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CBS Baltimore: Northwest Hospital Offering Innovative Treatment To Eliminate Fibroids

BALTIMORE (WJZ) — Doctors at Northwest Hospital in Baltimore are offering an innovative approach to get rid of fibroids.

It’s called acessa and many patients said it has changed their lives.

Fibroids are benign tumors in the uterus which can cause extreme pain and be very dangerous for women.

Dr. Dee Shiller decided to explore acessa to find a newer and less invasive approach. During the procedure, a doctor inserts a needle and uses heat to destroy each fibroid.

“This procedure is kind of melting the matrix of the fibroids,” she said. “There’s a lot less pain and they recover so quickly.”

Karen Fuller-Hardy reached a breaking point last summer after dealing with the pain of fibroids.

“I was bent over, excruciating pain, crying in tears,” Fuller-Hardy said. “It was pretty bad.”

Shiller is the first and only doctor in Maryland to perform acessa at Northwest Hospital, including on Fuller-Hardy.

Fuller-Hardy said it’s made an amazing difference in her life and took away the pain.

“I should have done this years ago,” Fuller-Hardy said. “I want women to know there’s other options besides going the full level of getting a hysterectomy.”

To see the full article and video interview click here.

The Houston Chronicle: A Struggle with Fibroids

“With Acessa, I can do a procedure on a Friday and by Monday, the patient is ready to go back to work,” Patolia said.

[Radiofrequency ablation] has been around for a while, but previously it was primarily used in medical procedures for the liver, prostate, pain and even varicose vein removal.

“For treatment of fibroids, it’s just gaining ground,” she said. “Anyone who has symptoms of fibroids is a candidate.”

For Finkeldey, a quick recovery would help her get back to her business as soon as possible.

“Because of what I do, I leaned toward Acessa,” she said. “It just made more sense.”

Finkeldey’s surgery was on Wednesday, Oct. 16; and she returned to work the following Monday. “I felt human again,” she said.

For the full article click here

AAGL Patient Info Sheet of Laparoscopic Radiofrequency Ablation of Fibroids (Acessa)

At the 2019 AAGL (American Association of Gynecologic Laparoscopists) Global Congress on MIGS (Minimally Invasive Gynecological Surgery) a new patient information sheet was released on the Acessa Procedure, also known as Laparoscopic Radiofrequency Ablation. This is a great step forward in updating the standard of care for women suffering from symptomatic uterine fibroids.

 Click here for the Patient Info Sheet of Lap-RFA (Acessa) by AAGL. 

 

Six-Signs-You-Might-Have-Fibroids

Six Signs You Might Have Fibroids

Unfortunately, it is normal for women to suffer through their monthly menstrual cycles for years before
learning their pain and other symptoms were caused by fibroids. Fibroids are a common condition, but
they aren’t commonly talked about. Some common signs of fibroids are:

1. My periods are so heavy.

The most common symptom caused by fibroids is heavy periods that:
– Last longer than seven days
– Cause women to soak through tampons or pads faster than one every hour for several hours
in a row.
Women with heavy periods often say, “I didn’t know my periods were not normal, because they were
normal for me.” By the time a woman is 40, they’ve likely had their period for 25 years, that’s a
long time to get used to dealing with heavy periods.
Often, women with fibroids report that they have “always had a heavier period”, but when they got
older, it got heavier and heavier. Unplanned spotting or bleeding between periods are also
common with fibroids. Some women report that they bleed for weeks and weeks in a row.

2. I’m so tired.

When women have heavy periods due to fibroids, they can feel physically weak because they lose too
much blood during their period, causing anemia and tiredness. Women may also feel
lightheaded and dizzy. In the worst cases, some women need blood transfusions because of the
blood loss.

3. I look pregnant, but I’m not!

Fibroids can also cause “bulkiness” or swelling in the abdomen. Bulk symptoms mean the fibroids are
large enough that the uterus is causing the stomach to extend outward. When women
experience bulk symptoms from fibroids, they often feel forced to wear loose clothing to avoid
uncomfortable questions about looking pregnant. Feeling insecure is common.

4. I’m in pain.

Fibroids can hurt when they are large and put pressure on other organs. This can mean back pain, leg
pain, rib cage pain and pain in other areas. Sometimes women feel constant pain, sometimes it
comes and goes. Fibroids may also be present with other painful gynecologic conditions such as
endometriosis or polycystic ovarian syndrome (PCOS).
One thing that may be embarrassing to talk about but is common in many women with fibroids is pain
during sex, especially when fibroids are located near the cervix. Fibroids can cause general
uncomfortable sensations, pangs and tenderness. Pain during sex can also lead to disruption in
social and relationships. Women who experience pain during sex due to fibroids also report
feeling alone, embarrassed and self-conscious.

5. I have to go to the bathroom all the time.

Frequent urination can occur when fibroids put pressure on the bladder. Sometimes women with
fibroids notice they can’t finish a TV show, or get through their workout without needing to go
to the bathroom. Some women also experience difficulty urinating and constipation.

6. I plan my life around my period.

Women with fibroids often find themselves planning their lives around their period. Whether it’s
because they have heavy flows, painful or long periods, long periods or a combination, they
dread their cycle.

Do any of these situations sound like what you are experiencing? We want to hear your stories! Contact
us at info@acessahealth.com

Sources:
Interviews with women dealing with fibroids (names redacted for privacy). Elaine Horton. 2018-2019

Signs and Symptoms of Uterine Fibroids

Signs and Symptoms of Uterine Fibroids

Over 35 million women in the United States currently suffer from uterine fibroids, noncancerous growths of the uterus. Women who do have uterine fibroids (also called leiomyomas or myomas) often find fibroids difficult to live with, as they cause many symptoms related to pain and heavy menstrual bleeding. Over 25 percent of women will experience significant symptoms and suffering as a result of their fibroids. At Acessa Health, we developed and offer the Acessa Procedure with the Acessa ProVu system as a way to treat uterine fibroids as a minimally-invasive option that spares a woman’s uterus. Before you talk to your doctor and figure out which fibroids treatment option is best for you, it’s best to learn exactly what might be happening to your body because of fibroids. At Acessa Health, we want to arm you with knowledge about uterine fibroids and symptoms and signs of uterine fibroids. There are a lot of wonderful overviews about uterine fibroids we’d recommend to get a broad idea about what they mean for everyone, but we also want to start considering what they mean for your body.

When determining your best course of action for uterine fibroids, determine the presence of fibroids is the obvious first step. While fibroids are common, many won’t experience symptoms immediately or severe enough to even know they exist. Many women will think one of the many symptoms they experience are unrelated to fibroids, especially some of the less severe (but not life-altering) ones. There are many kinds of symptoms which are caused by the many different ways your body experiences fibroids. Fibroids come in various sizes and shapes and can be found in various places inside and around the uterus. The most common are submucosal (attached to the inner part of the uterus), subserosal (pushing out from uterus, often onto the bladder) and intramural (in the uterine wall) fibroids. Some women will also have a type of subserosal fibroid called pedunculated fibroids that attaches to the uterus with a stem.

Uterine fibroids vary within the body and over time. While some may shrink, others enlarge and change in size and density sporadically, causing even more pain. Even if fibroids go away on their own or are surgically removed via myomectomy, they often return in the uterus and can even multiply.

While most fibroids are benign, noncancerous growths, that does not mean they are without symptoms, many of which are persistent and painful. Symptoms can run from bulges and lumps in your abdomen to frequent urination and constipation to long, heavy periods and constant pelvic pain. These symptoms can be frustrating, exhausting, painful, and life-altering. Every woman deserves to be without any uterine fibroids and their debilitating symptoms.

With all the possibilities of what fibroids can do to your body and their effect on organs, hormones, and regular, we want to present the most common symptoms for uterine fibroids.

Uterine Fibroids Symptoms

  • Heavy menstrual bleeding
  • Periods lasting more than a week
  • Regular spotting between periods
  • Constant pelvic pressure or pain
  • Frequent urge to urinate
  • Difficulty urinating
  • Constipation
  • Back and leg pain
  • Painful intercourse
  • Bulges or lumps in the lower abdomen
  •  Heavy menstrual bleeding

This is often the first sign of uterine fibroids. As the fibroids grow, they affect the uterine wall and cause heavy bleeding. Blockages and obstruction can also cause bleeding to be thicker or heavier than usual.

  •  Periods lasting more than a week

Likely caused by estrogen and progesterone, hormones connected to the uterus that may affect fibroid growth, fibroids will cause your period to last much longer than other women without fibroids, often lasting ten days or more. This is usually not a one-off experience; women have known their periods to last longer indefinitely, until fibroids are properly treated. Longer lasting periods can also cause anemia, or an iron deficiency, and cause lightheadedness and fatigue.

  •  Regular spotting between periods

As fibroids cause increased uterine bleeding during your periods, the same changes to the uterine wall cause sporadic and unplanned spotting at random times.

  •  Frequent urge to urinate

Uterine fibroids, especially subserosal fibroids attached to the outside of the uterus, will push against other organs and body parts as they expand to fill the space inside your body. One of those organs closest to your uterus is your bladder. This pushing on the bladder causes an urge and need to urinate much more frequently than women without symptomatic uterine fibroids.

  •  Difficulty urinating

While you might need to urinate more frequently, fibroids can often contract and pinch the bladder, making it harder to actually urinate once you feel the urge to go.

  •  Constipation

Similarly, growing fibroids in certain locations can also push against your rectum and cause issues with regular and painful constipation.

  •  Back and leg pain

Beyond general pain and cramping that comes along with your period, fibroids can also create unrelated soreness and aches along your lower back and down into your legs. While this can sometimes be the result of fibroids pushing against your spine, it can also be a sign that a fibroid might be dying on its inside (though still growing outwardly).

  •  Painful intercourse

Uterine pressure caused by growth of the fibroids can cause general uncomfortable sensations, pangs, and tenderness during sex, while growth near or in the cervix can lead to sharper pain and additional bleeding.

  •  Bulges or lumps in the lower abdomen

Often the most outwardly noticeable symptom of fibroids, especially larger and multiple fibroids is the bulking of the lower abdomen, usually right above the pelvic bone. This is caused by growth inside and outside of the uterus.

Risks and Factors of Uterine Fibroids

Research shows that 70 to 80 percent of women will develop uterine fibroids before the age of 50. While knowing the symptoms is helpful to diagnose and treat your fibroids, the below factors will often affect your risk for developing them or the severity of your symptoms:

  • Age

Fibroids become more common as women age, especially during the 30s and 40s and throughout menopause. After menopause, fibroids tend to shrink.

  • Puberty

Women who hit puberty and have their first period before ten years old have been shown to have a greater chance of developing fibroids over their life.

  • Family Genetics

A woman who has a mother who experienced fibroids is almost three times more likely to have uterine fibroids herself. Other family histories of fibroids can show a genetic proclivity towards your likelihood as well.

  • Race and Ethnicity

African-American women are three times more likely to develop fibroids than women of other races. Hispanic women have shown lower rates and propensity towards uterine fibroids when compared to other races.

  • Obesity

Weight affects the risk for fibroids, with research showing that overweight women are at higher risk for fibroids. For women with very high BMIs that extend into the “obese” range, the risk can be three times as high as other women.

Symptoms Quiz

While each and every one of these uterine fibroid symptoms by themselves could be explained by a number of different issues, having more than one could likely mean you need to discuss treatment with your doctor. Exploring all the symptoms to uterine fibroids can be helpful in knowing what might be happening to your body.. At Acessa Health, we want to help you understand your risk and options, so we want to offer our own Uterine Fibroids Symptoms Quiz.

https://acessaprocedure.com/patient-tools/#symptoms-quiz

After reading this blog, you might be asking “I have to urinate more often. Does that mean I have fibroids?” While you may, fibroids are often expressed in a constellation of symptoms and experiences. We hope our quiz can help you explore what your next steps are, even if you’ve already been diagnosed with uterine fibroids.  The Acessa Procedure is a quick, proven, and minimally-invasive fibroid treatment option that will spare your uterus, unlike a hysterectomy.

The Acessa Procedure | Treatment for Your Uterine FIbroids

Your uterine fibroid symptoms may vary and as such might require a wide array of treatment options. We’ve put together dozens of scientific papers and helped publish research about uterine fibroids treatment out there and the efficacy of what’s available. For some, medication can shrink fibroids and provide enough relief of pain and frustration. Some doctors will recommend myomectomy, uterine artery embolization (UAE), partial hysterectomy, or hysterectomy as more aggressive ways to treat fibroids, though recent studies have demonstrated that women with fibroids are up to six times more likely to undergo an unnecessary hysterectomy. Research is showing that uterus-conserving treatment is on the rise as more and better options are available.

For that reason, the Acessa Procedure offers women with uterine fibroids symptoms a minimally invasive, outpatient treatment for most types and sizes of fibroids. It uses laparoscopic radiofrequency ablation to destroy fibroids by applying controlled energy through a small needle array. The destroyed fibroid tissue will then be reabsorbed without harming the surrounding healthy uterine tissue.

No matter your symptoms and severity, it’s best to educate yourself when you have fibroids with all the treatment options available. Plan a visit with the Acessa physician nearest you right now to learn more about your symptoms, treatment options and what you can do next to say ”Goodbye fibroids!”

Phone: 866-402-6357

Signs and Symptoms of Uterine Fibroids

5/5 stars

My grandmother knew something was wrong. My mom went through the same thing and ended up having a hysterectomy. I was only 29 when I was diagnosed and hysterectomy was not an option I wanted to consider. First, I tried major surgery instead. Not only was it painful and the recovery time was long, but the fibroids grew back. So the next time around, I got the Acessa Procedure for fibroids. I was back on my feet in a matter of days after my Acessa procedure with Dr. Jessica Shepherd, and have never felt better. I have the best period of my life, it only lasts 5 days! The Acessa Procedure was life-changing for me.

Chanel H.

Signs and Symptoms of Uterine Fibroids

Rated 4.7/5 based on 4 reviews

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.

 

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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.

 

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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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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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