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thicken and shed with each menstrual
cycle. But the cells that lead to fibroids
seem to be extra-responsive to hormones, and it's this overgrowth of muscle cells that causes the benign tumor
to form. "They could be caused by an
overreaction to scarring, but we aren't
100 percent sure," Zelmanovich says.
3 Fibroids aren't cancerous.
Leiomyomas are always benign. But in
some cases, a leiomyosarcoma, or cancerous tumor, may develop in the uterus.
According to the Sarcoma Foundation,
leiomyosarcoma is extremely rare, affecting only 6 in 1 million women each year.
Simply having fibroids does not increase
your risk for it-nor are you more likely
to get other gynecological cancers.
3 Symptoms may vary-or not
exist at all. Women with fibroids may
experience heavy bleeding with menstruation or bleeding between periods.
Excessive bleeding can lead to anemia,
which may be one reason for treating fibroids. Other symptoms include
constipation or frequent urination (if
the fibroid is pressing on the rectum or
bladder), painful sex and difficulty getting pregnant. "Symptoms will depend
on the size and location of the fibroid,"
Zelmanovich says.
3 African-American women are
affected more severely. The Journal
of Women's Health reports that black
women are three times more likely
than white women to develop fibroids.
They're also more likely to get them
at a younger age; the reasons why are
largely unknown.
3 If you choose treatment, there are
many options. Doctors treat fibroids
if they affect a woman's quality of life.
Most of the time, the recommendation
will be watchful waiting; your doctor can
monitor the size of the fibroid at your
annual exams, typically with a transvaginal ultrasound. If you do opt for
treatment, the method you choose will
depend on a variety of factors, like your
age, whether you want to have children
and the nature of your symptoms.

Treatment options include:
Certain hormones. Taking the hormones progestin and estrogen orally
doesn't shrink fibroids, but it can
improve the symptoms by thinning
the endometrial lining, which lessens bleeding.
Drugs to suppress hormones. Also
known by brand names like Lupron and
Synarel, gonadotropin-releasing hormone
agonists can shrink fibroids by stopping
the production of certain hormones. But
it's considered unsafe to take GnRH agonists for longer than nine months, and
the fibroids will return once the drug is
stopped. For this reason, women typically use these drugs to either shrink
tumors before having surgery or solve
the issue temporarily if they are close
to menopause.
Myomectomy. This type of surgery
removes only the fibroids but leaves
the uterus and other organs, making it
a good option for women who want to
get pregnant someday. It can be done
through a large incision in the abdomen (sometimes called "open surgery"),
laparoscopically using tiny incisions, or
through the vagina, using a thin, flexible
tube called a hysteroscope.
Embolization. This minimally invasive procedure involves injecting small
gel particles to cut off the fibroids'
blood supply. Because embolization
also might affect the uterus, it is not

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recommended for women who wish to
have a future pregnancy.
Hysterectomy. This surgery refers
to the removal of the uterus and makes
future pregnancies impossible; it can
also lead to early menopause in younger
women. "It's usually only performed
when it's the last solution available,"
Zelmanovich says. ■

Treatment for
Fibroids
Uterine fibroids occur when an abnormal growth of a smooth muscle cell in
the uterus turns into a benign tumor.
OB-GYN Travis Haldeman, DO, says
these grow more rapidly during times
of increased estrogen, primarily prior
to menopause. All women of any age
can be affected by fibroids, but AfricanAmerican women see an increased likelihood in developing this condition.
Symptoms of uterine fibroids can
include heavy abnormal bleeding as
well as pelvic pressure and pain. While
medication and surgery are the most
common treatment methods, Haldeman
suggests that "a uterine fibroid embolization is another option, mainly for women
whose primary complaint is heavy bleeding." A thermal current is used to cauterize fibroids in an attempt to dissolve
them. This procedure requires no incision and offers the patient a minimally
invasive option with generally positive
results and a short recovery time.
While varied treatment options are
available depending on a patient's condition and medical history, not all women
seek treatment. Haldeman says treatment for uterine fibroids should be considered when symptoms are interfering
with a patient's daily life.

FALL 2019

http://www.COMHS.org

Vim & Vigor - Fall 2019 - CH

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