Fibroids! Fibroids EVERYWHERE what is one to DO??

This is a daily issue for me in practice. I see a woman for the first time. I take her history, she has had heavy bleeding on and off for years. No big deal for her. I do her exam and ZOWIEE! I discover the enlarged fibroid uterus. Sometimes about the size of a five month pregnancy. Now you know she knew about this.

If I don't find it, it doesn't exist.

Why do women want to hide their heads in the sand?

BECAUSE someone once said the H word.

Hysterectomy.

That is about as misunderstood and feared as Breast Cancer ( we'll go there another day ).

So, she has been suffering with heavy menstrual bleeding, urinating 15 times a day, constant pressure, having to put up with difficult bowel movements, and pressure, not to mention YOWSER cramps for YEARS.

All in the hopes that menopause will rescue her from the dreaded Hysterectomy.

NOW HEAR THIS.

Fibroids do not usually need the BIG H.

Fibroids are benign smooth muscle cell tumors of the uterus. The uterus is made up of the opening, the cervix which stretches ( dilates ) to allow a baby to be born, the lining ( the stuff that comes out as a period ) and the myometrium ( the muscle that is the body of the uterus that grows to accomodate the baby, and then contracts to deliver the baby ).

Fibroids can be on top of the muscle layer, in the muscle layer or protrude into the lining. At any rate many women will have them by age 40, and most don't need any treatment. They can be anywhere from the size of a corn kernel to a basketball. Most hang out and don't cause trouble. Some are some bad girls and cause bleeding and pain, not to mention the bulk symptoms of frequent urination, pressure and constipation. Oh, did I mention PAIN?
Yes, they can be bad.

So what is someone to do? There are many ways of evaluating and managing fibroids. Even when I practiced in rural America, I offered options.
So wherever you live, get the facts.

1. Women who no longer desire childbearing can have Uterine Artery Embolization.  Check it out with Dr. Google. It is a procedure done by a radiologist wherein the arteries feeding the individual tumors are injected with beads to reduce bloodflow and therefore shrink the beasts. No surgery, you get to keep your innards.

2. Myomectomy is for women who desire childbearing. It is done either as a traditional operation ( think C Section scar ) or as minimally invasive ( think through a Bic pen). We have some master gyn surgeons at Cleveland Clinic Florida who do these robotically. VERY SLICK. They remove the individual tumors and sew the swiss cheese back together. You keep the organs, you get to have periods and everything. They are good. No hysterectomy.

3. Removal of the body of the uterus only. This is called a supracervical hysterectomy. Hysterectomy is actually the name for removing the body of the uterus, not the ovaries, not the cervix ( that would be a total hysterectomy ). So you just get the part out that has the tumors. The advantage is shorter operating time and less blood loss. Great for women who never want children and don't want periods again. You keep the cervix and need Pap smears. You keep your ovaries and can continue to be as hormonal as you please. One day in the hospital and one week at home. EXCELLENT!

4. Sometimes hysteroscopy can help with a single fibroid that is in the lining causing heavy bleeding.

5. Sometimes the use of hormones or medication or a Mirena IUD will help for bleeding that is heavier than normal without much pain.


The Bottom Line is that you have OPTIONS. And OPTIONS are good :)

So the next time someone comes in with fibroids, hopefully they have read my blog and know I won't be recommending a hysterectomy any time soon................

Routine Breast Imaging or Boob Attack!

Part of the GYN check up is an examination of the breasts.Lots of new controversy surrounding what to do, how to do it and when to get imaging. And what kind of imaging to do.

The young woman has a risk of a benign conditions and tumors. They are found either by the girl herself, or during a gyn visit. Most of the imaging that is done is through ultrasound, as that is helpful for a young (under 30) dense breast. After that the breast starts to accumulte fat, and therefore it is easier for the radiologist to differentiate normal tissue from abnormal. A screening baseline mammogram is done about age 35. From forty on, annual mammograms are still the best way to look at the breast.

What do we ask the radiologist for during these imaging examinations of the breast? We ask them for a consultation regarding your breast. Is there evidence that leads us to need a biopsy ( ie further investigation) or can this breast be evaluated in a normal or other interval? Now the radiologist takes this very seriously, and will ask for not just the routine two picture views, sometimes they will ask to add other modalities such as ultrasound, or other views, like standing on your head. This of course, is something that drives women crazy.

It's like this. You slam the car door on your finger. You go to the Emergency Dept to see if its broken. The radiology tech takes a picture of your finger. They take the film to the radiologist ( or if digital, send it) and ask if it is adequate. The radiologist says no, turn the finger this way and that until she/he decides it is broken or not. Same with the breasts only the radiologist is ususally not sitting there. These routine films take a number. And these days your radiologist may be in India or Austrailia with teleradiology.

At any rate if the views taken are not sufficient to answer the questions posed, they will request that the ordering physician go back and do it again, this way and that.They may want to do ultrasound, or recommend a biopsy either through ultrasound or needle biopsy. They will also compare the films to prior years to guide them what is normal for you.

So that's it. Don't panic if you need more films. Be thankful they are paying attention!

Until next time