The F Word: Fighting Fibroids
Updated: Jul 4, 2019
Our Series on Fibroids Continues...
There are various treatment methods for fibroids depending on your future goals of childbearing, how far you may be from menopause and what symptoms you are experiencing. In this post I will describe my favorite methods.
Yes, this is a birth control method, but it is also a medication to decrease heavy periods. It is my go to method to women who have heavy vaginal bleeding because it lasts for 5 years and after a year of use nearly a third of women have just spotting to no periods. This is a great method to use if you have smaller fibroids that are not causing pain or pressure, but bothersome bleeding. There are many horror stories in the news about IUDs but the key is to select a physician who has placed many Mirenas place yours. Most of the complications online about IUDs happen at insertion.
The way the Mirena IUD works is it has progesterone hormone in it and literally sits in your uterus to prevent you from building up the tissue to bleed with your menses. Your ovaries make estrogen every month to build up tissue in your uterus that makes your period tissue. I always tell my patients that progesterone and estrogen are like Crips and Bloods, they can’t be in the same place at the same time. So with the Mirena IUD's progesterone there you will not build up tissue to bleed. This is not a good method for women with submucosal of fibroids because the decrease in bleeding effect may not be as possible. However, read later to find out the easy way to remove submucosal fibroids.
Many times women come to the emergency room with heavy bleeding and the doctors give them progesterone pills to stop the bleeding urgently. Essentially, the Mirena IUD is a way to do the same but with longer effect where you will not need to take a pill daily. The Mirena IUD prevents further bleeding instead of just treating it.
This medication mimics a hormone in the brain that regulates the menstrual cycle. The name of the hormone is Gonadotropin-Releasing Hormone (GnRH) and it is released to the beat of a drum every day. This medication is a high dose of GnRH to shut off signals from the brain and put your ovaries to sleep temporarily. This shutdowns the hormones feeding your fibroids to grow and stops your period. It is a good temporary stop to bleeding. Many doctors use this for a few months prior to surgery to help you regain your blood stores and help shrink your fibroids so surgery is less complicated by bleeding. Do not be alarmed if you have heavy bleeding for a week after the initial administration of the drug. Some patients respond to the large amount of hormone by having a flare in bleeding that stops after about a week.
Uterine Artery Embolization
This is a special procedure that is not performed by a gynecologist, but a radiologist. They feed a catheter through a vessel in your thigh that travels back towards the uterus and they trap permanent silicone beads at the smallest part of the arteries feeding the fibroids. This shuts off blood flow and nutrients that allow for the growth of the fibroids, causing them to eventually shrink. This is a good method for women who are finished childbearing but do not want surgery and want to keep their uterus. About 10% of women will end up with a hysterectomy but you could be in the 90%!
Those pesky submucosal fibroids that we talked about earlier that originate in the muscle and hang into the cavity of the uterus are best managed by this minimally invasive surgery. No incisions are made on your abdomen and it is completely performed in the vagina. A small camera is placed vaginally and through the cervix into the uterus and the cavity of the uterus is filled with fluid and a light shines to see the fibroids. On the same instrument as the camera is an ability to shave down the fibroid to restore the cavity to normal. Imagine a little machine shaving these little pooching fibroids in the cavity so that it goes back to smooth.
This procedure can be performed through small incisions on the abdomen or a larger incision like a c-section scar to remove fibroids. The approach depends on how many fibroids are seen on imaging. The larger size or the larger number of fibroids will need a larger incision. Basically fibroids are liberated from the uterus and then the holes they left behind are sewn to restore the uterus to some normalcy and strength. Often after this procedure, depending on how deep the fibroids removed are, you will need a cesarean section to deliver your baby. There is an increased risk of uterine rupture during pregnancy, which is when the scar from the myomectomy opens. The chances of this are still <1%, but the concern is great enough to not allow mothers to labor.
This surgery is for women who are finished childbearing and would like definitive treatment of their fibroids. Commonly women in the community refer to it as a partial hysterectomy because while the uterus and Fallopian tubes are usually removed, the ovaries are left behind for heart and bone health. Many women are scared to lose their wombs due to concerns about sex or feeling like a woman, but this is the only way to ensure that the fibroids will not return. It is also important to note that keeping your uterus when you will not be using it for fertility leaves an organ that can turn into cancer. Endometrial cancer is the most common gynecological cancer and while it is more common in white women, black women are less likely to survive than all other women regardless of stage. Many patients who have had hysterectomies still feel great and there have been no documented changes in sex life after a hysterectomy.
I hope reviewing some of my favorite ways of treating fibroids has given you more perspective to some procedures and medications you may have heard about from your friends or your doctor. Please comment below on any questions you have or experiences you have had with any of these.