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The “Morning After Pill” and Fibroid Treatment

Dr. McLucas comments on a recent U.S. study about the effects of the ‘morning after’ progesterone contraceptive in shrinking fibroid tumors.

A recent U.S. study published in the medical literature described the effects of the ‘morning after’ progesterone contraceptive in shrinking fibroid tumors.  While the drug is still experimental, this could be a welcome addition to help treat a problem affecting 40% of women over the age of 40, and the cause of nearly 500,000 hysterectomies and fibroid removal surgeries performed each year in the United States.

We don’t know what causes fibroid tumors to grow in the uterus. We do know that fibroids are stimulated by estrogen. Women have two periods in their reproductive lives when fibroids will undergo ”growth spurts.” First, during pregnancy, fibroids will often grow with rising estrogen levels. Second, in the years leading up to the menopause, when estrogen is not produced any longer by the ovaries, the menstrual cycle is dominated by estrogen.

So it is reasonable to expect that any hormone which is an ‘anti-estrogen’ such as progesterone will decrease the growth of fibroids. In some cases, fibroids will shrink, temporarily under the influence of progesterone. We have know for years that intra-uterine devices [IUDs] containing progesterone can decrease the size of fibroid tumors. So can depo-lupron injections which create an artificial menopause while the hormone is in the blood stream. These hormones have side effects ranging from spotting to decreased sex drive, oily skin, and hot flashes which cause many women to stop taking the pills or injections. When the medicine is out of the system, fibroids regain their normal growth pattern, and may enter a period of accelerated growth!

“We believe that progesterone works by decreasing the size of the blood vessels feeding fibroids. On the other hand, Uterine artery embolization [UAE] permanently blocks the blood supply to fibroids,” according to Bruce McLucas, MD, founder of the Fibroid Treatment Collective, and Assistant Clinical Professor of Obstetrics and Gynecology at the University of California, Los Angeles. McLucas introduced UAE to the U.S. in 1994. Since then, the FTC has treated more than 5,000 women from all over the world. Many have gone on to have successful pregnancies. Embolization is an outpatient treatment allowing women to retain their fertility and return to work in a few days, rather than the months required to recover from major surgery. In addition, compared to myomectomy, the surgery where fibroids are removed and the uterus preserved, UAE allows women to breathe freely, knowing this procedure permanently treats fibroids without the risk of future recurrence,” McLucas adds.

 

Uterine Fibroid Embolization and Sex

Want to find out about the effects of UFE on your sexual desire? Read here to find out the inside scoop about this topic!

Will UFE affect my sexual response?

Most patients report either no change or improvement in their sexual desire and response after Uterine Artery Embolization. Women that experience pain during sex, which can sometimes be a result of the presence of fibroids, usually experience an improvement in this area.

Some women experience intense, pleasurable contractions during orgasm.  This occurrence is called internal orgasm (different from clitoral orgasm) and a few have noted a decrease in this response after the procedure. The exact reason for this is uncertain but may be related to an injury of nerves supplying the cervix. Concerns about effects of UFE on sexuality should be discussed with your Interventional Radiologist during the initial consultation.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling 866-362-64633 or by requesting a free phone consultation. Additionally, you can find us on Twitter @fibroiddoctor and on Facebook at facebook.com/fibroids.

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What fibroid size responds best to UAE?

Virtually all fibroids respond to Uterine Artery Embolization (UAE). The question is will there be enough shrinkage to relieve symptoms? Generally speaking, the smaller the fibroid the better the response. However, even in a uterine size up to a 22-24 weeks of gestation or less, a 40-60% shrinkage is possible. In much larger fibroids which are greater than this size, the shrinkage may be a bit less when compared to a smaller sized fibroid being that the resulting shrinkage is relative to the starting size of the fibroid.

Also, it appears that after  women with reasonably large fibroids have under gone UAE, there is still a considerable decrease in pain and pressure symptoms, as well as in bleeding abnormalities. However, while patients with near term size uteri have been treated with UFE, in practice, 22-24 weeks gestational size seems to be the upper limit where a good response can be anticipated. This size limit is far from absolute and each case needs to be evaluated individually.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

 

Fibroids Inside and Outside of the Uterus

Read here to find out some facts about pedunculated fibroids and some of the symptoms to look out for if you have this particular type of fibroids.

I was recently told by my doctor that I have fibroids inside and outside of my uterus. I have an appointment coming up where she will discuss my treatment options with me.  My question is in regards to the effects of fibroids.  I have been experiencing nausea for some time now.  Is this common?

There are several complications that may arise with the presence of fibroids.  Common symptoms include heavy bleeding, bloating, pain in the lower back, urinary incontinence, etc.  With fibroids that are “outside of your uterus”, called pedunculated fibroids, additional symptoms can come about.  Because pedunculated fibroids consist of a fibroid that is connected to your uterus by a stem,  they  may twist and can cause pain, nausea, or fever.

Pedunculated fibroids consist of two general types: subserosal and submucosal.  Subserosal fibroids are located underneath the mucosal (peritoneal) surface of the uterus and can become very large. These pedunculated growths can actually detach from the uterus to become a parasitic leiomyoma. Submucosal fibroids are located in the muscle beneath the endometrium of the uterus and distort the uterine cavity. A pedunculated lesion within the cavity is termed an intracavitary fibroid and can be passed through the cervix which can inevitably cause pain and pressure during sex.

Left untreated, fibroid tumors and their associated symptoms can cause health risks and complications in the future. If you think that you have any of the above or other symptoms of fibroids contact your primary care provider or OB/Gyn as soon as possible.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

5 Common Questions About Fibroids

Read here to learn about 5 common questions women ask about fibroids. Take this list with you to your next Ob-Gyn visit!

1.  What is the size and location of my fibroids and can the fibroids affect my fertility?

The size and location of the fibroid has the ability to greatly reduce your ability to conceive or not at all. The primary issue that is greatly considered is whether the uterine cavity is distorted, which can cause it to interfere with an embryo’s ability to implant and thrive.  Your physician can find out this information by carrying out some diagnostic tests which reveal this information.

2.  If fibroids run in my family should I plan to have children sooner?

Across the board, most physicians will agree that it’s always wise to have children sooner rather than later because a woman’s age plays such a significant role in the quality of her eggs and potential complications during pregnancy. Because fibroids have the ability to affect conception and can possibley even cause miscarriage, one may be better off planning child birth sooner, rather than later so as to avoid additional complications that may arise.

3.  What are my treatment options?

Hysterectomy is a method that completely rids your body of fibroids by having your uterus removed. However, this procedure also shuts the door on future pregnancies and requires hospitalization, as well as six to eight weeks for recovery. Uterine artery embolization is a popular alternative that typically involves only one night in the hospital and a week of rest. It is a less invasive procedure that is optimal for women that want to experience the benefits of fibroid treatment without having to spend extended periods for recovery. Myomectomy, or removal of the fibroids while leaving the uterus intact, is another treatment for women trying to get pregnant, but it carries a risk of recurrence, and its effect on fertility hasn’t been studied. Currently, these procedures are among the most practiced for the treatment of fibroids; however, you may ask your doctor about additional treatment options that you may also find favorable.

4.  How can I tell if I really need treatment?

Diagnostic tests are more refined than ever in measuring the size and location of fibroids and helping your physician to predict their effects.

Additionally, you may also want to do some “soul searching” so as to gauge how severe your symptoms are and whether or not they are affecting your quality of life.  If you find that your symptoms are posing as an impediment, you may want to look into treatment.

5.  What is the risk of my fibroids growing back with each procedure?

Fibroids can recur, unless the uterus is removed, and the risk varies slightly with each of the new procedures.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

 

Fibroids Post-Embolization

Ever wondered what happens to your fibroids after the UFE procedure? Read on to find out what happens to these myomas and which types may put you at greater risk for post-complications.

What happens to fibroids when they are embolized? Do they merely shrink, or do they “fall off” in some way?

After losing their blood supply, fibroids lose their fluid content and they are removed by the body. In time they undergo a process of fibrosis, and lose their ability to grow again. The overall effect is that the fibroid shrinks but does not become detached and “fall off”. However, in some cases, when treating pedunculated fibroids ( fibroids that are stalked from the uterus) there is a possibility that they can eventually “fall off” into the pelvis and cause some complications. Embolizing a pedunculated fibroid may disrupt the stalk, thereby releasing the fibroid into either the subserosal or submucosal cavity.

Disrupting the stalk of a pedunculated subserosal fibroid can result in the fibroid’s release. This development can potentially cause chemical peritonitis (inflammation of the membrane that lines the abdomen), leading to prolonged pain after embolization. This risk of stalk disruption has led some interventional radiologiests (IRs) to evaluate the width of the fibroid’s attachment to the uterus before considering a patient as a UFE candidate. Recommendations have varied, but a stalk width greater than one-third to one-half the diameter of the fibroid is considered acceptable to most IRs. These recommendations are based on the idea that safety increases directly with the width of the stalk. At the present time, however, no studies have been performed to back these criteria.

When submucosal pedunculated fibroids lose their attachment to the uterus, they are at increased risk for expulsion from the uterus. Although expulsion is usually not associated with clinically significant complications, uterine obstruction can occur if the fibroid does not completely pass through the cervix. In this case, other procedures may be required to remove retained tissue, which may otherwise become secondarily infected leading to other secondary complications of the uterus.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

 

Fibroids in the Ovaries

Read here to learn more about fibroids in the ovaries and other parts of the uterus and whether UFE is an effective form of treatment.

I have heard that there can be fibroids in the ovaries. Can these be treated by UFE?

No. The blood vessels to these ligaments and the ovaries are different from the ones which supply the uterus. Hence uterine artery embolization will not reach these tissues. Additionally, attempting to embolize these blood vessels that lead to the ovaries can most certainly cause infertility.

At any rate, UFE can treat other types of fibroids, such as intramural, submucosal, and subserosal fibroids. Intramural fibroids are in the wall of the uterus, and can range in size from mucroscopic to larger than a grapefruit.  Many of these do not cause problems unless they become quite large.  There are a number of alternatives for treating these types of fibroids, but often they do not need any treatment at all. Submucous fibroids are partially in the cavity and partually in the wall of the uterus.  They too can cause heavy mentrual bleeding,  often refrered to as menorrhagia, as well as bleeding between periods. Lastly, subserous fibroids are on the outside wall of the uterus.

Most fibroids can be successfully treated by using fibroid embolizaton. Moderate to large perdunculated fibroids (those that hang from the uterus by a stalk) are the only type of fibroids that are generally not treated with UFE alone. This is due to the fact that there is a small chance of the stalk breaking after the fibroid loses its blood supply, which may eventually cause the fibroid to call into the pelvis and cause additional problems.  Patients with these types of fibroids can be considered as a candidate for joint procedures using a combination of UFE and laparoscopic myomectomy.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

 

When to Treat Fibroids Before Pregnancy

It is never too early or late to treat your fibroids! Find out why it is important to take that step, particularly if you plan on having children.

In a young non-pregnant patient who has a fibroid the size of a 12 week pregnancy, is it necessary to treat the fibroids with embolization before becoming pregnant?

This decision is ultimately a personal choice.  However, in some cases, if your gynecologist believes that the location of the fibroid might be a problem that can affect your ability to become pregnant or during a pregnancy, he or she may suggest that you look into fibroid treatment alternatives.  Some fibroids can become an issue by way of blocking  the birth canal or can be located  in the cavity of the uterus and may cause a miscarriage. If this is the case, your gynecologist may advise you to take steps to treat the fibroid ahead of time so as to avoid any unnecessary and preventable health issues.

Looking to embolization as a way to treat fibroids may be optimal for many women, like you, that don’t want to go through the complications of surgery and strive to look for a less invasive approach.    Up to date, there is no history to suggest that embolization would interfere with a later pregnancy. However, even though about 1% of patients may lose their periods after embolization, a similar number could develop infertility from adhesions as the result of a surgical myomectomy or complications of other surgical procedures.  Therefore, the risks associated with treating fibroids with any procedure are always a trade-off.

It is never too late or early to treat your fibroid issue. Let us help you in your journey to explore treatment options, give us a call at 866-362-6463.  By calling this number, you can request to have an in-office consultation with Dr. McLucas, or you can opt to engage in a FREE phone consultation in which he can give you a general assessment of your individual situation and offer you some valuable medical suggestions. Either way, we are here to help!

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Role of Gynecologist & Radiologist in Fibroid Treatment

To ensure optimal care, both gynecologists and interventional radiologists must be integrated into the care of UFE patients. Learn more about how this relationship works by reading on.

What kind of relationship does the radiologist and the gynecologist have during the process of Uterine Fibroid Embolization (UFE) and what are each of their responsibilities when treating me?

In order for the patient to experience optimal care, it is imperative for both the Interventional Radiologist (IR) and the Gynecologist (Gyn) to take a team approach. Both parties must be an integral part of the team to ensure the best care. There are times in which a patient may have combined problems, needing both UFE and a laparoscopic removal or some other gynecological procedure.  In these cases it is vital for both key players to be comfortable with offering a wide variety of procedures and be ready to provide optimal care.

By combining the resources offered by both the IR and the Gyn, it allows both physicians to evaluate, treat, and help all women with fibroids, regardless of their individual health situations.

Both types of physicians have an important role in the care patients with fibroids.  The Gyn is usually responsible for conducting a pelvic exam prior to the procedure and inspecting whether the patient is a viable candidate for UFE.  If so, the Gyn may then refer that patient to an IR capable of performing the procedure, assuming all alternatives were presented and the patient expressed a partiality for the UAE option.

To make certain that the patient is a quality candidate, a series of MRI’s and ultrasounds may be performed.  If all is well, from that point the IR plays an equally important role, if not more, in the primary care of the patient.  The IR not only performs the actual embolization, but he or she assumes the primary role of handling most post procedure care and any complications that arise.  Both the IR and Gyn must keep an open line of communication not only with one another, but with the patient as well, so as to ensure a successful UAE process.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

 

Why Didn’t My Doctor Tell Me About UFE?

Several women that have learned about the benefits of UFE wonder why their gynecologists can sometimes be reluctant to offer the procedures as an alternative.

Why didn’t my gynecologist refer tell me about Uterine Fibroid Embolization (UFE)? The only option he gave me was a hysterectomy or a myomectomy to treat my fibroids.

This question is quite complex, however there may be some contributing factors as to why your gynecologist may not offer UFE as an alternative.

First, traditional training for gynecologists yields that hysterectomy is offered as the “primary” treatment for women who don’t want more children. Due to the idea that fibroids can recur after myomectomy and sometimes embolization, many gynecologists want to avoid the possibility of more unnecessary surgery.  However, this thought is unjust in that it disregards the idea that many women, although they may not have plans to continue or begin child-bearing, DO NOT want to part with their uterus.

Additionally, in some case, there is a disconnect between the two parties needed to carry out the procedure- the interventional radiologist and the gynecologist.  Some gynecologists may lack an overall appreciation of the features and potential of UFE and may perceive it as a radiological alternative that can potentially threaten their own patient base.  Moreover, gynecologists may lack the skills necessary to offer such minimally invasive alternatives and for this reason they may direct their patients toward alternatives that include open procedures in which they might be more content performing.

Lastly, some gynecologists simply are uninterested in participating in the care of UFE patients or only offer it to patients that they believe are a possible candidate.  Many gynecologists, however, fall somewhere in the middle of these reasons, but there is no real way to know why UFE is sometimes not referred as an option.

Learn more about Uterine Fibroid Embolization online, or contact us directly by calling (866) 479-1523 or by requesting a free phone consultation.

 

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