Fibroids
Guest
: Gloria Richard-Davis, MD
From the Show: University of Arkansas for Medical Sciences
Fibroids are benign growths in uterine tissue. Dr. Gloria Richard-Davis, Director of Reproductive Endocrinology and Infertility at UAMS, discusses symptoms of fibroids and what to expect if you have fibroids.
Transcription:
Melanie Cole (Host): Uterine fibroids can cause a number of symptoms depending on their size, location within the uterus and really if you are a woman that’s been told you have fibroids; there are so many questions that you may have for your provider. My guest is Dr. Gloria Richard-Davis. She’s the Director of Reproductive Endocrinology and Infertility at the University of Arkansas for Medical Sciences. This is UAMS Health Talk. I’m Melanie Cole. Dr. Richard-Davis, I’m so glad to have you joining us today. What do we know about fibroids? What are they?
Gloria Richard-Davis, MD (Guest): Fibroids really refers to a benign growth of the muscular and fibrous tissue in the wall of the uterus. Very common. When we look at – we don’t really know what the exact incidence is but within the literature, you’ll see reported incidences of 40 to 80% of women experience fibroids. So, very, very common. Much more common in African Americans. We know that there is some genetic predisposition to it. And when we talk about what stimulates the growth, which is like the Nobel Prize question that every patient wants to ask; what causes it. We don’t really know what causes the initiation of the growth. We do know that, that tissue is very estrogen and progesterone sensitive and so, it responds and overgrows in response to those two hormones in particular and other growth factors.
Host: Well I’m glad you answered that because I was going to ask you how or why do they develop but since we really don’t know, tell us about the symptoms that we might notice, something that would send us to our doctor to get the pelvic ultrasound to see if we have fibroids.
Dr. Richard-Davis: The most common symptom is generally heavy menstrual bleeding and for some women, they have heavy menstrual bleeding and they think it’s normal. But if you have bleeding to the extent that you’re becoming anemic; that is certainly not normal. So, at that point, you really should seek evaluation and subsequent treatment. Other symptoms would really be – the fibroid is a space occupying lesion so it sits in the pelvic area and if you think about the bladder being in front of the uterus; that uterus sitting on top of the bladder applying pressure, you may have urinary frequency. You may be getting up at night to use the bathroom because your bladder can’t expand the way that it should. You can sometimes get constipation for the same reason. You have pressure on the rectum so stool is not passing as readily as it should. And those are probably the most common symptoms.
From time to time, women will say that they have pain from their fibroids. That’s not always very common. The pain is usually from when the fibroid sort of grows very rapidly and it outstrips blood supply, so parts of it starts to die off. That’s usually what causes the pain.
Host: So interesting. So, first of all, a lot of women have the question Doctor, do they turn into cancer like some colon polyps might? And if not, is treatment always necessary? Why would you treat them?
Dr. Richard-Davis: Fibroids are 99% benign. It is not something that we worry about becoming cancerous. In terms of when to treat, or do we treat; a lot depends on the patient’s symptoms. We talk about conservative management or expectant management. If you have small fibroids and they are not creating any symptoms; then there is no reason to remove them with a few exceptions. Obviously, being a fertility specialist; I have to point to the fibroids that you mentioned earlier. There are multiple areas that they can be located. So, the one that is in the wall of the uterus, if it does not disturb the endometrial cavity; then it doesn’t affect fertility. If they are submucosal; it affects fertility. So, anything that disturbs the endometrial cavity related to fibroids needs to be addressed for pregnancy. Otherwise, the decision as to whether or not to intervene really depends on all the other symptoms that the patient may be having.
Host: Then what are some treatment options that you might offer a woman who is having symptoms or who it might affect their fertility?
Dr. Richard-Davis: So, first we talk about where is this woman in her reproductive life. Is she done with childbearing or is childbearing in front of her? Right. And if childbearing is in front of her then we are talking about uterine sparing options. Those would include everything from myomectomy which can be done laparoscopically, abdominally or hysteroscopically depending on where the fibroids are, the size an dhow many there are.
There are nonsurgical options and I make the distinction because the nonsurgical options to date, have not really been approved for women who plan future pregnancies. And those would be things like uterine artery embolization. There is an ultrasound treatment for fibroids it is MRI focused ultrasound. There’s also cryo that one can use to treat the fibroids. But because those particular procedures basically causes degeneration of the fibroids; they possibly weaken the wall of the uterus and so we don’t want someone planning future pregnancy having those done. It doesn’t prevent pregnancy either, so you can end up pregnant after having any of those procedures done. But it’s not advisable.
Host: Do fibroids sometimes cause heavy bleeding, and then would that be another reason for treatment? What would you do in that case?
Dr. Richard-Davis: If a patient is having bleeding heavy enough to be a concern for her; and the typical patient comes in and they’ll say I have to have basically sanitary pads at home, at work, in my trunk, you name it to try and prevent from soiling my clothes. Or that they have been anemic, they are iron, some women have even been transfused and still don’t recognize the importance of addressing fibroids. Heavy bleeding to the extent that it is creating a problem for you does warrant intervention and of course the options are the same depending on childbearing.
There’s one other thing I would mention and I’m very hopeful that in the future, we will have some medical options for fibroids. We have a number of clinical trials that are ongoing now looking at progesterone receptor modulator drugs that may be able to be used to prevent future growth of fibroids and shrinkage of fibroids that are present. Our current medical options like Lupron or GRNH agonist is not something that we can continue to leave patients on because they will cause osteoporosis if it’s used long-term. It drops the estrogen and puts women at risk for osteoporosis. So, it’s not a long-term management medical option. But hopefully in the future, we will have some of those options approved.
Host: That’s so interesting. Doctor, wrap it up for us, your best advice for women who might be experiencing some of the symptoms you’ve discussed, when they should see their provider and really what you’d like them to know about uterine fibroids.
Dr. Richard-Davis: One is women who are experiencing any heavy bleeding, pelvic pressure, the typical symptoms that we talked about should seek evaluation. In that process, know what your options are going into your appointment. Because I’ve had many women who have come in and said once they were diagnosed with fibroids; the only thing that they were ever offered is a hysterectomy. And they don’t want a hysterectomy. That’s what keeps a lot of women from seeking treatment or intervention. There are non-hysterectomy options, you just have to find the right physician. So, if your physician is saying hysterectomy only; look for another physician if that’s not the option that you want to exercise. So be proactive in the process. There are lots of physicians out here who are very well versed in how to treat and manage uterine fibroids.
Host: Being proactive. Great advice. We have to be our own best health advocate. Thank you so much Dr. Richard-Davis for giving such great information and sharing your expertise today. And that wraps up this episode of UAMS Health Talk from the University of Arkansas for Medical Sciences. You can head on over to our website at www.uamshealth.com for more information and to get connected with one of our providers. If you found this podcast as interesting and informative as I did, please share on your social media, share with other women you know that way we can learn from the experts at UAMS together. And be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.
Melanie Cole (Host): Uterine fibroids can cause a number of symptoms depending on their size, location within the uterus and really if you are a woman that’s been told you have fibroids; there are so many questions that you may have for your provider. My guest is Dr. Gloria Richard-Davis. She’s the Director of Reproductive Endocrinology and Infertility at the University of Arkansas for Medical Sciences. This is UAMS Health Talk. I’m Melanie Cole. Dr. Richard-Davis, I’m so glad to have you joining us today. What do we know about fibroids? What are they?
Gloria Richard-Davis, MD (Guest): Fibroids really refers to a benign growth of the muscular and fibrous tissue in the wall of the uterus. Very common. When we look at – we don’t really know what the exact incidence is but within the literature, you’ll see reported incidences of 40 to 80% of women experience fibroids. So, very, very common. Much more common in African Americans. We know that there is some genetic predisposition to it. And when we talk about what stimulates the growth, which is like the Nobel Prize question that every patient wants to ask; what causes it. We don’t really know what causes the initiation of the growth. We do know that, that tissue is very estrogen and progesterone sensitive and so, it responds and overgrows in response to those two hormones in particular and other growth factors.
Host: Well I’m glad you answered that because I was going to ask you how or why do they develop but since we really don’t know, tell us about the symptoms that we might notice, something that would send us to our doctor to get the pelvic ultrasound to see if we have fibroids.
Dr. Richard-Davis: The most common symptom is generally heavy menstrual bleeding and for some women, they have heavy menstrual bleeding and they think it’s normal. But if you have bleeding to the extent that you’re becoming anemic; that is certainly not normal. So, at that point, you really should seek evaluation and subsequent treatment. Other symptoms would really be – the fibroid is a space occupying lesion so it sits in the pelvic area and if you think about the bladder being in front of the uterus; that uterus sitting on top of the bladder applying pressure, you may have urinary frequency. You may be getting up at night to use the bathroom because your bladder can’t expand the way that it should. You can sometimes get constipation for the same reason. You have pressure on the rectum so stool is not passing as readily as it should. And those are probably the most common symptoms.
From time to time, women will say that they have pain from their fibroids. That’s not always very common. The pain is usually from when the fibroid sort of grows very rapidly and it outstrips blood supply, so parts of it starts to die off. That’s usually what causes the pain.
Host: So interesting. So, first of all, a lot of women have the question Doctor, do they turn into cancer like some colon polyps might? And if not, is treatment always necessary? Why would you treat them?
Dr. Richard-Davis: Fibroids are 99% benign. It is not something that we worry about becoming cancerous. In terms of when to treat, or do we treat; a lot depends on the patient’s symptoms. We talk about conservative management or expectant management. If you have small fibroids and they are not creating any symptoms; then there is no reason to remove them with a few exceptions. Obviously, being a fertility specialist; I have to point to the fibroids that you mentioned earlier. There are multiple areas that they can be located. So, the one that is in the wall of the uterus, if it does not disturb the endometrial cavity; then it doesn’t affect fertility. If they are submucosal; it affects fertility. So, anything that disturbs the endometrial cavity related to fibroids needs to be addressed for pregnancy. Otherwise, the decision as to whether or not to intervene really depends on all the other symptoms that the patient may be having.
Host: Then what are some treatment options that you might offer a woman who is having symptoms or who it might affect their fertility?
Dr. Richard-Davis: So, first we talk about where is this woman in her reproductive life. Is she done with childbearing or is childbearing in front of her? Right. And if childbearing is in front of her then we are talking about uterine sparing options. Those would include everything from myomectomy which can be done laparoscopically, abdominally or hysteroscopically depending on where the fibroids are, the size an dhow many there are.
There are nonsurgical options and I make the distinction because the nonsurgical options to date, have not really been approved for women who plan future pregnancies. And those would be things like uterine artery embolization. There is an ultrasound treatment for fibroids it is MRI focused ultrasound. There’s also cryo that one can use to treat the fibroids. But because those particular procedures basically causes degeneration of the fibroids; they possibly weaken the wall of the uterus and so we don’t want someone planning future pregnancy having those done. It doesn’t prevent pregnancy either, so you can end up pregnant after having any of those procedures done. But it’s not advisable.
Host: Do fibroids sometimes cause heavy bleeding, and then would that be another reason for treatment? What would you do in that case?
Dr. Richard-Davis: If a patient is having bleeding heavy enough to be a concern for her; and the typical patient comes in and they’ll say I have to have basically sanitary pads at home, at work, in my trunk, you name it to try and prevent from soiling my clothes. Or that they have been anemic, they are iron, some women have even been transfused and still don’t recognize the importance of addressing fibroids. Heavy bleeding to the extent that it is creating a problem for you does warrant intervention and of course the options are the same depending on childbearing.
There’s one other thing I would mention and I’m very hopeful that in the future, we will have some medical options for fibroids. We have a number of clinical trials that are ongoing now looking at progesterone receptor modulator drugs that may be able to be used to prevent future growth of fibroids and shrinkage of fibroids that are present. Our current medical options like Lupron or GRNH agonist is not something that we can continue to leave patients on because they will cause osteoporosis if it’s used long-term. It drops the estrogen and puts women at risk for osteoporosis. So, it’s not a long-term management medical option. But hopefully in the future, we will have some of those options approved.
Host: That’s so interesting. Doctor, wrap it up for us, your best advice for women who might be experiencing some of the symptoms you’ve discussed, when they should see their provider and really what you’d like them to know about uterine fibroids.
Dr. Richard-Davis: One is women who are experiencing any heavy bleeding, pelvic pressure, the typical symptoms that we talked about should seek evaluation. In that process, know what your options are going into your appointment. Because I’ve had many women who have come in and said once they were diagnosed with fibroids; the only thing that they were ever offered is a hysterectomy. And they don’t want a hysterectomy. That’s what keeps a lot of women from seeking treatment or intervention. There are non-hysterectomy options, you just have to find the right physician. So, if your physician is saying hysterectomy only; look for another physician if that’s not the option that you want to exercise. So be proactive in the process. There are lots of physicians out here who are very well versed in how to treat and manage uterine fibroids.
Host: Being proactive. Great advice. We have to be our own best health advocate. Thank you so much Dr. Richard-Davis for giving such great information and sharing your expertise today. And that wraps up this episode of UAMS Health Talk from the University of Arkansas for Medical Sciences. You can head on over to our website at www.uamshealth.com for more information and to get connected with one of our providers. If you found this podcast as interesting and informative as I did, please share on your social media, share with other women you know that way we can learn from the experts at UAMS together. And be sure not to miss all the other fascinating podcasts in our library. Until next time, I’m Melanie Cole.
