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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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Endometrial Ablation vs. Radiofrequency Ablation: What’s The Difference?

 

The term “ablation” refers to a process by which tissue is destroyed, typically using either heat (thermal ablation) or cold (cryoablation). Ablative technologies are used to treat numerous medical conditions, including gynecological issues. We often hear of two procedures in particular, endometrial ablation, and radiofrequency ablation, and many people confuse the two treatments. Don’t let the similar names deceive you though: while both procedures leverage ablative technology, they are very different in their applications. To clear up the confusion, here’s a rundown on the defining characteristics of the two ablation therapies.

Endometrial Ablation (EA)

How EA Works
Endometrial ablation is typically used to treat prolonged, abnormal uterine bleeding. It does so by ablating the lining of the uterus, known as the endometrium, permanently destroying the tissue. There are several different methods of endometrial ablation: these include freezing (cryoablation techniques), directly applying heat from fixed-frequency microwaves or radiofrequency energy; and using hot fluid through techniques like balloon endometrial ablation.

In EA, treatment is limited to the endometrial layer, the surface tissue that lines the uterine cavity, and the basalis layer, where the endometrial tissue originates. Destroying the basalis layer prevents new tissue from growing, thereby reducing or eliminating menstrual bleeding.

EA procedures are performed in an office or hospital setting, usually with the patient under conscious sedation. Patients typically go home the same day, and full recovery takes about 1-2 weeks, depending on the specific procedure.

Outcomes
Endometrial ablation is used to control prolonged, abnormal vaginal bleeding. EA is most appropriate for patients that have completed childbearing, who have not seen results from other treatment approaches, and who are seeking an alternative to hysterectomy.

In most cases, EA meets its objective: an estimated 9 out of 10 women have lighter periods or no periods after undergoing the procedure. However, it’s difficult to predict whether a woman’s bleeding will stop completely. Estimates regarding the incidence of amenorrhea (the absence of menstrual bleeding) after EA vary widely from one study to the next, but it’s typically estimated to fall between 20% and 50%. A study by El-Nashar et al. asserted that the likelihood of amenorrhea occurring after EA depends on the type of ablative technology used, as well as patient characteristics like age and uterus size. Regardless, amenorrhea is not a guaranteed outcome. “If… a woman’s goal is amenorrhea, hysterectomy is the only reliable op¬tion,” reports Dr. Joseph Sanfilippo in an update to the medical community on EA-related developments.

It is important to note that endometrial ablation is not indicated for the treatment of uterine fibroids; any destruction of fibroids in the process of ablating the endometrium is incidental. Fibroids that grow partially or entirely within the walls of the uterus (known as intramural fibroids), as well as those growing outside the uterus (subserosal fibroids), are not reached during ablation. Those that protrude into the uterine cavity (submucosal) are sometimes shaved down hysteroscopically before ablation; however, if the fibroid originates below the basalis layer of tissue, it cannot be completely eradicated during ablation and may grow back, following the procedure.

Radiofrequency Ablation (Acessa Procedure)

How RFVTA Works
Radiofrequency ablation (short for “radiofrequency volumetric thermal ablation”, or RFVTA) is a specific ablation technique that is used to treat uterine fibroids in a procedure known as Acessa. In the Acessa procedure, a controlled volume of heat is applied directly to the fibroid, killing the tissue of the fibroid while leaving healthy surrounding tissue unharmed. Once the fibroid is destroyed, the dead tissue is simply reabsorbed by the body.
In performing RFVTA, a scope and a laparoscopic ultrasound probe are inserted through the abdominal incisions. Using the scope in conjunction with the ultrasound probe allows the operating physician to precisely pinpoint the fibroids’ location. Once the fibroids have been located, the surgeon uses a special tool with a retractable electrode array (the Acessa handpiece) to ablate the fibroid with radiofrequency energy.
RFVTA is performed in an outpatient setting. The surgery is minimally invasive: with the exception of two tiny incisions (no wider than 1/4 inch) on the abdomen, there is no cutting or suturing of uterine tissue. Patients go home the same day and return to normal activities within 2-3 days.

Outcomes
Clinical research has shown radiofrequency ablation to be very effective in shrinking or completely eliminating fibroids. The use of laparoscopic ultrasound reduces the risk of symptom recurrence by allowing the physician to find and treat all fibroids present in the uterus, not just the ones that were identified through previous diagnostic imaging. At 36 months post-treatment, 90% of patients needed no additional fibroid treatment. Though objectively measured bleeding at 12 months of follow up decreased in 82% of the women treated with RFVTA, the goal of treatment was not to destroy the endometrium or induce amenorrhea but merely to treat the fibroids.
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In the field of gynecology, ablation techniques can be used in addressing multiple conditions but it’s important to understand the difference between the technologies. Radiofrequency ablation with Acessa is an effective method for treating only the uterine fibroids without harming the rest of the uterus, whereas endometrial ablation effectively controls abnormal vaginal bleeding by directly ablating the lining of the uterus. Their usefulness is entirely related to their objective, and despite the commonality of a name, these procedures are very different in the objectives they serve.

SOURCES:

  1. American Society for Reproductive Medicine, “Endometrial Ablation”, ReproductiveFacts.org: 2011. Retrieved May 28, 2015, from http://www.reproductivefacts.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/endoablation.pdf
  2. El-Nashar, S.A. et al. ” Prediction of Treatment Outcomes After Global Endometrial Ablation”, Obstetrics & Gynecology, Jan. 2009; 113(1): 97–106. doi:10.1097/AOG.0b013e31818f5a8d.
  3. Sanfilippo, J. “Update: Options in Endometrial Ablation”, Supplement to OBG Management, Dec. 2009
  4. Berman, J.M. et al. “Three Years’ Outcome from the Halt Trial: A Prospective Analysis of Radiofrequency Volumetric Thermal Ablation of Myomas”, The Journal of Minimally Invasive Gynecology, 2014.

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Fibroids’ Psychological Toll

Fibroids hurt. The pain isn’t just physical: the psychological toll that comes with symptomatic fibroids is profound. In a 2014 study on the emotional impact of fibroids, researchers at Northwestern University’s Feinberg School of Medicine surveyed 48 women who had diagnosed, symptomatic uterine fibroids. The researchers found that the majority of those women had a “significant emotional response to their fibroids, ranging from general worry and concern to fear, anxiety, sadness, and depression”. More than half of the study’s participants reported feeling as though they had no control over their fibroids, mostly due to the difficulty of managing and predicting the heavy menstrual flow that is characteristic of the condition. The majority felt disempowered and possessed a “negative self-image”. The women also frequently expressed “concern over appearing pregnant, overweight, and less attractive”. Many of them expressed that the insecurities made intimacy with a partner difficult.

Despite both the physical and emotional suffering that the condition engenders, the prevailing attitude among women with fibroids seems to be that the condition is one to simply be endured. They resign themselves to “toughing it out”. Why would they voluntarily suffer? The answer partly lies in the woman’s perception of normalcy surrounding her experience with fibroids, according to researchers. M.S. Ghant et al. discovered in their 2014 study that many of the women they surveyed had delayed seeking a diagnosis for their heavy menstrual bleeding because they believed what they were experiencing was essentially a normal burden of womanhood. Even after receiving a diagnosis of fibroids, the researchers reported, many did not seek treatment: instead, they frequently minimized their suffering and “expressed that they were ‘just dealing’ with their fibroids”.

Fear about invasive treatments and the consequences of procedures like hysterectomy are clearly major deterrents for many fibroid sufferers who would otherwise seek treatment. Fortunately, new, outpatient treatment options like the Acessa Procedure offer women with fibroids alternatives to hysterectomy and invasive surgery. Evidence suggests that treating fibroids through a minimally invasive procedure of this nature leads to improved quality of life and psychological wellbeing.

A 2013 study by Guido et al. examined the impact of fibroid treatment via radiofrequency volumetric thermal ablation (also known as Acessa Procedure) on various aspects of patient’s wellbeing. Using the participant’s responses to follow-up questionnaires at 3, 6, 12 and 24 months post-procedure, the research team measured improvements in multiple quality-of-life factors, including: Concern, Activities, Energy/Mood, Control, Sexual Function, and Self-Consciousness. They concluded that the women participants, “showed significant improvement in their symptom severity and health-related quality of life [in the first] 3 months post treatment”. Moreover, the effects seemed to last; the researchers noted that the improvements they observed, represented in the graph below, were “sustained over 2 years, accompanied by a low rate of re-intervention (4.8%)”.

As awareness of minimally invasive treatment options increases, perhaps the painful emotions like fear, anxiety, and depression that commonly precede treatment decisions will be alleviated, and “toughing it out” will no longer be perceived as necessary. Moreover, for those women who take the next step of treating, rather than enduring, their fibroids through a minimally invasive procedure, the outlook for an improved emotional, physical, and mental state is a positive one.

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SOURCES:

  1. Ghant, M.S. et al. “An altered perception of normal: a qualitative assessment of women’s experiences with symptomatic uterine fibroids”, Fertility & Sterility. Sept 2014; Vol. 102(3):255.
  2. Ghant, M.S. et al. “Beyond the physical: a qualitative assessment of the emotional burden of symptomatic uterine fibroids on women’s mental health”, Fertility & Sterility. Sept 2014; Vol. 102(3):329.
  3. Guido et al. “Radiofrequency volumetric thermal ablation of fibroids: a prospective, clinical analysis of two years’ outcome from the Halt trial”, Health and Quality of Life Outcomes 2013 11:139.

 

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