Fibroids
(="Uterine Fibroids", Myomas Or Leiomyomas)Introduction:
All of these names describe the same thing, namely a benign tumor of the
uterus, which consists of smooth muscle cells, the same material that the uterus
is made up of. There is a capsule around this tumor and often inside of it a degenerative
process begins while the outer layers keep on growing. It is when there
is bleeding into such a fibroid or when the fibroid has reached such a weight
and size that it is pulling the uterus into different directions with positional
changes, that a woman feels pain. Although a lot of patients are very concerned
about whether the fibroid would turn into cancer, a development of cancer in a
fibroid is extremely rare (called a sarcoma, when it does occur). Occasionally
a fibroid as big as a large orange can develop over several years, which causes
pressure symptoms and would eventually lead to surgical removal by hysterectomy.
Newer insights particularly when testing hormone levels, have shown that
fibroids grow bigger under the influence of bioidentical estrogen, but shrink
in size when under the influence of bioidentical progesterone. Also, with menopause
fibroids often shrink in size. This has led to the concept that the cause for
the development of fibroids likely is estrogen dominance, a dysbalance between
estrogen production and progesterone production. Many women who develop fibroids
miss their ovulation and as a result can have fertility problems (no corpus luteum
developed in the ovaries). The reason for both infertility and fibroid development
is the lack of progesterone in the second half of the cycle (Ref. 10 and 11).
Symptoms:
Menstrual bleeding can be increased and more severe, particularly
if a fibroid is right under the lining of the uterus (=submucosal fibroid) or
inside the wall (=intramural fibroid). There can be urinary urgency, if a fibroid
grows in front of the uterus and pressure is exerted onto the bladder. If the
adjacent large bowel (sigmoid loop) or the rectum in the back of the uterus is
pressured by an enlarging fibroid, the constipation and possible lower back pain
(triggered from inside the pelvis) can be a problem. Fibroids often occur in multiples
throughout the uterus and this can cause problems with pregnancies. Getting pregnant
would not be affected, but recurrent abortions, premature labor, breech deliveries
or other malpresentations cause concern and often lead to a higher cesarean section
rate. Abdominal pain is common, mostly in the lower mid abdomen. Treatment: The
doctor will do an intravaginal pelvic examination first and likely diagnose the
fibroid first that way. Further tests will then be ordered such as an ultrasound,
CT or MRI scan. This way it can be determined how big the fibroid is, how many
fibroids there are, in case of several ones and whether they are submucosal, intramural
or subserosal (on the outside surface of the uterus, but under the membrane that
envelopes the uterus). Essentially there are medical means to minimize the impact
of fibroids and then surgical techniques to remove symptomatic fibroids. Dr.
John Lee (Ref.10) describes that fibroids will often shrink when 20 mg of a bioidentical
progesterone cream is applied to the skin during the second half of the cycle
(day 12 to 26 of the cycle). After three months an ultrasound examination can
be done to check the size of the fibroid. If it has not gained in size or has
shrunk about 10 to 15%, this would be considered a good response and progesterone
cream treatments should be continued until menopause when typically fibroids undergo
atrophy (being absorbed). If there is only a marginal improvement, the progesterone
dosage may have to be increased temporarily to 40 or 50 mg per day from day 12
to 26 of the cycle for several months.
As not all fibroids respond to this
therapy, the gynecologist may have to remove the fibroid laparoscopically (typical
recovery time 3 weeks versus the 3 months for a hysterectomy). Pain
relief: There is an FDA approved non-drug method available, IceWave
patches from Lifewave, which will control pain. This is mentioned in the
book "Breakthrough" by Suzanne Somers (Ref. 9) where newer insights
of antiaging medicine are also reviewed. Although the patches are placed over
acupuncture points, there are no needles involved. Nanotechnology, a newer technology,
was used in the manufacturing of these patches and infrared (heat) waves from
body heat are utilized to stimulate an acupuncture point, which modifies pain
perception and reduces pain to half or less. Medically this would be considered
an excellent pain reliever. For more info on the patches see the IceWave patches
from Lifewave link above (click "products"). In the US a 5 pack of the
IceWave spray is available that can be directly sprayed onto the skin in the area
where the pain is located.
| Treatment
options for fibroids | •An
asymptomatic patient does not need any treatment, just observation to make sure
that growth of the fibroid(s) is within reason. Normally there is a very slow
enlargement until menopause and then fibroids decrease in size. The smooth muscle
cells of fibroids have estrogen receptors on them, which makes them grow while
the ovaries still produce estrogen. After menopause that stimulus is taken away
unless hormone replacement is considered and often fibroids reduce in size. •Using
different hormone preparations, partially based on blood test, the gynecologist
may want to consider a trial of hormone therapy with progesterone to see whether
the bleeding abnormalities can be normalized. Unfortunately in many women this
is not very successful and a surgical option has to be considered. •Surgical
options are considered when pelvic pain is intolerable, when urinary or bowel
complaints are a problem, when dyspareunia (painful intercourse) has developed
or when uterine bleeding has become intolerable. In a couple where infertility
or recurrent abortions have been narrowed down to a single large fibroid, a myomectomy
(=surgical excision of the fibroid with preservation of the rest of the uterus)
can be done. •In cases where multiple fibroids are present
or where there is no more wish for children, the simplest procedure is an abdominal
or vaginal hysterectomy, where the uterus (and often the ovaries) are removed
surgically by the gynecologist. Prior to any of these procedures, there must be
a frank discussion between the couple, with the gynecologist and with the family
doctor to ensure the best decision is made in this particular case. Prior to surgery
the specialist might decide that a brief course with a gonadotropin releasing
hormone analogue would be useful to reduce the amount of bleeding and reduce the
size of the fibroid. This hormone is now available under the brand name Synarel
and can be taken as a nasal spray. However this is only safe for a shorter course
of therapy as it has been shown that with longer than 6 month treatments bone
density decreases (in other words osteoporosis develops). •Given
the options above, most women will not need anything done but be followed with
a yearly Pap test and pelvic exam. Most other women with unbearable symptoms will
likely need a hysterectomy, if hormone therapy does not work. |
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