Dr. John H. Rundback discusses the prevention, symptoms, and treatment of uterine fibroids

Dr. John H. Rundback discusses the prevention, symptoms, and treatment of uterine fibroidsUterine fibroids are noncancerous growths that develop in the muscle cells of the uterus. Women frequently present with symptoms in their late 30s or early 40s and the symptoms can be debilitating. Dr. John H. Rundback, one of the nation’s most respected and admired interventional radiologists, answered the following questions to help women prevent uterine fibroids, recognize the symptoms, and evaluate their treatment options.

Q: What are uterine fibroids?

A: Uterine fibroids occur in women. They are benign growths of the muscle layer of the uterus which are stimulated by estrogen. Even though fibroids are benign—the possibility that a fibroid is malignant or dangerous is extraordinarily low—they can cause numerous problems. This is predominantly because they have a rich blood supply. So each month, when a woman has her period, the fibroid can get exposed to the inner lining of the uterus and cause heavy or prolonged bleeding, excessive clotting, and/or frequent spotting in between periods.

Q: How common are uterine fibroids? What are the symptoms?

A: Fibroids are extraordinarily common and often asymptomatic. One in four women have fibroids, and up to 40 percent of African-American women have fibroids. Fibroids are fueled by estrogen, so when women reach menopause, their fibroids generally shrink and are not relevant. However, for some women who are menstruating and producing estrogen, fibroids can be very symptomatic. Each month fibroids can result in heavy bleeding, prolonged bleeding around periods, excessive clotting, and/or frequent spotting in between periods. Because fibroids are often large and numerous, they cause what we call bulk symptoms. These symptoms include pain, urinating frequently and urgently, bloating, and increased abdominal size. For example, women may notice an increase in their pant size. They may also experience discomfort during sexual activity, low back pain, and constipation. These symptoms can be related to the size of the fibroid(s) or pressure internally from them.

Q: If a woman is not showing symptoms, how is she diagnosed with uterine fibroids?

A: Most women who are of childbearing age or are menstruating go to the gynecologist with normal gynecologic health. Oftentimes annual exams or routine ultrasounds performed through the abdominal wall or transvaginally, detect fibroids. Fibroids can also be found during pregnancy evaluations. The truth is if they are small and not causing any symptoms or fertility issues, fibroids can be observed.

Q: Are there ways to reduce the symptoms of uterine fibroids?

A: Fibroids very often are not symptomatic. However if a woman is experiencing symptoms there’s not much to do, per se, in terms of alleviating the symptoms. If they are tolerable, a patient will be advised to maintain regular gynecologic health together with exercise and a healthy diet.

Q: Are there certain foods you recommend for women with uterine fibroids?

A: Yes, I have developed a fibroid prevention food plan. The plan focuses on detoxification, the lowering of estrogen levels, and hydration.

To help the liver detox and get rid of excess estrogen, a diet high in cruciferous vegetables is recommended. Sources include broccoli, cabbage, bok choy, kale, and turnip. Be sure not to overcook these vegetables so you don’t lose the health benefits.

The plan also focuses on foods that detoxify the blood such as garlic, carrots, beets, and artichokes, and foods with natural beta carotenes such as apricots, sweet potatoes, cantaloupe, carrots, pumpkin, and spinach.

It’s critical to drink plenty of water and keep the body hydrated. Green tea, which counteracts the effects of estrogen and lowers inflammation can also be beneficial. Black cohosh is an herb that might be beneficial as well.

Just as important as eating the right foods and staying hydrated is avoiding foods and beverages that increase estrogen. These include alcohol, animal fats such as red meat, soy-containing products, whole milk (choose low-fat milk instead), and artificial sweeteners.

Most importantly, for general health as well as to reduce inflammation, which can increase the inflammatory symptoms of fibroids, take a good daily multivitamin. Be sure the multivitamin is rich in B and C vitamins to help reduce the inflammation and pain associated with fibroids. In addition to a multi-vitamin, incorporate Omega-3 fatty acids found in oily fish or supplements. Foods rich in vitamin E including almonds, wheat germ, hazelnuts, and cod liver oil are also recommended.

And finally, exercise is really critical to the health and to prevent symptoms brought on by fibroids.

Q: What are the treatment options if the symptoms of uterine fibroids become intolerable?

A: When a woman who has symptomatic fibroids requires treatment, particularly for heavy bleeding or the bulk symptoms, there are a number of options.

One of these options, which I’ve been performing for more than 20 years, is Uterine Fibroid Embolization. This is a very effective and well-proven, minimally invasive treatment for women with fibroids. Fibroids are extraordinarily vascular, they have a rich blood supply—and that’s part of the problem. That means each month, when a woman has her period, the inner lining of the uterus passes and the fibroids get exposed, which results in heavy bleeding. Uterine Fibroid Embolization takes advantage of this rich blood supply by stopping and blocking the blood supply to the fibroids. The medical name for blocking the blood supply is embolization. Since we’re blocking the blood supply to the fibroids, which are located in the uterus, we call the procedure Uterine Fibroid Embolization or UFE.

Uterine Fibroid Embolization is a minimally invasive, non-surgical outpatient procedure. In most cases, Uterine Fibroid Embolization results in fewer complications, shorter recovery, and less discomfort than surgical options. Because there’s essentially no mark that’s made, there’s no indication that the procedure has been done. Uterine Fibroid Embolization is not disfiguring in any way.

Q: How is Uterine Fibroid Embolization done?

A: We work from the artery by the hip. If a woman is in the shower, you can feel the pulse by her hip—that’s where we would enter the artery. We prepare and sterilize the area and numb it up with Novocain. We generally administer a little bit of intravenous sedation as well. Even though we do this procedure every day, we understand that a Uterine Fibroid Embolization can be daunting and scary. A little bit of sedation, just to take the edge off, is all that’s necessary. Uterine Fibroid Embolization does not require general anesthesia.

Once the skin is numbed up, we place a very small plastic catheter in the artery, think of a catheter as a thin piece of spaghetti with a hollow center—like a long plastic tube. The catheter is threaded through the arteries. Women don’t feel this step as there are no nerve endings inside the blood vessels. Along the way, we inject X-ray dye and take pictures. This is called an angiogram. It shows us the arteries supplying the fibroids with blood, first on the right and then on the left. We’re then able to feed specialized material through the catheter to block those arteries. The material is made specifically to block the blood supply to the fibroids, stop the bleeding, block the estrogen, and cause the fibroids to shrink. The procedure takes, generally, about 30 minutes. That’s the embolization process.

Q: What’s the recovery from Uterine Fibroid Embolization like?

A: Afterwards women are observed for one to two hours and then they can go home. There’s some discomfort and cramping after the procedure because the fibroids immediately begin to shrink. The first night will be the most uncomfortable and then the discomfort will begin to taper off within one week. We do prescribe pain medication. While there is some discomfort, it’s important to point out that any pain is far less than what would be expected with surgery. The recovery is generally very tolerable and the results are fabulous.

Q: What are the long-term results from Uterine Fibroid Embolization?

A: I like to joke that I do this procedure for the hugs! The reason I say this is because women are incredibly strong. They don’t even realize since these symptoms come on gradually and they learn to tolerate them, that the symptoms have become part of their day-to-day life. After we perform the Uterine Fibroid Embolization, we follow up with our patients at the six-month mark. We get a lot of hugs because most women don’t even realize how incapacitated they were until they start to feel better and their quality of life changes dramatically after the procedure.

Q: What can a patient expect the day of her Uterine Fibroid Embolization? How can she prepare?

A: First of all, expect a very pleasant staff at American Endovascular. We’re here to help and make each patient comfortable. Our patient will put on a gown and be hooked up to an IV so we can administer sedation during the procedure. Even though we numb the skin and there’s not a whole lot of discomfort, we still want women to be comfortable and take away some of the nervousness which we expect during the procedure. We may ask our patient to use the bathroom and we may shave the area over the hip, generally on the right side.

Once we get into the room, we administer a little sedation through the IV, we’ll again clean the skin over the artery by the hip, and numb it up with some Novocain—just like the dentist’s office.

Q: What else is important for patients to know about Uterine Fibroid Embolization?

A: I think the most important thing is for women to know their options. There are a number of treatments available—both for women of childbearing age and for women who no longer wish to have children. It’s important when a woman visits her gynecologist that she is aware and familiar with all options whether she conducts online research or speaks with her physician.

For example, other options include myomectomy, which is a surgical procedure to remove fibroids in women who still want to have children; hysterectomy which is the removal of the uterus, with or without removal of the ovaries, in women who no longer wish to have children; and endometrial ablation which is a procedure generally performed in the gynecologist’s office in which a catheter is inserted transvaginally into the uterus to basically heat up the lining of the uterus and disrupt the fibroids. There’s also a procedure called Exablate which is an ultrasound or an MRI-guided system that focuses on the high-intensity ultrasound on the fibroid.

The reason I say it’s important to be familiar with all options is that very often doctors outline the procedures that they’re comfortable with and not necessarily all the options. This makes it impossible for a woman to select the option that’s ultimately best for her. Treatment of fibroids, like all facets of a woman’s health, is a very personal decision. The more a woman knows, the better she can make a good, informed decision about what works best for her health.

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