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Exploring The Connection Between Fibroids And Obesity

 

Fibroids_weightgainThe relationship between weight and uterine fibroids (also known as leiomyomas) is a complex one. However, while it is not fully understood, a link between obesity – which is typically defined by a Body Mass Index (BMI) ≥24 – and fibroid risk has been identified in multiple research studies. In fact, data suggest that obese women have two to three times the risk of developing fibroids than women of average weight.

Racial Disparities In The Impact of Obesity

Some research suggests that the relationship between BMI and fibroid risk differs between black women and white women. One study produced evidence that premenopausal black women may have higher ovarian hormone levels than white women (Woods et al., 1996). Another revealed that in black women, estradiol levels decrease as BMI increases in black women, whereas this was not the case for white women (Manson et al., 2001).

The Black Women’s Health Study, an ongoing prospective cohort study in the U.S. that was initiated in 1995, found the prevalence of obesity (BMI ≥30 kg/m2) to be nearly twice as high in black women as in white women. The incidence of uterine fibroids is also significantly greater in black women than white women, and the researchers involved concluded that this was not a coincidence: they hypothesized that a connection with the weight factor could partially explain the disparity in the disease burden. Looking more deeply at the results of the cohort study, the research team of Wise et al. noted that “weight gain was positively associated with risk among parous women (those who have given birth) only”.

Understanding the Hormone Connection

To understand the role that weight plays in fibroid development, one must start by looking at the common denominator: hormones. Ovarian hormones, particularly estrogen, play a key role in the development of fibroids. Obesity has been tied to hormonal and metabolic changes in women of reproductive age, included altered estrogen metabolism.

In a May 2012 article for Today’s Dietitian, Krystene DiPaola, MD, a reproductive endocrinologist and infertility specialist at the University of Cincinnati Academic Health Center, explains, “We do know that fibroids respond to estrogen, and that estrogen isn’t produced only in the ovaries but also in peripheral fat in the form of estrone,” she explains. “The estrone can, in higher doses such as in overweight women, affect fibroid growth and cause them to be more symptomatic.”

Does Diet Make a Difference?

The question then becomes, is it possible for an obese woman to minimize the occurrence or recurrence of her fibroids by losing weight? Unfortunately, research has not yet yielded a definitive answer to this question. However, some study data suggest that diet modification – and particularly the weight loss that may result – can make a difference in the presentation of fibroids. Because hormones are the driving force behind fibroid development, dietary choices that promote hormonal balance can potentially impact the development of fibroids and the severity of their associated symptoms.

DiPaola believes any nutritional modification that may lower peripheral fat stores, and therefore reduce estrogen production from those fat stores, only helps women with symptomatic fibroids. “In terms of my personal opinion,” DiPaola says, “the dietary component towards the treatment of fibroids can do nothing but help and may augment the traditional therapies to treat this condition.”

 

>> SEE ALSO:  The Fibroids-Diet Connection

 

SOURCES:

Takeda, T. et al. “Relationship Between Metabolic Syndrome and Uterine Leiomyomas: A Case-Control Study”, Gynecologic and Obstetric Investigation. July 2008; 66:14–17

Woods, MN. et al. “Hormone levels during dietary changes in premenopausal African-American women”,
Journal of the National Cancer Institute. Oct 1996; 88(19): 1369-74

Manson, JM. et al. “Racial differences in sex hormone levels in women approaching the transition to menopause”, Fertility and Sterility. Feb 2001; 75(2): 297-304

Wise, L. et al. “Influence of Body Size and Body Fat Distribution on Risk of Uterine Leiomyomata in U.S. Black Women”, Epidemiology. May 2005; 16(3): 346-354

Tempest, M. “Uterine Fibroids and Nutrition — Studies Suggest Healthful Dietary Modifications May Cut Risk and Ease Symptoms”, Today’s Dietitian. May 2012; 14(5): 40 http://www.todaysdietitian.com/newarchives/050112p40.shtml#sthash.tuDCxUd2.dpuf

 

 

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Fibroid Treatments Demystified, Part V: Pharmacological Hormone Therapies

 

Uterine fibroids are almost always benign, but the debilitating symptoms experienced by an estimated 30% of women with fibroids can feel far from it. The nature and severity of fibroid symptoms depends on the size, and/or classification (submucosal, subserosal, intramural, or pedunculated) of the fibroids: common symptoms include abnormally heavy uterine bleeding, pelvic pain and bloating, abdominal pressure, urinary frequency, and constipation. A variety of surgical options are available to eliminate the tumors; for many women, however, the first step in addressing their condition is to seek relief of the symptoms through pharmacological treatments.

How Hormone Therapies Work

The majority of pharmacological products used to treat uterine fibroids do so by acting on the body’s hormonal balance. Research has shown that fibroid growth is fueled by hormones, specifically the hormones estrogen and progesterone. By directly or indirectly altering the levels of these hormones in the body, hormonal therapies can reduce the severity of fibroid symptoms like heavy bleeding and potentially shrink or inhibit the growth of fibroids. Approved hormonal therapies include GnRH agonists, oral contraceptives, progestins, aromatase inhibitors (AI), and other hormone-suppressing drugs like mifepristone.

Gonadotripin-releasing hormone agonists (GnRH-a) suppresses the body’s production of estrogen, creating a post-menopausal degree of estrogen deficiency. GnRH-a therapy has proven effective in both shrinking fibroids and managing symptoms like heavy bleeding. However, these effects are not sustained after discontinuing treatment. Use of GnRH agonists carries certain serious long-term health risks, including bone loss. Furthermore, because GnRH-a therapy essentially pushes the body into a menopausal state, women undergoing the treatment experience menopausal symptoms like hot flushes, vaginal dryness, weakness and fatigue, mood swings, and lowered libido. The negative effects of GnRH-a therapy can be countered by supplemental hormone treatments, but its associated health risks make GnRH agonists appropriate only for short term use, typically no longer than 6 months. Perhaps its most useful clinical application is rapidly shrinking large fibroids in preparation for surgical removal.

Oral contraceptives and progestins can be used for symptom relief, but their ability to reduce fibroid size is still uncertain. Studies have shown improvement in abnormal uterine bleeding with oral contraceptives. Drugs in this category, including lynestrenol, dienogest, and norethisterone, are considered relatively safe, and their low cost combined with potential benefit make them a promising choice for some women. However, women with pressure symptoms may not experience relief with oral contraceptives and progestins since they do little to shrink the fibroids or provide relief of bulk symptoms.

Aromatase inhibitors (AIs), part of a class of drugs known as anti-oestrogens, suppress the activity of the enzyme aromatase, which is responsible for the conversion of androgens into estrogens. Studies have suggested that use of AIs could inhibit fibroid growth and eliminate the need for surgery; however, further research has failed to provide sufficient evidence of this effect. Research surrounding the usefulness of AI’s in treating uterine fibroids continues, but in the meantime, the treatment is still considered experimental.

Mifepristone, a drug formerly known as RU486, belongs to a class of drugs known as progesterone receptor antagonists. As the category name implies, the drug acts on progesterone receptors. Mifepristone has proven effective in reducing uterine volume, thereby reducing blood loss and relieving related “bulk symptoms” like pelvic and lower back pain, abdominal pressure, and urinary frequency. The side effects of mifepristone are similar to GnRH-a therapy’s menopausal symptoms: hot flushes, mood swings, fatigue, and decreased libido are common, as well as headache, nausea, and diarrhea. In clinical trials, endometrial hyperplasia, a thickening of the uterine lining that creates a potential cancer risk, frequently resulted from mifepristone use. Due to a lack of data related to the safety outcomes of mifepristone use, the drug is not indicated for long-term use.

Comparing Pharmacological Treatment Options

How do these various hormonal therapies compare in terms of effectiveness? Comparative study data is still somewhat limited. One study compared the oral progestin lynestrenol with leuprolide, a GnRH agonist, and found no significant difference in their effectiveness for relieving pelvic pain and heavy bleeding. A separate, randomized clinical trial compared the GnRH agonist triptorelin with an aromatase inhibitor called letrozole, and revealed similarly significant decreases in fibroid volume (33% and 45%, respectively) with both therapies. In the latter study, however, none of the women treated with the aromatase inhibitor reported experiencing hot flushes, whereas 96% of the women taking a GnRH-a did. All of the approved hormonal therapies have shown some degree of effectiveness in treating fibroid-related symptoms; what determines their relative usefulness is predominantly the patient’s unique health history, as well as the nature and severity of each drug’s known side effects.

Limitations

While the available treatments vary in their mechanism for altering hormone levels, the hormonal therapies have a common limitation: they are not meant for long-term use. Clinical studies have consistently associated safety concerns with continued use of hormonal therapies in the treatment of fibroids. For many women, however, pharmacological treatments are an appropriate first step in addressing symptomatic fibroids. When symptoms persist and fibroids continue to impact a woman’s quality of life after trying a pharmacological treatment, a surgical approach would be an appropriate next step. For women concerned about the invasiveness of surgery, or the potential harm to the uterus that a procedure like hysterectomy entails, less invasive surgical options are worth consideration. Minimally invasive, uterine-sparing fibroid treatments like the Acessa Procedure offer a quicker recovery then major surgeries like hysterectomy, while providing the longstanding results that pharmacological therapies cannot.

 

SOURCES:
Levy, B. S. “Modern Management of Uterine Fibroids”, ACTA Obstetricia et Gynecologica, 2008, pp. 812-823

Song, H. et al. “Aromatase inhibitors for uterine fibroids”, Cochrane Database for Systematic Reviews/Cochrane Library, Oct 23, 2013. Web: http://onlinelibrary.wiley.com/enhanced/doi/10.1002/14651858.CD009505.pub2. Retr: Aug 1,2015

 

 

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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 Is A GnRH Agonist?

If you’ve done a little homework on fibroid treatments or discussed treatment options with your gynecologist, you may have encountered the term “GnRH agonist”. Here’s what it is: GnRH stands for Gonadotrophin Releasing Hormone; it is a hormone that the body naturally produces and in women, it serves the function of stimulating egg production in the ovaries. The term “agonist” refers to a synthetic drug that simulates the body’s own, naturally produced material (or in this case, hormone).  Supplementing the body’s natural supply of GnRH with a GnRH agonist effectively inhibits the ovaries’ production of estrogen and testosterone, pushing the body into a menopausal state.

GnRH agonists have multiple uses in reproductive medicine, including treating pain associated with endometriosis and temporarily relieving symptoms of uterine fibroids. GnRH agonists can be used to treat heavy bleeding, one of the most common symptoms experienced by fibroid sufferers and women with endometriosis. In fact, for women taking GnRH agonists, bleeding tends to cease altogether, a condition known as amenorrhea. In this way, the treatment (also referred to as “GnRH analogue therapy”) helps to resolve anemia and a low blood cell count. When taken in advance of surgery, GnRH agonists can reduce the likelihood of a blood transfusion being required.

Furthermore, the drug’s significant effect on the growth of fibroids has been observed in many clinical studies. It’s not surprising: fibroids, benign uterine tumors, are estrogen-dependent. When estrogen levels in the body drop, fibroids shrink. By decreasing the body’s estrogen production, GnRH agonists—commercially available in such drugs as Lupron, Zoladex, Synarel, Buserelin, and Prostap—cause fibroids to shrink. Research indicates that continuous use of a GnRH agonist reduces fibroid size by approximately 50% after 3 months. Due to its fibroid-shrinking properties, GnRH agonists are commonly prescribed to women who are scheduled to undergo myomectomy; shrinking the fibroids in advance of the procedure minimizes the invasiveness of their extraction through laparoscopic surgery.

The most common symptoms experienced by patients undergoing the hormone-suppressing treatment are the symptoms typically associated with menopause: these can include hot flashes, vaginal dryness, moodiness or depression, headaches, and loss of bone density. “Add-back” hormone therapies (i.e. taking estrogen drugs) can usually provide some relief from these symptoms, without undermining the effectiveness of the primary therapy. No permanent side effects have been noted in human studies, though GnRH agonists are not indicated for long-term use. Studies have demonstrated the continuous use of a GnRH agonist, in conjunction with hormone add-back therapy to counteract bone density loss and other symptoms of estrogen deficiency, to be safe and effective for up to 2 years.

While the effects of taking a GnRH agonist may be profound, they are not permanent. Once the GnRH agonist is discontinued, estrogen levels start to return to the pretreatment state, reversing menopausal symptoms triggered by the treatment. In a study conducted by the research team of Rein et al., fibroid patients who were treated with a GnRH agonist became amenorrheic shortly after starting treatment. Four to ten weeks after discontinuing the treatment, the patients’ menses returned. The researchers also observed a rapid regrowth of fibroids once patients discontinued the GnRH agonist therapy. However, since fibroid patients GnRH agonists are most commonly prescribed in preparation for myomectomy, regrowth of fibroids following cessation of the drug is not a matter of concern.

 

SOURCES:

  1. Rein M. S. et al. “Fibroid and myometrial steroid receptors in women treated with gonadotropin-releasing hormone agonist leuprolide acetate” Fertility & Sterility. 1990; Vol. 53: pp.1018-1023
  2. American Society for Reproductive Medicine, “GnRH Agonist Therapy”, ReproductiveFacts.org: 2011. Retrieved July 10, 2015, from https://www.asrm.org/detail.aspx?id=1884
  3. Burbank, F. Fibroids, Menstruation, Childbirth, and Evolution, pp. 93-98. Wheatmark, 2009. Tucson, AZ.
  4. Friedman, A.J. et al. “Long-term medical therapy for leiomyomata uteri: a prospective, randomized study of leuprolide acetate depot plus either oestrogen-progestin or progestin add-back for 2 years”, Human Reproduction. 1994; Vol. 9: pp.1618-1625

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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.

“Won’t My Fibroids Go Away On Their Own?” Weighing the Wait-And-See Option

If you’ve done any Internet research on fibroids at all, you’ve probably encountered some mention of a woman’s fibroids disappearing on their own after menopause. It’s most likely a true story. Indeed, as the body’s natural production of estrogen declines in menopause, the estrogen-fueled fibroid tumors, also called leiomyomas, will follow suit—at least, in theory.

There are a number of reasons why a woman would continue to see the persistence or even growth of her fibroids after menopause: the reintroduction of estrogen with hormone replacement therapy or malignant changes in the tumor (cancer known as leiomyosarcoma) are two possible explanations for the continuation of symptoms. Hormone replacement, in particular, is commonly necessitated when a woman’s menopausal symptoms impact her quality of life, but the need isn’t foreseeable in pre-menopausal years. In such cases, fibroids that may have otherwise gone away naturally could continue to present problematic symptoms far later in life than anticipated.

Still, the natural disappearance of fibroids is a viable possibility. For many women, this raises the question, if fibroids will potentially shrink or even disappear on their own after menopause, should a pre-menopausal woman take steps to have them treated, or should she simply wait and see? The urgency for treatment typically depends on the severity of symptoms, according to Dr. Donald Galen, OB-GYN and former Surgical Director at the Reproductive Science Center of the San Francisco Bay Area.

The degree to which women experience common fibroid symptoms like heavy menstrual bleeding, pelvic pain and pressure, and urinary frequency varies substantially. For many women, fibroid symptoms are more than inconvenient: they can interfere with all aspects of her life and relationships. When symptoms are debilitating, a woman may want to consider treating her fibroids sooner, rather than later. With many available treatment options, including minimally invasive options like Acessa Procedure, treating any existing fibroids will improve her quality of life.

Women whose symptoms are less severe, on the other hand, may choose to delay treatment. “If symptoms are minimal,” Dr. Galen explains, “it is reasonable to follow these patients and as they progress in menopause…their fibroids and symptoms should progressively diminish and thus no other treatment may be needed.” Stressing the importance of the patient’s participation in the decision-making progress, he adds, “this decision is made by the woman, with counseling from her physician as to all available risks, treatments, alternatives, etc.”

Sources:

  1. Burbank, Fred. Fibroids, Menstruation, Childbirth and Evolution: The Fascinating Story of Uterine Blood Vessels. Tucson, AZ: Wheatmark, 2009. 135. Print.
  2. American Society for Reproductive Medicine, “What Are Fibroids”, Resources, ReproductiveFacts.org: 2011. Retrieved April 6 2015, from http://www.reproductivefacts.org/FACTSHEET_What_are_Fibroids/

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