What are the symptoms and treatments of uterine fibroids?

WEBVTT

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Periods, endometriosis, pelvic floor issues,

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PCOS, it's a barrel of monkeys down there. So much going on. Let's

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add uterine fibroids to the mix. That's what we're talking about

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today. What are uterine fibroids? Where do they come from?

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What happens if you happen to have them? Welcome to Sarah has questions.

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Those are 3 of the many questions I'm gonna ask. Let's get into it.

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I'm Sarah King, and I have a lot of questions. What

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exactly happens when you orgasm physically? Will popping a

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knuckle or a joint give us arthritis? What can we learn from our

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poop? The size of your body doesn't necessarily indicate your measure of health.

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Yes. And what are your thoughts on that? Cleansing. Do we need to do

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anything special to our nether regions?

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In this show, I get to ask all these questions to WakeMed doctors

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who happen to know everything about everything. Sarah Hess

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Questions is a production of Capital Broadcasting Company and Mix 101.5.

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It's presented by WakeMed. Today, I have doctor Michael

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Armstrong who's an OB GYN with, WakeMed. Thanks for coming in

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today. Thank you for having me. And we're talking uterine fibroids.

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What exactly is a fibroid? Uterine

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fibroid is basically a muscle tumor of the uterus. The uterus

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is made up of smooth muscle, and then sometimes you can have, like,

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a modern mutation of 1 of the basic cells, and then it

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grows. So as it grows, it grows into a little small, like, tumor

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ball, and that tumor growth is called a fibroid. Fibroid. Interesting.

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And and where do they grow on in the body?

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Just inside the uterus? Inside the uterus. And with the uterus, that means they can

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grow, like, outwards from the outer part of the uterus and exert pressure on

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other things within the abdominal cavity. They can grow inside the

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womb, so they can grow very, very close to the cavity where

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women, they start their menstruation. Mhmm. And they can be anywhere in between. We've talked

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about endometriosis before, which is, you know,

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where parts of the lining will grow everywhere. Can so does

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that mean fibroids can grow, like, on the ovaries, on the fallopian tubes,

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anything like that, or just the uterus? That's more rare when

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you kinda have what we call a parasitic fibroid. If it grows, like, on a

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tube or anything, that's what we consider to be extra uterine. That's more

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rare because it usually derives right from those basic muscle cells. I see.

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And then that one mutated cell, it just grows and grows and grows.

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So they can push like, outward towards the tube. They can

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push in towards the womb, like, where a baby would be. Mhmm. And they can

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be anywhere from the bottom of the uterus to the top of the uterus. Oh,

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man. And that's usually what we see. Okay. But parasitic fibroid,

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that that sounds scary. So what

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causes fibroids to grow? That's a good question

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with a complicated answer. I mean, honestly, we really don't

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know. We don't know what causes that basic mutation, but, what

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we know from a lot of science that's been done and studies that have been

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done, A lot of patients sometimes can have hereditary type

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fibroids so they can run-in some families. That was my next question is if it

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was genetic. Yeah. Sometimes they are. Some patients for whatever reason,

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whatever stress happens, they have a fibroid that stars that

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start and a lot of times you can see, like, the same

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cells in certain type of fibroids. There's a lot of patients that have fibroids.

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We usually see the patients that have significant size fibroids that cause them problems

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and that's why they come and see a doctor. Right. So you said stress.

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What do you mean by that? Like a stress can cause a fibroid? It can

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be and and that can be anything. Could it be from an infection?

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Could it just be from normal stresses of life? Could it just be just

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as you get older in your reproductive life? Yeah. It's something

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that critical that happens that causes that mutation to happen. And that's the part the

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complicated part. We really don't know what that is. Oh, interesting. Stress really

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is the bane of all things. It is. So you're saying

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these things start from a mutated cell. Yes. Is that the same as

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cancer? It's similar, but very, very

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different because fibroids are benign. And as majority of

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women have fibroids, I would say about 70, 80% of women in their

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lifetime, they'll develop fibroids. Okay. And we see maybe about a

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quarter of those women because those are the ones that have significant ones

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that they either have significant bleeding with their period Uh-huh. Or they have pain

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with their periods. Okay. Or they may have infertility during their reproductive

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life. Okay. So even though a majority of women have fibroids, it's only a

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certain percentage that usually have ones that cause problem. Cancer cells

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grow, and they grow They do. Yeah. And they grow on each other, and they

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they build tumors too. They do. So how is it different with

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a fibroid than a cancer? Like, what what differentiates the 2 types of

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cells? With cancer, they're they're prone to try to invade.

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So they'll invade other structures. I see. Whereas with fibroids, with that

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mutated cell, it kinda stays the same and it kinda grows within itself.

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Fibroid? Does it just stay there forever? Does it shrink and go away? Does it

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fall out? Like, what does it do? It does pretty much all those things you

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just said. You can have a fibroid fallout?

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You can. You can have a fibroid that grows within the womb of the cavity

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and it can prolapse and it could come out. Now you may need help. You

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may need surgery to help that fibroid to release and come out. But that is

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possible. Oh, interesting. Yes. But fibroids, they change. They get bigger, they

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get smaller. It's common during pregnancy. We see fibroids early in pregnancy

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actually enlarge and then at the end of the pregnancy, they get smaller

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again. Usually with menopause at the end of

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ambulatory function, usually fibroids, they get smaller because they are

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fueled by the hormones that the ovary makes. So that's fairly common

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also. They don't usually go away typically, but they may not cause

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problems as you get into menopause. What are the symptoms of having a

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fibroid? Usually, the most common symptom, I think, for the

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patients that I see is usually heavy menstrual bleeding. I would say

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that's probably the number one number one reason why the majority of patients come in

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because of heavy menstrual bleeding. What are some other ones? Other ones

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could be discomfort and pain with their cycle or outside of the

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cycle. Other ones could be they sometimes they can get to be really, really large.

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A lot of times we kind of equate the size of a fibroid to pregnancy

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size. So, like, we'll tell a patient, you know, you have a fibroid that's,

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like, 20 week size. Good. So that'll be the same for a patient who is

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20 weeks pregnant. So that is noticeable. So when

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when a patient has something like that, sometimes that's why they come in. So

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why would a fibroid cause heavy bleeding? Probably most

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likely the the size of the fibroid and the location. The fibroids that are

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closer to the endometrial cavity are most likely to cause more

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bleeding issue, and especially the ones that are actually inside of the womb. The ones

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in the womb are common for cause of abnormal bleeding. So

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so whenever you have a fibroid in your uterus and it's time for your

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cycle, you grow the lining. Yes. Is it because you have to grow more

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lining to cover the fibroid? Not necessarily. With the

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uterus with the muscle, the uterus is designed to cramp,

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and a lot of that cramp is to try to control and stop bleeding. So

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if you have these muscle tumors, you can imagine the uterus doesn't cramp and

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contract as well. Right. Doesn't contract as well. So that could lead to more bleeding.

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I see. Then if you have this tumor and it's just in the area right

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where the administration is, just being in that area is gonna cause more bleeding.

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And some of the fibroids, majority of fibroids actually in the actual

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cavity. I see. So having the actual fibroids in the cavity can cause irregular

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and heavy bleeding. We'll be right back because you know I have more

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questions.

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How do you diagnose a fibroid, a uterine fibroid? Yes.

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Sometimes it can be by physical exam. The larger ones when the patient

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comes in and have a pelvic exam, sometimes the physician's able to palpate

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it. A lot of times Palpate means? You're able just on

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your exam, like, with digital exam, you're able to actually fill it. Oh, yes. You're

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able to fill it. Women are familiar with the digital exam. It's like you're

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getting molded into a shape. Yes. Yes. Yes. So you're able to

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fill some of the fibroids. Yes. With technology and the advancements we have

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with radiology and imaging, the most common image that's good

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for looking at fibroids is ultrasound. Okay. So ultrasound is excellent for

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looking at fibroids, the ovaries, and most of the female

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organs. Okay. There's some limitations to ultrasound, but ultrasound, it

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will give you an idea about the number of fibroids. It'll give you an idea

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basically about the location of the fibroids. Sometimes you may

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need a better test. So with ultrasound, it may not

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tell you exactly what's the impact of that fibroid on the actual

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cavity of the uterus. And that's important. So sometimes we can do

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studies such as hysteroscopy. And that's what What is that? That's where we

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put a scope inside of the uterus. Okay. And with distension, usually

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fluid distension, you can look inside the cavity. A lot

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of studies a lot of women know about because of fertility and infertility is

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HSG. What does that mean? Histosalpingogram. That's where

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a radiologist uses contrast. They inject contrast into the

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cavity and they just shoot x rays. And with the contrast, you can see the

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shape of the cavity. And if there was a fibroid in the cavity, it would

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show up as an abnormal shape. Sometimes

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MRI. Oh, that makes sense. The MRI is very

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helpful for telling you in a three-dimensional way exactly the location of

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the fibroids, the number of fibroids and where they locate. This is a little off

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topic, but on just a backpack on that. What is the difference

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between getting an X-ray and an MRI? I always thought I really don't know the

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answer to this. Yes. X-ray is kinda what we call just plain

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film. So you're just shooting pretty much in that one dimension. So

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it's like from anterior to posterior. Okay. Whereas with MRI,

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it's a magnetic resonance, sometimes with a contrast or

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without contrast. So they can see the vasculature better. And with You can see your

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veins. You can, you can. And with that, you get more of a three-dimensional

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look. But MRI, CT is also can give you a three-dimensional look. But

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MRI is better for looking at these soft tissue structures Oh.

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Such as the uterus and ovaries. That makes sense. So you can get a better

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look at your muscles and those things. And x rays are good for bones.

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Yes. Gotcha. Okay. Are symptoms always worth

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worse with a larger fibroid, or do smaller ones cause terrible symptoms

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too, like lots of bleeding? It depends on the location. Now it's more common for

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the larger ones who cause more symptoms because the larger ones can generate more pressure.

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And sometimes that pressure can just be frustrating, especially if that pressure is pushing on

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your bladder. Oh, yeah. It makes you have to go to the bathroom all the

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time. Exactly. That's can and it can, I would imagine, shrink the size of your

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bladder? Not not, like, literally shrink, but, like It doesn't

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allow the bladder to expand Exactly. The way your bladder is designed to expand. Yeah.

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You're exactly right. So what age does fibroids

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typically become an issue? We usually see it when patients are kinda in

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their thirties to forties, definitely in the reproductive ages. But

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it's rare that you see younger patients, like, in their twenties having major

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issues with fibroids. It's possible, but that's not the usual. And after you

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go through menopause, you said it gets better? It does. Thank goodness.

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Finally, something positive about menopause. Because we had a menopause episode. Let me

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tell you. Not not to look forward to in this that realm.

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But no more periods? I know. And that is, that is a blessing. That is

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a blessing. During pregnancy Yes. What can happen to

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women with fibroids? During pregnancy, typically, like in

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the early part of pregnancy, I would say between 10 to 20 weeks, that's when

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you see most of the growth of the fibroid before it stables out. That

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increased growth sometimes can be painful. Fibroids, they

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depend on the blood supply. And if they grow fairly quickly and

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the blood supply cannot keep up, it can cause what we call degenerative

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pain. So degenerating fibroids are pretty painful.

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Pregnancy Is it feeling like a cramp? Intensely.

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Oh, yeah. Really like a spot. Like a It's kinda like if you took a

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rubber band and you wrapped around your finger real tight. Oh. And you didn't take

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it off. Oh. Yeah. That type of pain. Yikes. Yeah.

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And so if you have, like, a giant fibroid, I mean, is there

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even room for a baby? There is. There is. It can

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lead to the baby not being lining up correctly when it's time to deliver.

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So a lot of times, we can see the baby is what we call not

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head down, so we call it non vertex. Mhmm. So fibroids

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are a risk for cesarean delivery. It also maybe sometimes

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can lead to preterm delivery. If you have really, really, really large

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fibroids, that's possible. Sometimes it can obstruct the way for the

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baby to come out. Even if baby's head down, they may not be able to

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navigate past the fibroid for vaginal delivery. Well, thank God for

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cesarean. Yes. I mean, that that solves that problem. You can

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go in. And would you take the fibroid out along with the baby? Not

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necessarily just because the amount of blood that could be lost during that time. Yeah.

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That's true. Sometimes it's necessary, but we try to avoid that if

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possible. Oh, man. So if you are have a history of fibroids

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are and you have and you know that perhaps you know that you

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have fibroids when you become pregnant, are you then a high risk pregnancy?

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It it depends on the size, and it depends on the location. I see.

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If you've had prior surgery because your fibroids, most of those patients could be high

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risk. There's a type of surgery to remove the fibroids. Sometimes you

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should not have a vaginal delivery. Alright. Well,

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let's move on to some treatment options. I

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read about something called UFE. Yes. Uterine

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fibroid embolization. What is it,

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and is it effective? It's very effective. Uterine fibro

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embolization is a technique where a specialist in radiology

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or interventional radiologists, they're able to put a catheter through

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your vein in your leg. Okay. They thread that catheter. So

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it's going through major vessels and they're locating the blood supply

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to the actual fibroid. Oh, interesting. Once they locate that blood

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supply, they're using particles to basically knock out that blood

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supply to the fibroids. What do you mean by particles? They use

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different materials and these materials actually plug the vessels.

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Interesting. So you is it a camera they're putting up through there?

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Basically, with contrast. I see. With contrast and what we

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call fluoroscopy. So it's like real time x-ray the whole

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time. With the contrast, they're able to see the vasculature. The contrast

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in my mind is ink. I know it's probably not ink. But in my mind,

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you're shooting ink into our bodies and then looking to see the contrast.

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That's that's kinda what it looks like on a monitor. Oh, right on.

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So are there any medicines that you can take to

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to shrink a fibroid? There are. There are some newer medicines. What what I

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consider to kinda be higher order medicines or advanced medical therapy

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that you can use to shrink fibroids. Most of the medicines are gonna

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focus on trying to decrease estrogen and progesterone.

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Okay. So they're gonna mess with your hormone. Hormones really do mess with everything. They

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do. What about lifestyle changes? Can you do something

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to prevent a a fibroid?

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I'm not sure if you can do something to prevent it, but you definitely can

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do things to slow down the growth. Okay. Because

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hormones do impact the growth of fibroids. If you eat a

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diet that doesn't promote increase in estrogen and progesterone,

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so, a diet that's low in red meat, a diet

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that's low in sugar, a diet Sugar promotes hormones?

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It can. Interesting. It can. It can. So if you eat a

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diet that is kind of more anti inflammatory and doesn't

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promote, hormones, extra hormones, your fibroids

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may not grow as quickly or grow as fast. Wow.

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There's a lot to unpack there. How on earth could sugar mimic,

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hormone? Or is it because you grow fat cells and fat cells

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cause more estrogen? That's just that's exactly right. That in the

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PCOS episode. And if you wanna learn about it, it's back in our catalog.

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Does exercise help with this type of thing as well? Diet and exercise

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both do help. Yes. You've told me that they're typically benign. They're

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not cancerous. Thank god. But at what point do

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you need to remove it? I mean, I assume, like, if it's making, you

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know, peeing, you know, urinating rather, the medical term,

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number 1, harder to do, you would need to get rid of it. But

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are there any other reasons that you'd want to get rid of a fibroid? You

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know, it depends on the patient's desires, and definitely, that's the

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conversation that patient will have with their doctor to kinda come up with that decision.

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I see. I think the probably the first thing to figure out is what is

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their future fertility desires. In the future,

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do they desire to have more children or are they done are they done with

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childbearing? Definitively, the one cure that we know that

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has not changed, the one cure for fibroids is removing the uterus.

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If you remove the uterus, you're not gonna have fibroids. Well, that's like a last

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ditch effort on magic. Exactly. Exactly. That doesn't work for everyone. So it's nice that

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we have the medications that we can use. Yeah. Now most of the medications aren't

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meant to be used over a lifetime, but we mentioned the ones that kind of

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interrupt decrease in estrogen and progesterone. So if you use

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ones that decrease progesterone, ones that decrease estrogen. So decrease

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in estrogen could be aromatase inhibitor. Okay. It's used in

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patients who have breast cancer. I see. Because it decreases estrogen. Okay. If you're

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decreasing your estrogen in a young patient, you're also decreasing the building blocks and need

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for healthy bones. Oh, interesting. So for a short time, you can use that, and

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it does decrease the growth of fibroids. It should decrease their bleeding and decreases their

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symptoms. You're just trying to get them to menopause. That that's a bridge. Yeah. That

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makes sense. A lot of things that we use to kinda impact the bleeding

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and also decrease the size of the fibroids is not as helpful if they

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wanna get pregnant. Yeah. No. That makes sense too because you need estrogen. Exactly.

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Exactly. So in that case, surgery, not removing the uterus, but other

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surgeries or other techniques, maybe things that you do to try to help the patient

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their symptoms so they have that future option for fertility. Interesting.

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Okay. When you say, do you have any more questions or concerns

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with a patient, do you find that self advocation

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typically gets fibroids noticed, or you're gonna find them before the

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patient is even knows to ask? And I understand

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exactly what you're saying because the usual symptoms I'm saying while most people

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present with heavy menstrual bleeding, a lot of

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patients I'm thinking they just don't talk about what's normal.

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Right. Patients are used to what's normal for them. Right. Which might be really,

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really heavy and so they may not realize they could have symptoms of fibroids.

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I think it is important to kind of just ask questions. If you have a

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question to talk to family, talk to friends, talk to your doctor because if you

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pick up on things early, I always want patients to feel like they have all

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the options but when it comes to fibroids, at some point in your

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lifetime, your options may be limited. Yeah. So it's a lot easier to

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get pregnant and have your babies when fibroids are small. But if

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you wait too late and they get to be big, then you may need assistance.

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Yeah. Maybe you may need reproduction technology to help with that or it may make

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it difficult to wear it. It may not be possible. So the earlier

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pickup on things like that, you know, hopefully, you can, you know, mitigate some of

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the impact that fibroids can cause. Yeah. So no. Don't just like,

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when you're with your friends, some people are very shy about that kind of thing.

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Yeah. But it's important to talk about these things with your friends and with your

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doctors. Don't be shy. Yes. You've seen everything, heard everything. That is

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true. Well, thank you for your time, doctor Armstrong. I really, really appreciate

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it. You're very welcome. 70 to

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80% of women will have uterine fibroids. Did you hear that?

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Yet another thing we have to deal with as women. The number one

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symptom is heavy period. So if you're bleeding a lot, don't just assume that's

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your quote, unquote normal. Ask your doctor about it. My guest today

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was doctor Michael Armstrong, and you can find him at wakemed.org.

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We would love to hear from you at wralfm

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dotcom/sarahhasquestions. We're always looking for new topics, so

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send us your ideas. May your periods be light and your

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uterus be fibroid free. See you next time.