Awareness of things feminine
The White Dress Project, dedicated to raising awareness of the condition called uterine fibroids, has designated July “Fibroid Awareness Month.” It is hoped such awareness will further the research and financial support for this condition. Like many conditions that are exclusively in women, attention to fibroids has taken some time to catch up with the attention to medical conditions that afflict all people or just men. However, in this age of specialization, specialists like Dr. Ulas Bozdogan of NYCEndometriosis have always been painfully aware of what fibroids are and what they do, which is why he has dedicated his practice to addressing the condition.
What are fibroids and what do they do?
A fibroid (“leiomyoma”) is a growth of fibrous tissue and smooth muscle in your uterus. It is not a cancer, but its very presence interferes with the normal tissues in your uterus:
- Your uterus cannot compress its normal muscle tissue to close off the openings of small blood vessels that are exposed during your period. Thus, periods become heavier due to brisker flow of blood. There is even the risk of severe life-threatening anemia, requiring transfusions.
- More bleeding means more blood collected in your uterus during your period. Since your uterus is a muscular organ, more blood means it has to “flex” stronger to force the blood out—for you, this means much more cramping and pain with your periods.
- The size of a single fibroid or that of multiple fibroids, collectively, can interfere with normal implantation of a fertilized egg, and besides causing infertility, can also increase the risk of miscarriage.
- The added weight of your uterus, normally supported by ligaments in your pelvis, causes tugging on them, creating pain where they’re inserted, e.g., lower back, inguinal areas, rectum, and vagina.
- Such increased movement also effects your bladder control, because continence is very dependent on normal anatomy; the extra weight and movement can tug on the support tissues of your sphincter, resulting in incontinence.
- The laxity of the ligaments and extra weight of your uterus, likewise, can cause pain with the mechanical action of intercourse such that sex becomes prohibitively painful, which can then secondarily affect relationships and marriage.
Who gets fibroids?
Uterine fibroids are so common that in days past they have even been considered as “normal variations” in the female anatomy. But this is a cruel disservice to women who end up with a condition which effects both quality of life and fertility. At NYCEndometriosis, you can be assured Dr. Bozdogan sees the fibroid as the serious disease it is and,unfortunately, the most common pelvic tumor there is. Fibroids are usually diagnosed during your reproductive years, but they may have been present for years before anything wrong (heavy, painful periods or infertility) was noticed. Some researchers feel a woman with fibroids may have been born with them, so small as to be imperceptible on exam or ultrasound; only after growth over the years making them big enough to be identified.
Studies vary, but is has been shown that in women aged 35-49, 59% of black women have fibroids compared with 43% of white women. These percentages have been shown to reach as high as 90% the closer to menopause a woman gets. Such a frequency is astounding, which is why it has been considered—incorrectly—as a “normal” variation. But it is not!
Luckily, many fibroids are so small as to be negligible in the day-to-day goings-on of a woman’s life. But this is also why the actual occurrence of them may be missed, making their actual presence much higher: the “invisible” affliction of fibroids.
Obstacles to adequate care based on race
The race disparity that had unfairly presented obstacles to appropriate care for black patients is especially worrisome to Dr. Bozdogan, since black women are much more prone to having fibroids than other demographic groups. This means they are more likely to suffer infertility, pelvic pain, and diminished quality of life. There is no reason to accept this, and Dr. Bozdogan is especially sensitive to this.
How are fibroids treated?
While it has been hoped that they could be shrunk hormonally, the success of this has been very disappointing. The fact is…fibroids are a mechanical problem, so they must be removed mechanically—that is, via surgery. Surgery for fibroids is a good news…bad news proposition.
The bad news: it means surgery. Also, the longer you wait, the bigger the fibroids can get and the bigger the surgery needed.
The good news: surgery today is not your mother’s surgery of yesteryear. Endometriosis specialist Dr. Bozdogan uses the same minimally invasive surgery techniques and technology for fibroids that he uses for endometriosis, that is, robotic surgery with the da Vinci robot. This realizes, for his patients, minimal incisions, minimal discomfort, faster recovery to get back to your life, and even same-day surgery.
More good news: unlike endometriosis, which is invasive and for which surgery can mean peril to normal tissues, too, fibroids are encapsulated with a membrane such that they can be “shelled” out, leaving you with as much reproductive tissue coming out of surgery as you went in with.
Ways to treat fibroids include the following
- Hysteroscopy: this is a vaginal approach that allows removal of a fibroid hanging with the uterine cavity.
- Myomectomy: this is the shelling out of individual fibroids, typically done laparoscopically, or as Dr. Bozdogan prefers, robotically.
- Hysterectomy: this is removal of your uterus, which is the final, most definitive cure for fibroids. However, with the success that myomectomy offers, it should be reserved only for women who are finished their families (childbearing). Again, Dr. Bozdogan uses robotic surgery for this as well.
- Uterine Artery Embolization: blocking the arterial supply to a fibroid by threading a catheter into a blood vessel. While this seems much less of a bodily invasion than surgery, it is not a benign procedure. It has risks of infection and a sepsis-like syndrome when all that tissue dies but remains in you. Requiring overnight stays, one must reconsider the benefits that same-day surgery offers over this method, specifically, to definitively remove the fibroid(s).
- Ultrasound: focused by Magnetic Resonance Imaging, this is reserved for smaller fibroids and can risk trauma to surrounding tissue. It is very expensive and success depends on specialized centers with vast experience in doing it.
When should fibroids be removed?
Since their main problem is occupying the space that is important to other normal tissues, the sooner the better. There are criteria for which size mandates treatment, but that goes out the window if you are symptomatic [SEE ABOVE].
Like most conditions that are affected by time (growth and progression), even if you have no symptoms you should be screened for fibroids during a well-woman GYN exam. Make an appointment today with Dr. Bozdogan of NYCEndometriosis. Your future fertility and quality of life may depend on it!