Uterine Fibroid Treatment: Different For Every Woman
By Alicia Armeli MSEd MSN RDN CHLC

UFE_P3

Although uterine fibroids are a common occurrence for many women, they’re very case specific. These benign tumors differ in location, size, and number from one individual to the next. For this reason, the therapeutic approach must reflect each unique situation in order to ensure the best possible health outcome.

Uterine fibroids can grow in any part of the uterus, whether it’s inside the uterine cavity (submucosal), within the uterine wall (intramural), or outside of the uterus (subserosal).1 2

Although the majority of fibroids grow within the intramural space, many variations are possible. “Fibroids arise from normal uterine cells which mutate and then grow in an abnormal way,” said Dr. James Spies MD MPH, Professor, Chairman and Chief of Service of the Department of Radiology at Georgetown University School of Medicine. “They’re benign tumors, but as they grow, they can cause symptoms, and these symptoms vary depending on the location of the fibroids within the uterus. They can affect everywhere from the inner portion of the uterus to the outer portion.” 

Although single or multiple fibroids can grow anywhere in the uterus, these characteristics are often a secondary issue. How deeply embedded a fibroid is within the uterus is reason for concern, especially since this particular type of fibroid has been linked to severe symptoms. “The fibroids that cause the biggest problems are typically those deep within the uterus,” Dr. Spies explains. “One woman might only have one fibroid that’s small but deep that causes significant symptoms. Another woman may have very large fibroids but in a position where they don’t cause the same kind of symptoms.”

Yet, fibroid size can’t be entirely discounted. In conjunction with depth, large fibroids can bring on severe symptoms and diminish the effectiveness of treatments. This can be an obstacle for procedures where the goal is to shrink and destroy fibroid tissue.

According to one study, after UFE treatment, fibroids shrink by approximately 45% in diameter and turn into a scar.3  Although there’s no size restriction for UFE, relatively speaking, if a fibroid is already very large upon treatment, symptoms may not improve dramatically if the entire fibroid could not be completely destroyed. In cases like this, surgical removal of the fibroid, as seen with a myomectomy, may be a sound option.4

Medications are another therapeutic point of interest, but at this time more research is needed for them to be considered an effective stand-alone treatment. “There is not a pill you can take that’s going to control the growth of fibroids or solve fibroid problems long-term,” Dr. Spies continues. And again it depends on the woman. “A woman with fibroids deep within the cavity of the uterus—usually medication alone is unlikely to solve the problem.”

Medications like contraceptives may at times be prescribed in cases with smaller fibroids to alleviate symptoms such as heavy painful periods. Others such as gonadotrophin releasing hormone (GnRH) analogues are a short-term option that may be used to help shrink fibroids before a surgical procedure.2 5

Every woman is different and because of this there isn’t an umbrella treatment protocol to follow. “There are so many variables you really can’t easily distill it down to that.” Dr. Spies clarifies. “Patient preference is a strong issue.” Whether or not a woman even wants surgery or desires to preserve her fertility are very valid concerns that need to be taken into consideration.

As with any condition, it’s important to first be properly diagnosed and learn the benefits and risks associated with each therapeutic approach. “A woman can’t self-diagnose or choose a treatment option without guidance. It takes someone who practices in the field and who is experienced to be able to get a sense of which fibroids are key and which are not and which therapies are best for her particular fibroids.”

 

ABOUT THE AUTHOR   Alicia Armeli has a Master of Science in Nutrition and Whole Foods Dietetics (MSN/DPD) and is a Registered Dietitian Nutritionist, a Certified Dietitian, and a Holistic Life Coach. In addition to writing, she enjoys singing, traveling abroad and volunteering with her local animal shelter.

ABOUT THE DOCTOR   James Spies is the Chairman, Chief of Service, and a Professor of the Department of Radiology at Georgetown University School of Medicine. He is an interventional radiologist whose primary clinical and research interest is in uterine embolization for fibroids. His specialty is in radiology and his special interests include uterine artery embolization and gynecologic intervention.

REFERENCES

  1. US Department of Health and Human Services, Office On Women’s Health. (2015). Uterine fibroids fact sheet. Retrieved April 21, 2015, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html?from=AtoZ
  1. King, R., & Overton, C. (2011). Management of fibroids should be tailored to the patient. The Practitioner, 255(1738): 19-23, 2-3.
  1. Lee, M. S., Kim, M. D., Jung, D. C., Lee, M., Won, J. Y., Park, S., Lee, D. Y., & Lee, K. (2013). Apparent diffusion coefficient of uterine leiomyoma as a predictor of the potential response to uterine artery embolization. Journal of Vascular and Interventional Radiology, 24(9): 1361-1365. doi:10.1016/j.jvir.2013.05.054
  1. (2014). When is a myomectomy better than a uterine fibroid embolization (UFE)? Retrieved April 20, 2015, from http://ask4ufe.com/videos/when-is-a-myomectomy-better-than-a-uterine-fibroid-embolization-ufe/
  1. Segars, J. H., Parrott, E. C., Nagel, J. D., Guo, X. C., Gao, X., Birnbaum, L. S., Pinn, V. W., & Dixon, D. (2014). Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations. Human Reproduction Update. doi:1093/humupd/dmt058

Fibroid Risk Factor: Obesity
By Alicia Armeli MSEd MSN RDN CHLC

ObesityBlog

Uterine fibroids are the most common tumor among women in their reproductive years with some studies reporting 20-80% of women developing fibroids by age 50.1,2 Given the widespread prevalence of these tumors, it’s important to be familiar with the risk factors involved.

Women who possess a hereditary link, who are African American, or who are within their reproductive years are at an increased risk for developing fibroids.2 Although we have no control over things such as our DNA or the number of candles on our birthday cake, there’s a risk factor that wasn’t mentioned; one that’s considered preventable—obesity.

Obesity and the Risk of Uterine Fibroids
According to the US Department of Health and Human Services, obesity refers to excess fat on the body. A person’s body mass index (BMI) is used to measure whether an individual’s weight correlates with his or her height. When a person has a high BMI, or is considered obese, it’s most commonly linked to the amount of fat on his or her body.3

The risk of uterine fibroids is two to three times greater in women who are obese.2
Studies have found that women with higher BMIs—particularly carrying excess fat in the abdominal area and having a body fat percentage of over 30%—were at an increased risk for fibroids.1

What Is the Connection Between Excess Fat and Fibroids?
Uterine fibroids are believed, in part, to be a hormone-related disease.4 Rates of uterine fibroids are seen to decline after menopause but some studies report that fibroids afflict women of all ages and more so in those who are obese—even after menopause.4,5

Obesity has been linked to higher rates of circulating estrogen and its production.6 For example, in premenopausal women, anovulatory menstrual cycles can happen more frequently. This causes prolonged amounts of time where estrogen is present without the compensatory effects of progesterone.7

Additionally, in obese individuals there’s found to be less serum hormone-binding globulin (SHBG) proteins that attach to sex hormones. When this occurs, it leaves more estrogen to circulate unbound and active. Obesity can also cause changes in estrogen metabolism and disruption in the communication between cells in the uterine wall, both of which can cause abnormally high estrogen levels.8

After menopause, obesity increases the amount of circulating estrogens due to estrogenic hormones produced by excess fat tissue.7

This definitely poses a problem but the solution also lies within.

What Can I Do?
Even a small amount of gradual weight loss, approximately 5-10% of your body weight, has been seen to lower the risk of chronic disease. This means if you weigh 200 pounds, losing 10-20 pounds could make a world of difference in the realm of prevention.9

Could it also help to decrease estrogen levels? A study published in the Journal of Clinical Oncology observed whether a weight-loss diet, an exercise plan, or combined diet and exercise would have any effect on estrogen and SHBG levels among postmenopausal women.10

Results showed after one year, diet was clearly effective but diet and exercise combined had the greatest effect on weight loss and hormone levels. Average weight loss with diet and exercise together saw an 11.9% reduction. Estrone and estradiol levels decreased by 11.1% and 20.3% respectively. Moreover, SHBG levels increased 25.8%. The authors of the study concluded that losing more weight had a greater effect on hormone levels.10

Slowly making small lifestyle changes can help with weight loss, uterine fibroid relief, and overall wellness. Talk to your doctor today about how healthy and sustainable weight loss can help you take control.

 

ABOUT THE AUTHOR Alicia Armeli has a Master of Science in Nutrition and Whole Foods Dietetics (MSN/DPD) and is a registered dietitian nutritionist, a certified dietitian, and a holistic life coach. In addition to writing, she enjoys singing, traveling abroad, and volunteering with her local animal shelter.

REFERENCES
1. Yang, Y., Yuan, H., Zeng, Q., & Li, S. Association of body size and body fat distribution with uterine fibroids among Chinese women. Journal of Women’s Health, 23(7): 619-626. doi:10.1089/jwh.2013.4690
2. US Dept of Health and Human Services, Office on Women’s Health. (2015). Uterine Fibroids Fact Sheet. Retrieved April 14, 2015, from http://www.womenshealth.gov/publications/our-publications/fact-sheet/uterine-fibroids.html?from=AtoZ
3. US Department of Health and Human Services, National Institute of Diabetes and Digestive and Kidney Diseases. (2012). Overweight and Obesity Statistics. Retrieved April 14, 2015, from http://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx
4. Khan, A. T., Shehmar, M., & Gupta, J. K. (2014). Uterine fibroids: current perspectives. International Journal of Women’s Health, 6: 95-114. doi: 10.2147/IJWH.S51083
5. Sommer, E. M., Balkwill, A., Reeves, G., Green, J., Beral, D. V., & Coffey, K. (2015). Effects of obesity and hormone therapy on surgically-confirmed fibroids in postmenopausal women. European Journal of Epidemiology. doi 10.1007/s10654-015-0016-7
6. Sarwer, D. B., Spitzer, J. C., Wadden, T. A., Rosen, R. C., Mitchell, J. E., Lancaster, K., Courcoulas, A., Gourash, W., & Christian, N. J. (2013). Sexual functioning and sex hormones in persons with extreme obesity and seeking surgical and non-surgical weight loss. Surgery for Obesity and Related Diseases, 9(6). doi: 10.1016/j.soard.2013.07.003
7. Van den Bosch, T., Coosemans, A., Morina, M., Timmerman, D., & Amant, F. (2012). Screening for uterine tumours. Best Practice & Research Clinical Obstetrics & Gynaecology, 26(2): 257-266.
8. He, Y., Zeng, Q., Dong, S., Qin, L., Li, G., & Wang, P. (2013). Associations between uterine fibroids and lifestyles including diet, physical activity and stress: a case-control study in China. Asia Pacific Journal of Clinical Nutrition, 22(1): 109-117.
9. Centers for Disease Control and Prevention. (2011). Losing Weight. Retrieved April 15, 2015, from http://www.cdc.gov/HEALTHYWEIGHT/LOSING_WEIGHT/INDEX.HTML
10. Campbell, K. L., Foster-Schubert, K. E., Alfano, C. M., Wang, C., Wang, C., Duggan, C. R., Mason, C., Imayama, I., Kong, A., Xiao, L., Bain, C. E., Blackburn, G. L., Stanczyk, F. Z.,  & McTiernan, A. (2012). Reduced-calorie dietary weight loss, exercise, and sex hormones in postmenopausal women: randomized controlled trial. Journal of Clinical Oncology, 30(19): 2314-2326. doi:  10.1200/JCO.2011.37.9792