Posts

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

 

 

LI-00-0527-A

 

Fibroid Treatments Demystified, Part IV: Myomectomy

 

Myomectomy, a widely practiced method of removing subserosal or intramural uterine fibroids, is an alternative to hysterectomy for fibroid patients seeking uterine preservation.

How Myomectomy Works

In myomectomy, a surgeon removes one or more fibroids by cutting them out of the uterine wall. While incisions are made in its tissue, the uterus itself ultimately stays in place. Depending on the type and location of the fibroids, myomectomy may be performed laparoscopically (accessing the uterine cavity through abdominal incisions) or hysteroscopically (accessing the uterine cavity by way of the vagina).
The method used for performing myomectomy dictates the recovery and hospitalization time. Post-operative hospital stays currently range from 0-2 days, and recovery time ranges from 4-6 weeks.

Treatment Outcomes

Myomectomy patients typically see an enduring reduction in symptoms: in a recently published study, the research team of Pitter et al. reported that 62.9% of the myomectomy patients in their study population were free of symptoms at three years post-procedure.

Once a fibroid is completely removed, it will not grow back. That is not to say, however, that new fibroids won’t develop, potentially triggering the return of symptoms. A study by Yoo et. al assessed the probability of fibroid recurrence in laparoscopic myomectomy patients over an 8-year follow-up period. The researchers observed that the cumulative probability increased steadily from 11.7% at 1 year post-procedure to 84.4% at the 8 year mark. Factors influencing fibroid recurrence were found to be patient age, number of fibroids, pre-operative uterine size, and childbirth following the procedure. Another team of researchers, Obed et al., added family history of fibroids and multiple symptoms as to that list of factors, and concluded from their own study that “there is a high recurrence of uterine fibroids following myomectomy”.

Risks associated with myomectomy include post-surgical adhesions and both intra- and post-operative bleeding. Dubuisson et al. observed adhesions, or scars produced as incisions in the uterine tissue heal, in 35.6% of patients during “second-look” laparoscopy; this result that has been corroborated by additional studies. Cases of uterine rupture during pregnancy following a laparoscopic myomectomy have also been reported.

Since a myomectomy does not involve removal of the uterus, it is possible to preserve the patient’s fertility. Research largely suggests that myomectomy is an appropriate procedure for fibroid patients who desire pregnancy. That said, certain complications associated with myomectomy, such as adhesions, can, themselves, impair fertility – a fact that should be taken into account when considering the fertility-sparing aspects of the procedure.

One technique for removing larger fibroids through small ports in laparoscopic myomectomy, called power morcellation, has recently been the subject of major controversy. In power morcellation, a tool called a morcellator is used to dissect large fibroids, so that the dead tissue may be more easily extracted without expanding the abdominal incisions. In April 2014, the Federal Drug Administration (FDA) released a safety communication notice discouraging use of power morcellation, citing concerns that the technique could spread cancerous cells within the abdominal cavity if it came in contact with cancerous tissue. While uterine fibroids (also called leiomyomas) are almost always benign, the rare fibroid (about 1 in 1,000) that is malignant may not be detected as such in advance of surgery. Several manufacturers of the power morcellator have since pulled the device from the market, and power morcellation is now rarely used in laparoscopic myomectomies.

 

 

SOURCES:

Pitter, M.C. et al. “Fertility and Symptom Relief following Robot-Assisted Laparoscopic Myomectomy”, Obstetrics & Gynecology, Apr 19, 2015. ePub. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4417601/. Retrieved July 2, 2015

Yoo, E. et al. “Predictors of leiomyoma recurrence after laparoscopic myomectomy.” Journal of Minimally Invasive Gynecology, Nov-Dec 2007; Vol. 14(6):690-7

Obed et al. “Uterine fibroids: risk of recurrence after myomectomy in a Nigerian population.” Archives of Gynecology and Obstetrics, Feb 2011; Vol. 283(2):311-5

Dubuisson J.B., et al. “Second look after laparascopic myomectomy”, Human Reproduction. 1998; Vol. 13:2102–6

“FDA discourages use of laparoscopic power morcellation for removal of uterus or uterine fibroids”, FDA News Release, Apr 17,2014. Web: http://www.fda.gov/newsEvents/Newsroom/PressAnnouncements/ucm393689.htm. Retrieved July 2, 2015.

 

LI-00-0492

Fibroid Treatments Demystified, Part III: Focused Ultrasound

 

Among the hysterectomy alternatives available to women with fibroids is the high intensity focused ultrasound approach (HIFU), more specifically identified as Magnetic Resonance Guided Focused Ultrasound (MRgFUS). MRgFUS is a thermoablative technique that destroys fibroids by focusing a high-intensity beam of ultrasound energy on specific tissue.

Performed as an outpatient procedure, the focused ultrasound method is entirely non-invasive: no insertion of a catheter or needle is necessary, and no cutting is involved. The MRgFUS procedure is approved by the FDA for use in premenopausal women with symptomatic fibroids who have completed childbearing. While certain limitations prevent the technique from being widely used or universally appropriate, its effectiveness in reducing symptom severity and improving patients’ quality of life has been demonstrated in a variety of cases.

How Focused Ultrasound Works

MRgFUS is performed without anesthesia, under conscious or no sedation, by a physician, with the patient in an MRI unit. Using magnetic resonance imaging (MRI) allows the practitioner to achieve clear visualization of the reproductive organs and provides real-time thermal monitoring, enabling the practitioner to optimize the ultrasound treatment’s ablative effects. The physician then directs high intensity ultrasound waves to a small area of fibroid tissue, destroying the targeted tissue with thermal energy. The ultrasound beam has a frequency range of approximately 1–1.5 MHz, which is on the low end of the spectrum for diagnostic ultrasonography. Immediately following the treatment, the patient is injected with an MRI contrast agent called gadolinium, which allows the practitioner to view the treatment’s impact on the fibroid’s vascular structure.

Treatment Outcomes

Patients who undergo a focused ultrasound procedure typically experience rapid recovery. Symptom improvement is usually seen within the first three months post-procedure, and research has shown this improvement to be sustained through 24 to 36 months in most cases.

While generally effective, focused ultrasound therapy is limited in its usefulness. For example, MRgFUS cannot be performed effectively if certain kinds of structures—such as the bowel, the pelvic bone, a skin fold, or an implanted device — are obstructing the path to the fibroid. Furthermore, characteristics of the fibroids themselves—including size, vascularity, and placement—can sometimes make them difficult to treat. The maximum size treatable is uncertain; however, most practitioners surveyed indicated that fibroids larger than 10cm are generally more difficult to treat with focused ultrasound.

Since focused ultrasound is limited in its ability to target all fibroids, repeated treatments are often required: Stewart et. al found that, “With minimal [initial] treatment the probability of additional treatment exceeds 50% at 24 months, but this is substantially reduced with increasing ablation”.

The MRgFUS procedure is not widely available, mostly due to cost: few clinics are equipped with the high-priced system, and insurers are not typically inclined to cover costly procedures. On the positive side, short-term morbidity is low and the recovery time is short. No specific pattern of complications with pregnancy has been identified; however, the procedure is not indicated for women who plan to get pregnant. For others who are seeking a uterine-sparing, non-invasive treatment to relieve symptomatic fibroids, the focused ultrasound approach may be a viable option.

 

SOURCES:
Stewart, E. et al. “Clinical Benefit of Focused Ultrasonography”, Obstetrics & Gynecology. Aug. 2007; Vol.110(2):279-287
InSightec, “MR Guided Focused Ultrasound for Uterine Fibroids”, Information for Prescribers: ExAblate Version 2.46. Revised Nov. 2004
“HIFU Treatment (High Intensity Focused Ultrasound).” Uterine Fibroids. Retrieved June 26, 2015. http://www.uterine-fibroids.org/hifu.html.

 

LI-00-0490

The Fibroids-Diet Connection

 

More than a decade ago, researchers identified a connection between a meat-heavy diet (specifically, the consumption of ham and beef) and uterine fibroids. The same study, published in the medical journal Obstetrics & Gynecology, produced evidence that diets heavy in green vegetables reduced the risk of developing fibroids. Since that time, numerous studies have sought to further explain the connection between diet and fibroid risk. Unfortunately, that research has yielded few answers, and the connection remains largely misunderstood and widely debated.

Foods Impacting Fibroid Growth

While no causal links have been established, there are clear themes emerging from study data. Multiple studies have correlated increased consumption of fruit, vegetables, and low-fat dairy products with reduced risk of developing fibroids. A study published in 2010 in the American Journal of Epidemiology was one such study. The research team of Wise et al. followed trends in the dietary intake of more than 22,000 premenopausal black women from the US Black Women’s Health Study over a 10-year period. Self-reported data from questionnaires gave the researchers insight into participants’ intake of dairy foods – including milk, cheese, yogurt, and ice cream – and nutritional components of dairy – like calcium, vitamin D, and butyric acid. The collected data revealed a connection between higher dairy consumption and a lowered risk of uterine fibroids. The researchers theorize that calcium and butyric acid (present in milk fat) inhibit the proliferation of cells that would otherwise form the benign pelvic tumors.

In a separate research effort, Wise et al. used the diet questionnaires collected from a cohort of participants in the Black Women’s Health Study to gather evidence regarding the link between fibroid risk and the consumption of fruits, vegetables, and carotenoids. In the December 2011 issue of American Journal of Clinical Nutrition, the researchers reported finding a reduced risk of uterine fibroids among the women with higher levels of fruit and retinol in their diets. These findings build upon those reported more than a decade ago by Chiaffarino and colleagues, who determined that a high intake of green vegetables has a protective effect against fibroids.

Margaret Wertheim, MS, RD, LDN, a Chicago-based dietitian, sees the same value in green vegetables. She advises her clients with fibroids to increase their intake of cruciferous vegetables like cabbage, broccoli, and kale. “This group of vegetables, in particular, contains indole-3-carbinol,” she explains, “which research has suggested may prevent estrogen-driven tumors due to its effect on estrogen metabolism.”

While research has drawn attention to the protective effects of foods like dairy consumption and green vegetables, it has also revealed a heightened risk of fibroids associated with the consumption of meat products. Women whose daily diets include meats like beef and ham are – according to the research – more likely to develop fibroids than women who consume a strictly vegetarian diet.

Some research, including a 2010 study by Di and colleagues, has suggested that certain phytoestrogens found in soybeans, called isoflavones, may inhibit the growth of estrogen-dependent uterine fibroids. Contradictory evidence was produced by Radin et al, however, when they examined the soy intake of a subpopulation from the aforementioned U.S. Black Women’s Health Study and found no connection between soy consumption and uterine fibroid risk.

Fibroid growth is fueled by estrogen. Thus, in theory, any chemicals or nutrients that affect the body’s estrogen levels will impact fibroids in some way. Growth hormones in non-organic beef and phytoestrogens in soy are simple examples, but other potentially problematic substances are those that indirectly impact the body’s hormonal balance. For example, Wertheim recommends that women with fibroids watch their caffeine and alcohol intake. Both caffeine and alcohol stress the liver, which can make the liver work less effectively at metabolizing estrogen in the body. “With fibroids,” she explains, “you want to support the health of the liver by getting rid of alcohol and caffeine so it may optimally metabolize circulating estrogen.”

Finally, the role of vitamin D in affecting fibroid growth has been a subject of recent interest. A study published in a 2011 issue of Fertility and Sterility reported that vitamin D inhibits the growth of cells involved in uterine fibroid growth. The data produced by the researcher team of Sharan et al. suggested that low levels of vitamin D may be a risk factor for their developing fibroids.

Diet Modification: Does It Help?

Though certain dietary connections may seem clear, the implications of dietary modification for treating existing fibroids certainly aren’t. Bala Bhagavath, MD, an endocrinologist at the Center for Reproduction & Infertility at Women & Infants Hospital in Rhode Island, explains the limitations of the existing data in a 2012 article from Today’s Dietitian. He points out that the studies that have been conducted are all observational in nature; no interventional studies have been conducted to determine the effectiveness of diet modification as a treatment strategy. “It’s not known if modification of diet in women with established uterine fibroids will result in resolution of these tumors,” he says. “Even if they do, the length of time this dietary modification has to be maintained has to be established. It’s possible that dietary modification may decrease the incidence of fibroids in women at high risk for developing them. However, even this question of prevention remains unanswered at this time.”

Based on what we know (and don’t know!) about the fibroids-diet connection, it’s unrealistic to expect that dietary changes alone can eliminate and/or prevent fibroids. However, the knowledge that has been uncovered regarding dietary risk factors can be useful in guiding nutritional strategies that will support a broader treatment protocol. Simply understanding the impact – direct or indirect – that certain vitamins and nutrients have on fibroid growth enables women with symptomatic fibroids to make better dietary choices, avoiding foods that could worsen their condition, and possibly enhancing the effectiveness of other medical treatments as a result.

 

SOURCES:

Stewart, E. “Uterine Fibroids”, New England Journal of Medicine. 2015; 372: 1646-55

Chiaffarino et al. “Diet and uterine myomas”, Obstetrics & Gynecology. 1999; 94(3): 395-398

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

Levy, B., “Modern management of uterine fibroids”, Acta Obstetricia et Gynecologica. April 2008; 87: 812-823

Wise, et al. “A prospective study of dairy intake and risk of uterine leiomyomata”, American Journal of Epidemiology. 2010; 171(2): 221-232

 

LI-00-0479-A

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.
***
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.

LI-00-0470-A

“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/

LI-00-0450-A

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.

5_8 post

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.

 

LI-00-0451-A

How Fibroids Affect Fertility

For women of childbearing age who are diagnosed with Uterine Fibroids, a common concern is how fibroids will impact their fertility. Fortunately, the incidence of infertility occurring as a direct result of fibroids is low. While research has shown that that approximately 5-10% of infertile women have one or more fibroids, the fibroids can only be identified as the single cause of infertility in 2-3% of those cases.

When fibroids do impact a woman’s fertility, they can do so in several possible ways: namely, by impacting the movement of the egg, embryo, or sperm through the woman’s reproductive organs. As fibroids grow in size, they can change the shape of the uterus, push surrounding reproductive organs, and create blockages. Changes in the uterine muscle that are caused by an intramural fibroid can inhibit the movement or implantation of an embryo. If a fibroid blocks the fallopian tubes, it could prevent eggs from moving freely during ovulation. If its positioning results in movement of the cervix, sperm may not be able to successfully move through the cervix to reach the uterus. In any one of these scenarios, the presence of a fibroid can impact a woman’s fertility.

To some extent, the size of the fibroid can make a difference; it is known that fibroids larger than 5 centimeters are more likely to affect the success of in-vitro fertilization (IVF). In addition to creating blockages and displacement of reproductive organs, a fibroid can impair fertility by causing inflammation in the uterine wall and thereby discouraging implantation of an embryo. Moreover, the position of a fibroid could restrict blood flow to the uterine cavity where an embryo would implant.

The bottom line is fibroids can affect fertility and may decrease the chances of success for women undergoing IVF. That said, the mere presence of fibroids does not preclude a woman from becoming pregnant, and if infertility is a problem, it is unlikely that fibroids are the sole cause.

Sources:

  1. American Society for Reproductive Medicine, “Fibroids and Fertility Fact Sheet”, Resources, ReproductiveFacts.org: 2011. Retrieved March 16, 2015, from http://www.reproductivefacts.org/FACTSHEET_Fibroids_and_Fertility/
  2. “Fibroid Tumors.” [Video]. American Society for Reproductive Medicine, 21 Feb. 2012. Retrieved March 14, 2015, from https://www.youtube.com/watch?v=eSJ-ztQ97Og

LI-00-0448-A

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

LI-00-0419-A