Press For Progress

For International Women’s Day, Dallas Physician is Committed to Offering Women More Options…

It’s very important for women to take charge of their own health and know exactly what is going with their bodies. However, many women suffer in silence with uterine fibroids.

Jessica Shepherd, MD, MBA, a minimally invasive gynecologic surgeon at Baylor University Medical Center at Dallas, explains that uterine fibroids (myomas or leiomyomas) are tumors within the uterus that are the most common benign tumor of the pelvis. Fibroids can be various sizes that can range from the size of a grape to the size of a cantaloupe. In addition, they are also the leading indication for hysterectomies in the USA, where roughly 600,000 of these surgeries are performed per year. According to Dr. Shepherd, “there are so many other options for fibroids that as a physician, I feel it is my responsibility to counsel women. I have met so many women in their journey with fibroids that need reassurance and also a broader discussion on what they can do.”

Uterine fibroids have been show to impact between 70% and 80% of women before the age of 50 with severe symptoms occurring up to 30% of these patients. Symptoms include heavy menstrual bleeding, pelvic pressure and pain, painful intercourse and abdominal bloating depending on size and location of each fibroid. Fibroids can also affect fertility and in women who have fertility issues due to fibroids, they need options that will preserve the uterus so they can have pregnancies in the future.

Healthcare providers are able to offer various treatment options to address the symptoms that are presented from medical therapies, to minimally invasive gynecological procedures, such as the Acessa Procedure, up to and including major surgeries. The most important part of treating fibroids is that every patient’s journey is different, and every patient is looking for different outcomes. The results of treatments can vary depending on the age of the woman, severity of symptoms, the reproductive desire of the patient and the duration of their symptoms. In light of International Women’s Day, Dr. Shepherd is committed to #pressforprogress, and offer her patients the most comprehensive treatment options available.

The Straight Truth: Hair Relaxers and Fibroids

 

The incidence of fibroids in the United States is 2-3 times higher in black women than white women, with their likelihood of developing the benign uterine tumors estimated at 80% and 70%, respectively. Researchers have spent several decades investigating this racial disparity, and they continue to seek answers, as the phenomenon has not yet been fully explained. However, certain epidemiological links have been established through the research, yielding information that could help reduce the incidence of this all-too-common condition among black women – provided they are aware of it. Hair relaxers are an example.

In the late ‘90s and early 2000s, researchers investigating the racial bias of uterine fibroids hypothesized that endocrine-disrupting chemicals in hair relaxers could impact a woman’s risk of developing the condition. They found evidence to support this hypothesis in surveys amassed by a large-scale U.S. cohort study, The Black Women’s Health Study. The surveys, collected from 59,000 premenopausal African-American participants, asked questions about the use of chemical hair straighteners, including: age of first use, frequency of use, number of scalp burns experienced, and type of formula(s) used.

Of the women surveyed in The Black Women’s Health Study, 94% reported having used hair relaxers for at least 1 year. Of all the participants, researchers observed that women who used hair relaxers were 1.17 times more likely to have uterine fibroids than those who did not use hair relaxers. Almost a third of the women who reported using hair relaxers did so on a frequent basis, at a rate of 7 or more times per year. With this group, the incidence of fibroids increased to 1.23 times that of women who do not use hair relaxers. Research determined that the womens’ age at first hair relaxer treatment and the type of relaxer they used (lye vs. no-lye) did not impact the incidence of fibroids; however, both duration of hair relaxer use and the number of burns experienced were positively correlated with the occurrence of fibroids.

Hair relaxers contain a variety of toxic chemicals: lye-based relaxers contain sodium hydroxide; “no-lye” relaxers contain calcium hydroxide and guanidine carbonate; “thio” relaxers contain thioglycolic acid salts; and almost all varieties contain endocrine-disrupting phthalates, which often appear on a label as “fragrance” or “perfume”. All types – including the “no-lye” relaxers – have been known to cause burns and lesions on the scalp (despite advertising claims to the contrary), and such injury facilitates the entry of the chemicals into the body.

Phthalates, a group of hormonally-active compounds, can be absorbed topically (through the skin) or through inhalation. Studies have shown that certain phthalates have an estrogenic effect on cells. Fibroid tumors are estrogen-dependent, so chemicals like phthalates that disrupt the body’s natural estrogen production can potentially spur the development of fibroids.

Since cosmetic products are not subject to regulation by the Food and Drug Administration, manufacturers are not required to disclose all of a product’s ingredients on the label. Thus, while endocrine-disrupting chemicals like phthalates are ubiquitous in cosmetic products, their presence may not be readily evident. There are, however, certain indicators that point to the presence of phthalates. In a 2011 study, the research team of Wise et al. noted:

Because the vast majority of hair relaxers list ‘fragrance’ as an ingredient, and 100% of popular fragrances tested in a 2002 study were found to contain phthalates, most hair relaxers likely contain these chemicals. In addition, some hair relaxer products directly list phthalates as one of their chemical ingredients. (Wise et al. 2012)

Of course, phthalates are not the only endocrine-disrupting substance that black women – or consumers, in general – encounter on the day-to-day: chemicals known for their reproductive toxicity appear in products all around us, and without knowledge of their presence, consumers will continue to be subjected to the detrimental effects of those chemicals.

That said, the link between hair relaxers and increased fibroid risk is a significant discovery, both because it could partially explain the racial bias of uterine fibroids and because it serves as actionable information that enables women to moderate their exposure to the toxins that could contribute to the growth of fibroids. With this knowledge, women can make an informed decision about whether the potential cost of hair straightening treatments simply outweighs the beauty benefits.

 

>> SEE ALSO:  What Causes Fibroids: The Known Risk Factors

 

SOURCES:

Wise, L. et al. “Hair Relaxer Use and Risk of Uterine Leiomyomata”, American Journal of Epidemiology. 2012; 175(5):432-440

“New Study Finds Exposure to Toxic Phthalates in Decline; Consumer Demand for Safe Cosmetics a Factor”, Campaign for Safe Cosmetics, Jan 15, 2014 . Online. http://www.safecosmetics.org/about-us/media/press-releases/new-study-finds-exposure-to-toxic-phthalates-in-decline-consumer-demand-for-safe-cosmetics-a-factor/#sthash.YhCKOLu2.dpuf

 

 

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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

 

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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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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

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Fibroids and Cancer | The Cancer Risks of Fibroids in the Uterus

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Do Fibroids in the Uterus Increase Cancer Risks?

The word ‘tumor’ evokes feelings of fear largely because it is commonly associated with cancer. However, the majority of tumors are benign and unlikely to spread by metastases. This does not render them harmless, with some growths causing symptoms that are severe enough to warrant surgery.

Fibroids in uterus are muscular growths that form on the wall of the uterus or in the abdominal and endometrial cavities. When benign, they often cause heavy bleeding, abdominal enlargement, pain in the lower back, pelvic area and during periods and frequent urination. Many sufferers don’t experience any symptoms at all. In contrast, cancerous uterine fibroids grow quickly and can cause vaginal bleeding in postmenopausal women, but even benign fibroids can grow at a rapid pace.

The Difference Between Cause and Correlation

In the past, studies have shown that there is no link between fibroids in uterus and cancer, but recent studies have revealed that women who are at increased risk of fibroids are also at increased risk of uterine cancer. This research has been misconstrued to mean that there is a causal link between the two, whereas it only reveals the already-known fact that postmenopausal women between the ages of 50 and 60 are more likely to suffer both from benign fibroids and uterine cancer.

As of yet, there are still no studies that can directly and causally link benign uterine fibroids to cancer. In essence, correlation is not the same as causation. The statistics reveal the rarity of cancerous fibroids, with only 1 in 1000 cases of uterine fibroids being malignant.

Dramatic Treatments

The presence of fibroids is cause for concern, given that there are overlapping symptoms for benign and malignant growths. Doctors use biopsies, pelvic exams, blood tests and MRIs to diagnose whether the growths are malignant or benign. Uterine fibroids can be extremely debilitating. 35 percent of premenopausal women with uterine fibroids find that their condition interferes with their lifestyles and ability to work. One of the most drastic cures and one that was commonly used until recently is a complete hysterectomy in cases where less invasive procedures were ineffective. This left those who had not yet reached menopause with infertility and early hormonal changes that produced their own disruptive symptoms.

Common Problems with Uncommon Solutions

Despite the fact that 20 percent of premenopausal women and 80 percent of postmenopausal women have benign fibroids, effective treatments have been notoriously evasive. Apart from the dramatic solution of hysterectomy, treatments include hormone replacement therapy, which comes with its own symptoms, myomectomy and endometrial ablation. The latter two surgical options involve the removal of the fibroids themselves or removing the uterus lining respectively. Both can render the sufferer infertile.

It is also possible to cut blood flow from the uterus to force growths to shrink. Whether this nonsurgical procedure leads to infertility remains unknown. However, it can come with rare complications such as premature menopause, the formation of scar tissue and the discontinuation of menstruation. For patients with minor symptoms, medications such as non-steroidal anti-inflammatories and birth control pills can help to relieve symptoms.

Many patients seeking to avoid the drastic medical options available to them have sought help through alternative therapies that hold little proven benefit. Nutritional changes target symptoms indirectly by preventing bloating that might make uterine pain worse. Attempts to change hormonal balance through dietary changes do not make room for patients who are not overweight or who are suffering from imbalances caused by stress. Herbal formulations remain unstandardized without the control and research of guided FDA regulations and trials.

In 2012, the FDA approved a non-invasive procedure that treats benign fibroids. Acessa is a laparoscopic procedure that negates the need for harsh surgeries while removing only the fibroids rather than the tissue surrounding them. Radiofrequency energy is used to target only the tissue causing symptoms, offering a workable same-day solution that is as effective as it is safe.

Looking For More Information on Treating Fibroids?

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 Physician Finder 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://obgyn.ucla.edu/body.cfm?id=289
  2. http://www.cancer.gov/cancertopics/wyntk/uterus.pdf
  3. http://www.nichd.nih.gov/health/topics/uterine/conditioninfo/faqs/Pages/Do-fibroids-lead-to-cancer.aspx
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