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    Uterine Fibroids – Part 2

    by Ngozi Osuagwu, MD | April 14th, 2024

    Uterine Fibroids – Part 2

    There are so many questions when it comes to uterine fibroids. Last week, we talked about fibroids and how the diagnosis is made.  This week, we will add to the discussion.

    Will the fibroids turn into cancer? Fibroids are benign. They are not cancer. There is a cancer called leiomyosarcoma. It looks like fibroids.  It is a rare cancer. Women at risk for this type of cancer are usually older, have had pelvic radiation therapy in the past, have been on the medication Tamoxifen or have a rare genetic condition. Majority of fibroids are not cancer. Usually  an MRI will have features suggestive of this cancer. Also, taking a tissue sample from the uterus through an endometrial biopsy may help make the diagnosis. Typically before any major surgery for very large fibroids, the doctor will order an MRI and/or get a tissue biopsy to make sure there is no cancer.

    What are the treatments for fibroids?  I once read in a New York Times article – “diagnosing fibroids is simple, deciding what to do is hard”. The management of uterine fibroids will depend on your age, your reproductive plans (whether or not you want children), your symptoms, your long term goals, and the size, the number and location of the fibroids within the uterus.

    What is important when making a decision is that to remember it is a shared decision. Ask questions. Remember, you can always get a second opinion. You are always allowed to change your mind.

    The options include the following:

    Doing nothing– Yes, this is an option especially if you are not having any symptoms.  Now when I say nothing, I mean none of the medical or surgical interventions that I will list. Next week, we will talk about a holistic approach to managing fibroids even without symptoms.

    Non-steroidal anti-inflammatory agents (NSAIDs) – An example would be Ibuprofen. Ibuprofen can help with the pain and can even help with the bleeding if taken at the onset of the menstrual cycle. This will not do anything for the bulk like symptoms you may have.

    Tranexamic acid – The trade name is Lysteda. This medication helps with heavy menstrual flow that is associated with uterine fibroids. It works by affecting the substance in the blood that deals with clotting. Tranexamic acid comes in 650 mg tablet. You would take two tablets three times a day on the onset of the heavy bleeding. You should not take it longer than 5 days each month.

    Hormonal intervention – any of the contraceptives that contain hormones may be helpful especially with the heavy menstrual flow. They can be helpful with pain management. The most commonly used are birth control pills or the levonorgestrel releasing IUD.

    Gonadotropin-releasing hormone (GNRH) agonist – This medicine shuts down the ovaries so that you do not produce estrogen that is thought to feed the fibroid. This will cause the fibroids to get smaller while you are on the medication. Once you stop the medication, the fibroids will grow back. The reason we cannot use this medication more than 6 months is because it can cause your bones to be fragile. Typically this medicine is used for women who are close to menopause or in women ready to have surgery and need their fibroids smaller or women who are anemic (low blood count) and need to increase their blood count. This medication is given intramuscularly.

    Gonadotropin-releasing hormone (GNRH) antagonist – This is new since 2017. This medicine shuts downs the hormones released from the brain and ovaries. This medication is given in pill form. When prescribed, it is prescribed in combination with the hormones that you find in birth control. This helps prevent the menopausal symptoms, you may have. It is a medication you can take up to two years. This medication is primarily used to help with the heavy bleeding, however studies have shown that it may also be helpful for relieving the pelvic pressure due to the size.

    Endometrial ablation – this can help with heavy menstrual flow, however you may need to remove the fibroid that is in the inside of the uterus that is affecting the lining of the uterus. You should only get this procedure when you have decided not to have any more children.

    Uterine artery embolization – this is where we use a material to block blood flow going to the uterus. Not recommended if you want to be able to have children in the future. This procedure is done by the radiologist. You will need an MRI before the procedure to see if you are a candidate.

    MRI-guided focused ultrasound Surgery (MRgFUS) – Uses ultrasound technology to burn the fibroids. This is done by the radiologist. You will need an MRI before the procedure to see if you are a candidate.

    Radiofrequency Ablation – Done in the operating room through little incisions made on your abdomen to burn the fibroids.

    Myomectomy – This is surgery where we remove the fibroids. You will still have your uterus. You can still have children. There are various approaches to a myomectomy and it is dependent on where the fibroid is located. You can have a myomectomy through hysteroscopy where no cuts are made on your belly. This is done if the fibroid that is causing most of your symptoms is located in the cavity of the uterus. This type of fibroid is called submucosal fibroid. A myomectomy can also be done laparoscopically, robotically or by making a large incision on your abdomen. There is a chance years after your initial surgery, new fibroids will form and you may need this type of surgery again. If your desire is to have children, you may need to wait for at least 6 months after a myomectomy depending on how extensive the surgery was.

    Hysterectomy – This is removal of the uterus. This is the most effective treatment for uterine fibroids. You will not have to worry about the fibroids again. Please remember a hysterectomy does not cause you to go into menopause. Click here for the blog titled, Gynecology 101: Does a Hysterectomy Cause you to go into Menopause. Once the hysterectomy is performed, you will not be able to carry a pregnancy. If you decide to proceed with a hysterectomy, have your physician take out your tubes. We now know the tubes are the origins of ovarian cancer. You no longer need your fallopian tubes if you are having a hysterectomy.

    If you did not have a chance to read last week’s blog, please click – Uterine Fibroids – Revisited.

    4 Responses to “Uterine Fibroids – Part 2”

    1. Dayna L Hale says:

      Good info!

    2. Linda K. Jackson says:

      Very valuable information. Looking forward to next week’s info, because I’ve read where sometimes diet can impact fibroids.

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    With her trademark wit and straightforward communication, Dr. Osuagwu continues to dole out valuable medical advice using the letter form and addressing women’s health conditions and issues in a method that was praised for its innovative approach in her earlier award-winning book, Letters to My Sisters: Plain Truths and Straightforward Advice from a Gynecologist. In this book, each letter is paired with reference sources and statistics about the condition that is the subject of the letter.

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    Secure Your Copy of Letters to My Sisters by Dr. Ngozi Osuagwu.
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    The book discusses common gynecological and women’s health issues in a series of witty and entertaining letters. These letters, all educational, offer suggestions on what approaches to take in tackling the medical problems that typically bring women to an ob/gynecologist. The letters are spiced with art, a poem and quotes. Although its emphasis is on gynecology and women’s health, it touches on some other medical issues that make women visit their doctors.

    The second half of the book briefly discusses the most common gynecological conditions and also provides an overview of sexually transmitted infections. A list of annotated websites dealing with the different topics in the book is provided for the reader who wants to pursue each subject in depth.




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