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Melanie: Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back To Health features conversations about trending health topics and medical breakthroughs from our team of world renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And I hope you'll join us today as we discuss fibroids. Joining me is Dr. Tamatha Fenster. She's an assistant professor of Clinical Obstetrics and Gynecology at New York Presbyterian Weill Cornell Medical Center with a subspecialty in minimally-invasive gynecologic surgery. And she's also the Director of Innovation of the Fibroid Center at Weill Cornell Medicine.

Dr. Fenster, it's a pleasure to have you join us today. And I told you off the air, as someone who has fibroids myself, so the listeners know I'm coming from a place of these questions are questions that I have myself. So what do we know about women and pelvic pain? Tell us what fibroids really are.

Dr Tamatha Fenster: Oh, Melanie, thank you so much for having me discuss a topic that's so near and dear to my heart. And certainly, you are not alone. It is an incredibly common condition that women have. Fibroids are essentially just benign smooth muscle tumors. Smooth muscle, the same muscles found in the uterus starts growing in an uncontrolled fashion in these circular balls and they get bigger and bigger and grow at any location and shape and size in the uterus.

Melanie: So it's kind of a little bit scary in my opinion when you hear you have fibroids. Tell us a little bit about why or how they develop. I think every woman's biggest fear is if they're on their ovaries, they're on their uterus, wherever they are, is this going to turn into cancer?

Dr Tamatha Fenster: So fibroids themselves are benign smooth muscle tumors. They are not cancer. However, there is a type of cancer that almost takes on a similar appearance to a fibroid, and that's called a leiomyosarcoma. And there's actually numerous types of sarcomas. They are on the rare side, but they can occur. Fibroids, however, typically do not turn into cancer themselves. There are a host of other symptoms fibroids can cause. So fibroids cause bloating and they can cause abnormal bleeding and they can make women's uteri and subsequently their bellies look really big and distended. And I have patients who get told that they can have their seat on the subway because women look pregnant from having fibroids that are so big.

Sadly, fibers can cause such heavy bleeding women can become so anemic that they get short of breath and they get lightheaded and they get dizzy, they can pass out. So certainly, there are other symptoms that can be caused from fibroids that are deleterious and affect life in a negative way. But for the most part, fibroids themselves are not cancer.

Melanie: So as someone who really, I feel like the only symptom that I have is bloating and I'm just kind of always bloated, what do we do about them? Do we do anything about them?

Dr Tamatha Fenster: Certainly, there are options to treat fibroids. And there's a whole range of everything from medical interventions to surgical interventions. So medical interventions are useful because they can treat the symptoms of heavy bleeding. There is a medicine that can actually shrink the fibroids, but that's a temporary measure. And it's usually used for presurgical planning and presurgical intervention. And then once the surgery is done, that's how the fibroids are ultimately taken care of.

In terms of getting rid of that bloating feeling and that big puffy belly definitely without needing to be on lifelong medicine, surgery is a great option, as well as other kinds of newer interventions, so there's a couple of them. One is uterine fibroid embolization, and that is done by an interventional radiology doctor. But on kind of a global scale, what they do is they put particles into a major artery in the leg that feeds up to the uterine arteries and the particles are different sizes and shapes. So depending on the particular size of the particle, they'll get stuck in blood vessels that go to the fibroids, making it so blood flow can't go to the fibroids and then the fibroids shrink. So that's one way to shrink fibroids. It doesn't get rid of the fibroid entirely. And the fibroid is not going to shrink a hundred percent, but it may shrink enough so your symptoms are somewhat alleviated.

The other interventions, there's an ultrasound intervention that can shrink fibroids as well. However, few patients are candidates for that because bowel cannot be in between the skin and the uterus. And if it is, it can get damaged. And few women have a perfect setup where uterus would be directly adjacent to the belly and you'd be a good candidate for the ultrasound intervention. And so then we get into the world of surgery.

So for robotic surgery, what we do is we put a camera in your belly button and we put additional holes in the belly. We use long instruments, almost like chopsticks, and we're able to do the surgery all with just those limited incisions. And we open up the muscle of the uterus, dissect out the fibroid and then reapproximate the muscle in multiple layers. And the muscle is so resilient and so good at healing, that within six months, the uterus completely shrinks back down to its normal size. There's also laparoscopic surgery and that's similar to robotic surgery, except that as the surgeon, you're adjacent to the patient the entire case, rather than sitting separately on the robotic console. But the incisions on the belly are very similar.

And then there's open surgery. One of the discussions that I have with my patients as a surgeon is the approach, the surgical approach and the intervention approach. Does the patient want a medical intervention, something that will temporarily maybe treat symptoms to bridge them into menopause? Or does the patient want a minimally invasive surgery? Does the patient want an open surgery? And I say bridge them to menopause because we know that when a patient goes into menopause, the estrogen and the progesterone levels in their body will decline and fibroids primarily grow from estrogen and progesterone. So when you go into menopause, fibroids will naturally shrink.

Melanie: Wow, This is so interesting because I'm someone in menopause. I'm done with it already. So I'm past that. So now, you're giving me hope that maybe mine are shrinking because I don't have estrogen anymore. Can you tell us just a little bit about how we know? I mean, we kind of jumped ahead to interventions, but you mentioned some symptoms, bloating, all of these things, bleeding. But Dr. Fenster, as women, sometimes these things happen to us no matter what's going on, right? Tell us a little bit about what would send us to our GYNE. And then does it always require an intravaginal ultrasound? How do you know that we have them?

Dr Tamatha Fenster: No, it's a great question because the symptoms of fibroids can definitely overlap with symptoms of other conditions. And some conditions, that can be quite concerning. So a great rule of thumb is if something doesn't feel right with your body, if you feel that you're gaining weight, if you feel that your belly is big and swollen, or you're peeing all the time, or you have heavy vaginal painful bleeding, I would go to your gynecologist.

And certainly, you should be getting a visit with your gynecologist once a year, anyway, for an annual exam. And sometimes it's as simple as a bimanual exam. So that means a vaginal exam from your gynecologist and he or she would be able to feel the tumors just with that exam alone without any other studies.

Sometimes if a gynecologist feels a pressure or a bulk or some larger tumor in your belly, they're going to send you for imaging. And you mentioned a transvaginal sonogram, but there's also abdominal sonograms, so external sonograms that are done on your outside skin on your belly, that can look all the way into your uterus and see if you have these big circular tumors. After that study is done, your gynecologist may want an additional study like an MRI. And an MRI is a magnetic study where you go in that tunnel and it makes the banging noise. But they're able with that study to see with incredible precision and detail where every single tumor in the uterus is, and that helps tremendously with surgical planning.

Melanie: Wow. So many options available for women. So Dr. Fenster, wrap it up for us. Since so many of us have fibroids and they can be concerning when you first hear about them. But as you've said, It's pretty rare and they don't turn into cancer necessarily, so give us some hope and encouragement and when you would like us to visit our doctors.

Dr Tamatha Fenster: The reason why I am totally passionate about fibroids and I've really dedicated my entire career to helping women with fibroids is there are so many options available to women, and it's so important that they know all of their options and they don't immediately jump to something on the complete opposite extreme, open hysterectomy or something like that, which may be very appropriate for a particular patient, but that decision needs to be had between patient and doctor and other input after they've considered all the other options that are out there.

And I really feel that it's important as females to be very well-informed and empowered in making that decision. It's your body. And you really should have all of the information and education before you make a surgical decision. As I say to my patients, when you go to sleep on that table, I want you to be completely comfortable and completely satisfied with why you're having surgery and what you're about to have done, and not have any trepidation. It's very important as a patient to really know all of your rights and decisions and options.

Melanie: Such important information and what an educational episode this was, Dr. Fenster. Thank you so much. And you're so right, we women have to be our own best health advocate and take care of ourselves because otherwise we can't take care of the ones that we love. So thank you so much for that great information.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate, and review Back To Health on Apple Podcast, Spotify and Google Podcast. For more health tips, you could always go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. Thanks so much for listening. I'm Melanie Cole.

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