuations. Pregnant women often experience rapid growth in existing fibroids and may develop new fibroids during pregnancy, due to the heightened levels of estrogen that their bodies are producing. Conversely, fibroids typically shrink after menopause, because the ovaries have stopped producing estrogen. (Post-menopausal women undergoing hormone replacement therapy can expect the opposite to occur, however, since they are artificially replacing the missing estrogen.) Although fibroids do tend to disappear naturally after menopause, pre-menopausal women who are suffering with symptoms of uterine fibroids may not want to wait.

When fibroids are interfering with the quality of life, it’s advisable to discuss treatment options with a gynecologist. With a plethora of treatments available to women with fibroids, including uterine conserving methods like Acessa Procedure, it’s not necessary to endure long-term suffering!

 

SOURCES:

American Society for Reproductive Medicine, “What Are Fibroids? Fact Sheet”, Resources, ReproductiveFacts.org: rev. 2012. Retrieved Aug 26, 2015, from http://www.reproductivefacts.org/FACTSHEET_What_are_Fibroids/

Levine, D.J. et al. “Sensitivity of Myoma Imaging Using Laparoscopic Ultrasound Compared With Magnetic Resonance Imaging and Transvaginal Ultrasound”, Journal of Minimally Invasive Gynecology. Nov/Dec 2013; Vol 20(6): 770-4

Burbank, Fred. Fibroids, Menstruation, Childbirth and Evolution: The Fascinating Story of Uterine Blood Vessels. Tucson, AZ: Wheatmark, 2009. 135. Print.

 

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What Causes Fibroids: The Known Risk Factors

 

Uterine fibroids, also known as leiomyomas, are the most common benign pelvic tumor in pre-menopausal women. According to the American Society for Reproductive Medicine, uterine fibroids will affect 8 in 10 African American women and 7 in 10 Caucasian women before menopause.

Despite the prevalence of the condition and the plethora of studies that have sought to explain it, the cause of fibroids is still not fully understood. However, evidence suggests that fibroids’ development can be attributed to a combination of genetic and hormonal traits.

Hormonal Risk Factors

The link between fibroids and hormones is well documented. Specifically, it is known that fibroids are estrogen-dependent. As a result, fibroids grow during a woman’s childbearing years, while the ovaries are naturally producing estrogen, and they typically shrink after the onset of menopause, when levels of the hormone drop. The influence of hormones on fibroid growth renders the following traits “risk factors”:

Age – The risk of fibroids increases with age, up to the point of menopause. Once menopause is reached and the body’s estrogen production naturally declines, fibroids typically shrink and – in many cases – disappear entirely.
Contraceptive use – Women who began taking oral contraceptives before the age of 16 are at a greater risk of developing fibroids. However, studies have revealed that using progestin-only injectable contraceptives is associated with a reduced risk of fibroids.

Obesity – Researchers believe that being obese increases the risk of uterine fibroid development, possibly due to the association between obesity and high circulating estrogen levels.


Genetic Risk Factors

Race – The connection between race and fibroids isn’t entirely understood, but an abundance of clinical data shows it to be a significant risk factor. Black women are nearly three times more likely to develop fibroids than white women. Furthermore, research has shown that black women tend to have larger and more symptomatic fibroids than women of other races.

Family health history – Researchers and medical practitioners have long observed a familial predisposition to fibroids. To date, various clinical studies have identified over 100 specific genes as having potential links to fibroid development. OB-GYN Dr. Donald Galen frequently observes the genetic trend in his fibroid patients: “It is common for a woman with fibroids to have a history of her mother, maternal aunt, or sister who also have fibroids, ” he says.


Other Risk Factors

Certain lifestyle and environmental traits have been thought to play a role in the development of fibroids, though clinical studies have yielded somewhat contradictory results.

Diet – Research has shown that women who eat a vegetarian diet are less likely to develop fibroids than women whose diets include meat. Some studies suggest that consuming more fruits, vegetables, and low-fat dairy products could reduce the risk of developing fibroids; however, the effectiveness of changing dietary habits in slowing the growth of existing fibroids or preventing the development of new fibroids has not been conclusively established.
While the exact cause of fibroids remains unclear, existing research points to a confluence of genetic and hormonal traits. Given the prevalence of the condition of uterine fibroids, its epidemiology will undoubtedly continue to be the subject of research. The risk factors that have been established, however, help us to understand who is susceptible to developing fibroids and what physical and lifestyle changes may prevent or minimize fibroids’ occurrence.

 

SOURCES:

  1. American Society for Reproductive Medicine, “Fibroid Tumor Video Transcript”, ReproductiveFacts.org: 2011.
  2. Retrieved July 13, 2015, from http://www.reproductivefacts.org/Fibroid_tumor_video/
  3. Stewart, E. “Uterine Fibroids”, New England Journal of Medicine. 2015; 372: 1646-55.
  4. Wise, L. et al. “Age-Specific Incidence Rates for Self-Reported Uterine Leiomyomata in the Black Women’s Health Study”, Obstetrics & Gynecology. Mar 2005; 105(3): 563–568.
  5. Levy, B., “Modern management of uterine fibroids”, Acta Obstetricia et Gynecologica. April 2008; 87: 812-823
  6. Burbank, F. Fibroids, Menstruation, Childbirth, and Evolution, pp. 89-90. Wheatmark, 2009. Tucson, AZ.

The Future of Fibroid Research

Hysterectomy may have been the prevailing standard for treating uterine fibroids in the past, but times have changed. Abundant research on the subject of fibroids has yielded new advances in treatment modalities for the condition, fueled by the widespread demand from fibroid patients for uterine- and fertility-sparing treatment options. Thanks to this research, numerous alternative therapies are now available for women with symptomatic fibroids, and awareness of non- and minimally-invasive fibroid treatment options is growing among both patients and health care providers. As fibroid research continues, we can expect the number and availability of alternative treatments to further expand.

“It is extremely important for women to know the options available to treatment of uterine fibroids,” says Dr. Elizabeth Stewart, M.D., Chair of Reproductive Endocrinology at Mayo Clinic. “Equally important,” she adds, “is the need to continue to study fibroids to assist in developing better treatments.” The Mayo Clinic is endeavoring to do just that, launching a massive research effort to compare existing treatments for uterine fibroids. With funding from the Patient-Centered Outcomes Research Institute (PCORI) and the Agency for Healthcare Research and Quality (AHRQ), researchers from several institutions, including Duke University, University of California – San Francisco, and Mayo Clinic are establishing an observational registry that includes 10,000 women with diagnosed uterine fibroids. The research initiative, called COMPARE-UF, will look at the factors that most heavily influence the treatment choices of its women participants and will evaluating all available treatment options in terms of those priorities. Recognizing the importance of uterine-sparing and fertility-sparing therapies that has been widely expressed by women with fibroids, researchers will look at a variety of hysterectomy alternatives, including minimally invasive procedures like radiofrequency ablation.

Beyond the COMPARE-UF registry, a slew of other studies are focusing on alternatives to hysterectomy in the treatment of fibroids. Researchers at UCSF, Duke University, and Mayo Clinic are currently conducting research to compare two uterine-sparing procedures, uterine artery embolization (UAE) and MR-guided focused ultrasound. Their “FIRSTT” study, funded by the National Institute of Health, is the first in the U.S. to compare UAE and MR-guided focused ultrasound. The researchers will look at the differences between the two treatments in terms of symptom relief, side effects, impact on quality of life, and recurrence/re-intervention.

Another major fibroid treatment study is also underway at UCSF: the ULTRA study is being conducted to help patients and doctors better understand how radiofrequency ablation (Acessa Procedure) changes fibroid symptoms, affects fertility and pregnancy, and impacts the need for additional fibroid treatment in the future. While the procedure has already received FDA clearance and is being performed with increasing frequency, studies of this nature provide the kind of additional data that facilitate acceptance by major health insurers.

The increasing focus by medical researchers on hysterectomy alternatives stands to benefit more than the patients; the medical community and the U.S. healthcare system could see a significant, positive, long-term impact from the shift. According to Dr. Jay Berman of Wayne State University’s School of Medicine, the medical community’s demand for safer, less invasive and less expensive treatment options is growing. He explains, “while hysterectomy will continue to be a option for the appropriate patient, some alternative techniques appear to save the cost of hospitalization, are organ-sparing, have low re-operation rates, and result in high patient satisfaction… It behooves the decision-makers to look at the overall acceptability of less-invasive, outpatient treatments that keep hospital beds for the sickest of our patients and reduce the demand for future healthcare services.”

For patients and physicians alike, the improved understanding of the condition and its treatment that research produces translates to improved quality and availability of treatment options. Having options is essential, because fibroid treatments are not “one-size-fits-all”. While hysterectomy’s consequences and general invasiveness make it an undesirable approach to many women seeking fibroid treatment, hysterectomy is still the most medically appropriate approach in certain cases. Mayo Clinic’s Dr. Stewart believes the decision on how to best treat a woman’s fibroids should be guided by the nature and severity of her symptoms; her age and health history; and the size, number, and location of the fibroids themselves. The key for women with fibroids is awareness of all the available treatment options, and —thanks to continuing research on the subject —those options will continue to improve in the future.

Sources:

  1. Rosen, P. “The Endangered Uterus”, More.com Dec 2008/Jan 2009; 117-121, 157-158
  2. “Exploring Treatment Options for Women with Fibroids.” Medical Xpress. April 23, 2015. Retrieved May 7, 2015. http://medicalxpress.com/news/2015-04-exploring-treatment-options-women-fibroids.html.
  3. Berman, Jay M. “Alternative Procedures For the Treatment of Symptomatic Fibroids”, Wayne State University School of Medicine

 

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Types of Fibroids

Uterine fibroids, the most prevalent benign pelvic tumor in women, are estimated to affect more than 70% of reproductive-age women. Although all uterine fibroids arise from myometrium, they are classified by their location in the uterus. Uterine fibroids fall into three major clinical categories: subserosal, submucosal, and intramural. A fourth type, pedunculated fibroids, are characterized by their structure and behavior, rather than their location. In addition to their different positions in relation to the uterus, fibroid types vary in terms of associated symptoms, as well as their potential impact on reproductive functions, including fertility.

Subserosal fibroids are located on the outer wall of the uterus and protrude into the abdominal cavity. The most common of the three types, approximately 55% of uterine fibroids can be classified as subserosal. As subserosal fibroids grow outward, they can press against surrounding organs, causing what are known as “bulk symptoms”—pelvic pain, pressure, and urinary symptoms being common examples. Large subserosal fibroids that push on the bowel, pelvic wall, or vagina can result in painful bowel movements or intercourse.

The second category, submucosal fibroids, grow on the inside of the uterus, protruding into the uterine cavity. While submucosal fibroids are the least common type, comprising only 5% of cases, they are the most likely to be symptomatic. They are typically responsible for the heavy bleeding that many fibroid patients experience; this bleeding occurs because submucosal tumors disrupt the endometrial lining of the uterus and, when particularly large, can distort or enlarge the uterine cavity.

Whereas subserosal and submucosal fibroids grow from the wall of the uterus, the third type of fibroid, intramural, grows within the muscular layers of the uterine wall. Symptoms related to intramural fibroids include heavy bleeding, pressure and pain, depending on their size and location within the uterine wall. Enlarged intramural fibroids located close to the uterine cavity can change the shape of the uterus and interfere with menstrual and reproductive functions.

By disrupting the reproductive mechanism of the uterus in certain ways, submucosal and intramural fibroids can affect a woman’s fertility; large intramural fibroids, for example, can press into the fallopian tubes, interfering with ovulation. Having fibroids inside the wall or cavity of the uterus has also been shown to decrease the chance of success with in vitro fertilization (IVF), particularly if they are larger than 5 cm.

Pain is a common symptom of uterine fibroids, though the nature and severity can vary. A particular type of fibroid is especially painful, however: pedunculated tumors, which are connected to the uterus by a thin stalk, can easily twist, causing extreme pain. As they develop, submucosal and subserosal fibroids can become pedunculated.

Fibroids don’t tend to occur singularly: In fact, the average affected uterus has 6 to 7 fibroid tumors, and they can develop in different locations simultaneously. Moreover, while the clinical classification separates fibroids into distinct types by location, in reality, most fibroid tumors are “hybrids”; for example, a fibroid that is predominantly intramural can extend past the endometrium and protrude into the uterine cavity, rendering it a hybrid of the intramural-submucosal types. As a result, multiple diagnostic methods may be required to determine the actual size and location of all existing fibroids.

SOURCES:

  1. Center for Uterine Fibroids, “What Are Fibroids”, Fibroids.net. Retrieved May 4, 2015 from http://www.fibroids.net/fibroids.html
  2. Galen, D. et. al, “Does Menstrual Bleeding Decrease After Ablation of Intramural Myomas? A Retrospective Study”, Journal of Minimally Invasive Gynecology. May 2013; Vol 20(6): 830-835
  3. “Fibroid Tumors.” [Video]. American Society for Reproductive Medicine, 21 Feb. 2012. Retrieved April 28, 2015, from https://www.youtube.com/watch?v=eSJ-ztQ97Og
  4. Wilde, S. and Scott-Barret, S. “Radiological Appearances of Uterine Fibroids”, Indian Journal of Radiology and Imaging. Aug 2009; Vol 19(3): 222–231. doi: 10.4103/0971-3026.54887
  5. Burbank, F. Fibroids, Menstruation, Childbirth, and Evolution, p. 106. Wheatmark, 2009. Tucson, AZ.

 

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Why Fibroids Are Everyone’s Problem

Uterine fibroids, benign pelvic tumors that are also known as leiomyomas, are a nightmare for more than just the millions of women who endure the condition’s symptoms: the U.S. healthcare system also feels the pain. A 2011 study by Cardozo et. al quantified that pain, estimating the annual cost of uterine fibroids to the United States at between $5.9 and $34.4 billion, “more than breast cancer, colon cancer or ovarian cancer, and nearly one fifth the annual cost of diabetes”. The enormous economic burden of the condition led another group of researchers, Eltoukhi et. al, to conclude, “fibroid tumors should be considered a public health issue, given the magnitude of the problem and costs of health care for this disease.”

Estimating the real cost of fibroids to the U.S. healthcare system is no simple task. Multiple research studies have delivered a wide range of figures. To thoroughly understand the fiscal burden, estimates have to account for both direct costs—including hospitalizations, outpatient visits, surgical procedures and medical treatments—and indirect costs, like the lost work productivity that correlates with the condition of symptomatic uterine fibroids.

Examining the full economic impact of the condition, the Cardozo study considered both direct and indirect costs. The researchers estimated that between $4.1 and $9.4 billion is spent annually on medical treatments for fibroid patients. The range is fairly wide, due to the difference in cost between various fibroid treatment modalities; the more invasive surgical methods incur the greatest cost. “As approximately 200,000 hysterectomies and 30,000 myomectomies are performed annually for [fibroids],surgical costs alone contribute significantly to the total annual costs of this disease.”

However, healthcare costs are not the only expense contributing to fibroids’ fiscal impact: the Cardozo study found that lost work productivity accounted for the largest portion of the fibroids’ societal cost, potentially totaling as much as $17.2 billion dollars annually. Hartmann et. al determined that women with diagnosed with Uterine Fibroids were 3 times more likely to file a disability claim than their healthy counterparts. Furthermore, Lerner et. al, looked at work-performance limitations and productivity loss in women with untreated uterine fibroids and found that “symptomatic fibroids interfere substantially with women’s ability to function at work”.

Researchers in the Lerner study evaluated survey data from 58 women with symptomatic fibroids and 56 healthy women in a control group. They found that productivity loss related to absenteeism was 5.4% among women with fibroids versus 1.4% for women in the control group. The researchers also looked at ways in which having symptomatic fibroids impacted various aspects of women’s work performance, including time management, performance of mental and interpersonal job tasks, performance of physical tasks, and overall output. Their findings indicated that symptomatic uterine fibroids negatively impacted all aspects of the women’s job performance. The relative impact is represented in the chart below.

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The results of the Lerner study revealed that, on average, the work performance of fibroid sufferers was impaired 18% of the time, compared to 8% of the time for the average member of the control group. The study, which was published in the Journal of Occupational and Environmental Medicine in 2008, reported that, “the [group with fibroids] had mean at-work productivity deficits that, while lower than observed for primary care patient samples with major depressive disorder or osteoarthritis, are similar to those documented for clinic patients with diagnosed migraine headache”.

The U.S. Bureau of Labor Statistics reports that, “in 2013, women accounted for 51 percent of all workers employed in management, professional, and related occupations, somewhat more than their share of total employment (47 percent)”. Considering the high prevalence of fibroids among adult women, the societal impact of lost productivity, absenteeism, and disability claims attributable to fibroids is one we simply can’t afford to ignore.

The societal and economic impact of uterine fibroids also has a racial dimension. Multiple studies have observed that the incidence of fibroids is higher in African American women than in women of other races. The reason for the disparity in fibroids’ occurrence isn’t fully understood, but the problem is a big one: while it’s estimated that fibroids occur in as many as 70% of women, the incidence of fibroids in black women is even higher, with estimates reaching 80%.
Treated or untreated, the occurrence of fibroids has a particularly negative impact on women of color. African Americans are the “disproportionate majority” having surgery for fibroids, according to Moore et. al. Furthermore, race-based differences have been observed in health outcomes and responses to treatment: for example, African American women have a higher risk of post-surgical complications. Of those women studied by Lerner et. al whose symptomatic fibroids were untreated, women of color experienced greater productivity loss at work. The Lerner study reported that, “racial/ethnic minority status was associated with more difficulty managing physical and mental-interpersonal job tasks”.

A study by Eltoukhi et. al pointed to unequal access to care as an underlying factor. “Socioeconomic status and race influence access to appropriate health care. This disparity is a significant and controversial problem in the United States health care system, especially because access to some therapies is directly affected by insurance status and cost of the procedure. When hysterectomies are performed, white women and women of other racial groups with private insurance are more likely to undergo laparoscopic procedures, whereas African Americans, Hispanics, and women with Medicare coverage are more likely to undergo abdominal procedures, even for the same indication.”

The research team of Weiss et. al found a different explanation for the phenomenon, at least in terms of African American women’s higher likelihood of undergoing hysterectomy: they concluded that, “racial differences in the frequency of hysterectomy for benign conditions are consistent with differences in presenting symptoms, where African-American women seemingly have larger, more symptomatic fibroids”. While the reason for the disparity in treatment remains elusive, the implications have a direct and significant impact on the overall cost of fibroids to the U.S. health system.

Recovery time for a hysterectomy generally exceeds 4 weeks. That’s a lot of lost work days. The Cardozo study determined that “if the percentage of women undergoing hysterectomy was minimized as was the cost of lost work for these women, it would result in a 25.6% savings in the total annual costs due to uterine fibroids”. With that profound statistic in mind, we have reason to be hopeful: newer fibroid treatments such as the Acessa Procedure can effectively treat fibroids through minimally-invasive means, allowing for a faster recovery time. A study by Garza et. al showed that patients who underwent the Acessa Procedure were able to return to work or normal activities in an average of 3-4 days.

The increasing availability of less invasive treatment options that are associated with shorter recovery times give reason to be optimistic in the face of this public health crisis. While a faster recovery means less productivity loss related to fibroid treatment, it could also potentially minimize the productivity loss from untreated fibroid symptoms by reducing the consequences that commonly lead women to delay seeking treatment. If safe, effective, minimally invasive treatments are widely available and accessible to all women with uterine fibroids, the decision to seek treatment would likely be an easier one. In these ways, as fibroid treatment options improve, perhaps the economic burden that the condition creates will do the same.

Sources:

  1. Cardozo, E. et. al, “The Estimated Annual Cost of Uterine Leiomyomata in the United States”, American Journal of Obstetrics and Gynecology. 2011, doi:10.1016/j.ajog.2011.12.002
  2. Hartmann K.E. et al. “Annual costs associated with diagnosis of uterine leiomyomata”, Obstetrics and Gynecology. 2006;108:930 –937.
  3. Lerner,D. et. al, “Impaired Work Performance Among Women With Symptomatic Uterine Fibroids”JOEM. Oct. 2008; Vol.50(10):1149-1157
  4. U.S. Department of Labor and U.S. Bureau of Labor Statistics, “Women in the Labor Force: A Databook”. 2014 edition, 1052. Retrieved 4/15/15 from: http://www.bls.gov/opub/reports/cps/women-in-the-labor-force-a-databook-2014.pdf
  5. Moore, A.B. et. al, “Association of race, age and body mass index with gross pathology of uterine fibroids”, Journal of Reproductive Medicine. Feb. 2008; Vol.53(2):90-6
  6. Eltoukhi, H.M. et. al, “The health disparities of uterine fibroid tumors for African American women: a public health issue”, American Journal of Obstetrics and Gynecology. Mar 2014; Vol.210(3):194-9
  7. Weiss G. et. al, “Racial differences in women who have a hysterectomy for benign conditions”, Women’s Health Issues. May-Jun 2009;Vol.19(3):202–10
  8. Pitter, M.C. et. al, “The Impact of Different Surgical Modalities for Hysterectomy on Satisfaction and Patient Reported Outcomes” Interactive Journal of Medical Research. Jul-Sep. 2014; Vol. 3(3): e11.
  9. Garza, L. et. al, “Laparoscopic ultrasound-guided radiofrequency volumetric thermal ablation of symptomatic uterine leiomyomas: feasibility study using the Halt 2000 ablation system”, Journal of Minimally Invasive Gynecology. 2011;18(3):364–71.

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Fibroids Are Not Color Blind

Over the years, researchers have examined the epidemiological connection between a wide variety of patient characteristics and the occurrence of uterine fibroids, seeking to identify risk factors. Age, weight, diet, geographic location, lifestyle factors like cigarette smoking, medical conditions, and history of childbirth have all been studied, and many have been correlated with fibroids in one way or another. But time after time, study after study, one characteristic has stood out as a major indicator of fibroid risk: race. And the conclusion that researchers have consistently reached is this: uterine fibroids (also known as leiomyomas) disproportionately affect women of color.

Certain, specific differences have been seen in the cases of black women: research shows that, in comparison to white women, black women tend to develop a larger number of fibroids and experience more fibroid-related symptoms. A study published in 2013 by the American Society for Reproductive Medicine reported that, “African-American women had substantially more fibroids” with an average of 9.9 fibroids compared to the Caucasian subjects’ average of 4.5 fibroids. Additionally, Weiss et al. conducted a multi-ethnic, multisite, longitudinal study of 3,302 women ages 42-52 and concluded that “previously diagnosed leiomyomas were presenting symptoms more frequently in African-American woman than Caucasian women (85% vs. 63%)”.

The racial disparity in fibroid occurrence isn’t fully understood. The research that exists mostly defines the relative risk of the condition in terms of black and white. Obviously, black and white women aren’t the only ones affected by uterine fibroids. While very little data exists on the differences in susceptibility and symptoms between other ethnicities, a 2011 study conducted by the U.S. Armed Forces identified the relative risk of fibroids for multiple ethnic groups. The study looked at the population of active military women who were diagnosed with fibroids between 2001 and 2010: 11,931 cases were recorded. The researchers concluded that, relative to the white, non-Hispanic population, the risk of fibroids was slightly higher (1.1 times) for Hispanics and Asians/Pacific Islanders, and slightly lower (.9 times) for American Indians/Alaskan Natives. By comparison, African American women were 4.4 times more likely to have the same diagnosis, and women in the ethnic category of “Other” had almost double (1.9 times) the incidence of fibroids. These findings are depicted in the graph below.

Fibroids--race_MSMRgraph

As of now, there are no clear answers to explain why symptoms and presentation of uterine fibroids are different in women of color. However, the connection between fibroids and race is certainly a topic of interest to researchers, physicians and fibroid patients alike, and one that continues to be the subject of medical research.

Sources:

  1. Schwartz, S.M. “Epidemiology of uterine leiomyomata”, Clinical Obstetrics & Gynecology. June 2001; Vol.44(2):316-26
  2. Moorman, P.G. et al. “Comparison of characteristics of fibroids in African American and white women undergoing premenopausal hysterectomy”, Fertility & Sterility, March 2013; Vol.99(3)768-776>
  3. Weiss, G. et al. “Racial differences in women who have a hysterectomy for benign conditions”, Women’s Health Issues, May-June 2009; Vol.19(3):202-10
  4. Eltoukhi, H.M. et al. “The health disparities of uterine fibroid tumors for African American women: a public health issue”, American Journal of Obstetrics & Gynecology, March 2014; Vol.210(3)
  5. “Uterine Fibroids, Active Component Females, U.S. Armed Forces, 2001-2010”, Medical Surveillance Monthly Report, December 2011; Vol.18(12):10-13

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Why are Fibroids a concern?

Uterine fibroids grow on the inside or outside of a woman’s uterus, and can also be present on the uterine wall. Many women understandably want to know: Are fibroids dangerous, or do they just potentially cause painful problems?

The Prevalence of Fibroids

Doctors sometimes refer to uterine fibroids as fibroid tumors, but do not become confused or alarmed and assume that fibroids are cancerous. They are rarely cancerous, and many women do not even know they have them. Physicians are uncertain as to the exact causes of uterine fibroids, but many believe they are somehow related to the production of female hormones. This may be why women are commonly diagnosed with fibroids in their 30s and 40s when their hormones oftentimes begin to change in preparation for menopause.

When to Be Concerned

Although many women do not have problems with uterine fibroids, there are some complications that can occur. The potential dangers of fibroids include intense pain in the pelvic area, coupled with heavy menstrual bleeding. Heavy menstrual bleeding can be particularly dangerous if you are already at risk for anemia. Other issues, such as pain during bowel movements, frequent urination and bloating are also symptoms that could be caused by uterine fibroids. Although the dangers of fibroids are obvious for a person who is at a higher than normal risk of experiencing anemia, the other symptoms mentioned can cause disruption to the overall quality of life for any woman.

Prescription Medicines to Treat Fibroids

If you have been diagnosed with uterine fibroids, a doctor may prescribe pharmaceutical interventions for pain relief and/or to shrink the size of existing fibroids. Additionally, medicine may be prescribed to compensate for symptoms of anemia. However, these solutions are temporary, and many women prefer treating the actual cause of the problem, the fibroids, rather than just attending to the symptoms.

An Easy Way to Treat Fibroids

Fortunately, women now have the welcome opportunity to pursue an outpatient procedure that uses the FDA-cleared Acessa System to treat symptomatic uterine fibroids. Using a laparoscope, a physician treats all of a patient’s detectable fibroids, so the chances of reoccurring problems are quite low. This minimally-invasive procedure also allows women to return back to work in only four to five days, especially if they take the prescribed anti-inflammatory medication after the procedure.

If you’ve been diagnosed with uterine fibroids, it’s important to keep in mind that the condition is very common among women who are still having their menstrual cycles. Luckily, the Acessa System offers an appealing way to treat this problematic condition in a way that makes sense for women who want to be proactive about their health.

Sources:

  1. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-symptoms
  2. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-topic-overview
  3. http://www.webmd.com/women/uterine-fibroids/uterine-fibroids-medications
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Uterine Fibroid | How Common are Fibroids of the Uterus

Uterine-Fibroids-are-More-Common-Than-You-Think_blog-pic_LI-00-0244-AUterine Fibroids are More Common Than You Think

Uterine fibroids are non-cancerous growths that appear within the uterus, often during a woman’s childbearing years. Although the diagnosis may sound scary, it’s actually very common and there are several courses of treatment to pursue. Additionally, according to the Mayo Clinic, this condition is not associated with an increased risk of cancer in the uterus and the chance of the existing tumors becoming cancerous is very low.

A Look at Some Statistics

The Academy of Women’s Health website notes that 70% of Caucasian women may develop the disorder in their lifetimes and that percentage rises by 10 points in African-American females. A hysterectomy, also known as a surgical removal of the uterus, was once the standard treatment for the condition. Although alternatives now exist, some physicians are still recommending this drastic course of action for patients. The Academy of Women’s Health website also examined data related to the number of people who opted to have hysterectomies to treat this disorder of the uterus. It was discovered that in 2006, the year associated with the most recent data available, almost 300,000 women decided to have hysterectomies to remove their tumors.

A Lack of Symptoms

The Mayo Clinic website notes that although as many as three out of every four women may be affected by this condition, most don’t realize it, simply because patients often do not have symptoms. In fact, you may only become aware of the issue after undergoing a pelvic exam or prenatal ultrasound.

Risk Factors

Scientists have also discovered that some things may cause a person to be at an increased risk of developing uterine fibroids. They include eating a diet that’s higher in red meat than vegetables and fruit and starting to menstruate at an early age. Genetics also plays a role, because if your mother or sister is diagnosed with the condition, you’ll be at an increased likelihood of dealing with it too.

Treatment May Not Be Required

To close on a hopeful note, it’s worth mentioning that the National Uterine Fibroids Foundation website discusses how out of every four women who have the condition, only one of those will have symptoms severe enough to require treatment.

With that in mind, be proactive about your health and continue receiving annual gynecological exams. If your health care provider diagnoses you with this common issue, make sure to carefully evaluate all available treatment options, rather than immediately scheduling yourself for a hysterectomy.

Take the Next Step

If you feel you may have the symptoms or have been diagnosed with uterine fibroid tumors, it is a good idea to discuss all of the available treatments for fibroids.

Click on the Physician Finder at the right to find an Acessa-trained physician near you to see if the Acessa procedure is right for you. Or for more information, please contact Acessa Health at 877.412.3828.

Sources

  1. http://academyofwomenshealth.org/mppost-september-4-2013-uterine-fibroid-tumors-a-surprisingly-common-and-highly-treatable-condition/
  2. http://www.mayoclinic.com/health/uterine-fibroids/DS00078
  3. http://www.nuff.org/health_statistics.htm
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