L.A. Parent interview with Dr. Bruce McLucas

Uterine Fibroid Blog

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L.A. Parent interview with Dr. Bruce McLucas

Your Uterus And You!
Get To Know This Important But Oft Overlooked Reproductive Machine

Welcome to our tour of the female reproductive engine. From the day you get your period until you make it through menopause this large, muscular organ produces, directs and plays a big part in an important show. The uterus – like most working mothers – constantly multi-tasks, has many jobs and basically never gets a day off. Oh, and goes largely unnoticed until something goes wrong.

Let’s Meet Your Uterus
Everyone’s first home, the uterus is where the fetus grows. And before there is a fetus in there, your uterus is tiny. Weighing only about two ounces and measuring about the size of your fist, it hangs behind your pelvic bone in your pelvic cavity, behind your bladder. Like a mother tending her toddler, your uterus bends forward over itself. Like your heart, your uterus grows with your baby (to 16 inches and a weight of two pounds) and like a five-star hotel, it’s very accommodating. But this hotel looks like an upsidedown pear (with ears) or a strung-out cow.

In the House
Upstairs to the left and right are your ovaries and fallopian tubes. Your ovaries are about the size of an almond and produce eggs and hormones. Ovary follicles are one of the first things to show up in a female fetus. Your fallopian or uterine tubes are like stairs leading down from the ovaries. At the entrance is the fimbria (Latin for fringe),
which is lined with little hair-like pushers to help eggs along on the all-important journey down from the ovaries.

Up at the top between the tubes is the fundus, which is where the contractions start when it’s birth time. Fundus is Latin for opposite the opening. And what’s opposite from the fundus? The cervix! The cervix, which is Latin for neck,connects with the top of everyone’s favorite, the vagina. The cervix is a smooth muscle lined with mucous. And what an important role the cervix plays. Any woman who has delivered a baby knows how it has to dilate (why can’t they just say open?) to 10 centimeters for the baby to pass through. Below the cervix is the vagina, Latin for scabbard,” a sheath for holding a sword (ouch!) – the way in to and out of this amazing house. The sperm enters, the baby exits. And as my friend who does bikini waxes says, No one should be allowed in there without an engagement ring.” The area between the fundus and cervix is the body or cavity of the uterus, where your uterine lining readies itself each month in case it has to grow a baby. Your uterine lining is made up of three layers of cells and tissue. Your endometrium is the inner lining, which thickens and sheds with your menstrual cycle – like spring cleaning every month. The myometrium is the middle layer and expands your uterus during pregnancy and then shrinks it back when the baby comes out. It also gets rid of the placenta. The perimetrium is the outer layer of the uterine lining.

The Cycle
Your friend, your period, menstruation (in Latin means month), is the monthly cycle that prepares your body for pregnancy. Your uterine lining gets all thick and friendly, inviting a fertilized egg to implant. If that doesn’t happen, the endometrium sheds and the whole process starts over again. Menopause happens when your ovaries either stop producing eggs or are surgically removed. You are in menopause if you go for 12 months without a period, perhaps feeling a bit moody or, as my kids would tell it, psycho.

Trouble Down Below
With so many hard-working parts in the house, the female reproductive system is sub-ject to its share of problems. For instance, fibroid tumors. These benign growths in the uterus affect about 40% of women and are the number-one reason for hysterectomies. Symptoms and size of the fibroids vary. Some women experience no symptoms and some women suffer terribly. Some tumorsn are barely detectable and some grow so large they fill up the uterus. Sometimes the fibroids grow outside of the uterus. According to Bruce McLucas, M.D., founder of the Fibroid Treatment Collective at UCLA, one in every 800 fibroids is cancerous. Uterine cancer, also known as endometrial cancer, is when cancerous cells are present in the endometrium. It is the most common form of reproductive cancer and its most common symptom is heavy, abnormal bleeding. Cancer can also strike the ovaries. Ovarian cancer often has no symptoms and is difficult to detect early. And the American Cancer Society says one in every 40-60 women in the U.S. has a lifetime chance of developing it. Endometriosis is when uterine lining grows outside the uterus, causing pain and heavy bleeding. No one knows what causes it and there is no cure, but treatments for the symptoms include surgery and hormone therapy. About 30-40% of women with endometriosis are infertile. Prolapse, a weakening of the muscles holding your uterus in place, usually affects women who have given birth and are older. This is when your uterus actually slips and/or sags out of its position. Treatment ranges from surgery to Kegel exercises, to a pessary, which is like a diaphragm without a middle inserted through the vagina to prop up your uterus.

Losing Your Uterus – Or Not
When things go super-wrong down there, hysterectomy – the removal of your uterus, your problems, and your ability to have a baby – is one option. According to the Centers for Disease Control, after Cesarean section, hysterectomy is the second most frequently performed major surgical procedure for women of reproductive age in the United States. Approximately 600,000 hysterectomies are performed each year here. For a woman who wants to have children, hysterectomy can be a wrenching decision, says Anandhi Narasimhan, M.D., a Los Angeles-based psychiatrist. Life goals, life stage, age and medical condition are the big decision-making factors. The main reason for the surgery,” she says, is relief from pain and suffering. In the case of uterine fibroids, alternatives to hysterectomy exist, and there is a movement in the medical community to promote them. According to Stanley West, M.D., author of The Hysterectomy Hoax (Next Decade Inc., 2002), about 40% of the time, the ovaries are unnecessarily removed. And as with any major surgery, recovery is intense, especially with your body being thrust into surgically induced menopause. McLucas, a pioneer in an alternative called embolization, calls the hysterectomy rate an epidemic. Embolization, a relatively new procedure (the first one was done in 1994), ;deprives the fibroid of blood, they shrivel and shrink and the problem disappears,” says McLucas, adding most insurance companies are familiar with the procedure. Another alternative is myomectomy, the surgical removal of the fibroids (with a onethird return rate).

Three Stories
No matter what stage of life you might be in, your uterus plays a role – and sometimes causes complications. Amy was in her late 30s and planning on having children when at her annual exam, her doctor felt lumps. Fibroids were diagnosed. She never felt any pain – only a lump when she lay on her stomach. Her fibroids grew outside of her uterus, and she does not remember struggling with the decision to have a myomectomy. Her doctor removed eight fibroids, one the size of a baseball. Amy considers herself lucky and is a mother today. Beth was 51 and a mother of two when she had an abnormal pap smear, and after a biopsy was diagnosed with endometrial cancer. Her pap smear was done at the end of her period, while she was still spotting. Cells from her endometrial lining showed up on the pap slide, and she thinks this saved her life. She had a full hysterectomy, plus removal of her pelvic lymph nodes and pelvic tissue, then internal radiation. She went through hell, but today is cancer free and has no regrets. After being unable to
conceive, Sue, now in her early 50s, embarked on a fertility journey that involved dealing with fibroids, artificial insemination, and in vitro fertilization. Unexplained infertility is how she describes her ordeal, and she chose not to continue the expensive, exhausting process. She never found out why she could not conceive. We might never understand all there is to know about the amazing workings of our bodies – especially those that bring new life into the world. But knowing as much as we can is the key to keeping our bodies in top working order. Period. Amy Simon is a Beverly Hills writer, humorist and mom.

Centers For Disease Control – www.cdc.gov

U.S. Dept. of Health and Human Services site for women – www.Womenshealth.gov

MyOptumHealth – www.healthatoz.com

National Institutes of Health – www.nih.gov

National Institute of Child Health and Human
Development – www.nichd.nih.gov

American Cancer Society – www.cancer.org

HERS Foundation – www.hersfoundation.com

National Uterine Fibroids Foundation – www.nuff.org/health

Fibroid Treatment Collective – www.fibroids.com

L.A. Parent interview with Dr. Bruce McLucas

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