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Let's Talk About Fibroids

Location! These pictures are all of the round muscle knots called uterine fibroids. Usually your physician can feel the fibroids, that are either on the outside of the uterus or ones that make your uterus large, on a pelvic examination. Not every fibroid is appreciated on pelvic exam.

Heavy Menstrual Bleeding!

Heavy periods from fibroids do need treatment, especially if you are anemic. However, every fibroid will need treatment, and we wonder should hysterectomies be done for heavy uterine bleeding with fibroids?

Medications: Most gynos say most often no a uterine fibroid will not necessarily require surgery, definitely not initially. There are other things to try. And many women haven’t even heard of some of their alternatives for the treatment of these uterine muscle tumors, and there are new ones being developed.

Surgery: Uterine fibroids are the most common gynecologic tumor. And with over 500,000 hysterectomies being done in the USA each year for bleeding, we can actually save a lot of uteri and avoid complications with fewer days out of one’s life if alternatives are evaluated for the treatment of fibroids. Exactly what should be done is based on : How big: grapefruit size lumps on the normal egg sized uterus, that’s large. The location of the fibroid: under the lining they bleed a bit more, poking at your bladder you pee a bit more, and deep in the pelvic area there can be pressure on upper legs, back or with bowel movements. How much bleeding? Well, good question there too: if you are anemic and cannot keep up then yes, it’s too much. More kids planned? Absolutely you need to keep your uterus in working order. So what to be done? Think about medications, myomectomies and an effective treatment for bleeding that might not change the fibroid size itself is a uterine ablation.

Actually post menopause, eventually, the fibroids may shrink and become unnecessary to treat. Oral contraceptives and DepoProvera can control uterine bleeding, but they won't necessarily affect the fibroids themselves. Luprolide (Lupron) injections can shrink fibroids, and stop bleeding, but the shrinkage may not last indefinitely. The newest medication that has been studied, but is not approved in the US for use with fibroids is, ulipristal acetate selective progesterone receptor modulator, was evaluated for treatment of fibroids an it was found to both work about as well as the lupron, and to help control heavy periods. A new medication, Orilissa, approved in the summer of 2018 for endometriosis is being tested for effectiveness of uterine fibroids. e

For some women they got some shrink in the size of the fibroid, but at least in one early study the shrink of the overall size of the fibroid was less with the ulipristal acetate than with the luprolide (Lupron). Another option for controlling the bleding would be the medication tranexamic acid (Lysteda) which is both not a hormone nor a daily medication and often will work with just 1-3 days of use per cycle. So when you are told you have uterine fibroids, be sure to look into your alternatives.

Uterine fibroids are responsible for a large percentage of gynecologic surgeries and hysterectomy, and yet so far few treatments are available to cure them. No scientist or medical research has established what causes the presence or growth of fibroids, but we think that they are linked to longer female hormone exposure (early menarche, late menopause, and high estrogen states such as not ovulating regularly) is a known risk factor, as are race and hereditary. In one of the newest studies of fibroids Dr. Borahay at the University of Texas Medical Branch in Galveston investigated the effects of statin medications on uterine fibroids. 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors, also known as statins, are the most effective class of drugs for lowering serum low-density lipoprotein cholesterol and thus preventing cardiovascular disease. In this study almost 50,000 women with fibroids were compared to almost 150,000 women who did not have them. They then looked at statin medication use over the past two years and found that statins were actually somewhat protective with regards to uterine fibroids. Simvastatin was the most common statin used. In the women who used statins, but had uterine fibroids, they had less bleeding, less pain, fewer myomectomies, and actually less anemia that non-users of statins. Interestingly the rates of hysterectomy were about the same whether the patient used statins or not, in which case we may be seeing such a mild effect it wasn't enough to prevent the cases requiring major surgery. It's unclear what the reasons for the effects of these medications, it's possible there is a direct effect, it is possible it is a secondary effect of improving pelvic circulation. And if you are on the fence about using statin medication, perhaps you should weigh in any fibroids you may have been diagnosed with.

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