Can UFE Treat Pedunculated Subserosal Fibroids?
Alicia Armeli

Pedunculated Subserosal Fibroid UFE

Uterine fibroid embolization (UFE) is a well-established, minimally invasive fibroid treatment that’s recommended for select women who want to retain their uterus. Improving -related symptoms in 85%­­­­­–90% of women treated, UFE targets fibroids of different sizes and locations in the uterus, relieving symptoms like heavy periods, pelvic pain, and urinary dysfunction.1 Watch a helpful video about how the UFE procedure works.

And yet, despite these advantages, whether UFE should be used to treat pedunculated subserosal (PS) fibroids—a type of fibroid that grows on a stalk on the outer uterine wall—is still debated. Research has shown a very low risk—only three major complications related to treating PS fibroids with UFE have been reported2-4 —that involves a PS fibroid separating from the uterus, causing infection and subsequent sepsis if not naturally discharged from the body.5 To better address concerns, researchers at Yonsei University College of Medicine in Seoul, Korea, evaluated UFE’s treatment of PS fibroids and found it to be safe and effective even in cases considered high risk.5

“More data on [UFE] for PS [fibroids] may help in making better treatment recommendations,” the researchers write in the Journal of Vascular and Interventional Radiology study.5

The 9-year study enrolled 55 women with PS fibroids who underwent UFE.5 Researchers labeled each PS fibroid by risk, depending on the thickness of the fibroid stalk: High-risk PS fibroids have thinner stalks, whereas low-risk PS fibroids have thicker stalks. Three months following UFE, the women had MRIs to measure how well the procedure worked. Any complications were also noted.

Results showed that over 96% of the women experienced symptom improvement.5 Minor complications occurred in three women and included fibroid expulsion—or the passing of fibroids from the body—and temporary pelvic pain. None of the women had major complications related to PS fibroids.

“This report dismisses the commonly held idea that [UFE] in patients with PS fibroids is associated with unique and significant risk of complications,” the researchers conclude. “[UFE] is safe and effective even in PS [fibroids] having extremely narrow stalks.”5

Because this study had a relatively short follow-up period of 3 months, “the university maintains a website where patients can report complications over the long term. However, the researchers note that complications related to PS fibroids haven’t been reported.

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English education and nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES

  1. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  2. Braude, P., Reidy, J., Nott, V., et al. (2000). Embolization of uterine leiomyomata: Current concepts in management. Hum Reprod Update, Nov-Dec;6(6):603–608.
  3. Tropeano, G., Amoroso, S., Di Stasi, C., et al. (2014). Incidence and predictive factors for complications after uterine leiomyoma embolization. Hum Reprod, Sep;29(9):1918–1924.
  4. Ravina, J., Aymard, A., Ciraru-Vigneron, N., et al. (1998). Embolisation artérielle particulaire: Un nouveau traitement des hémorragies des léiomyomes utérins. Presse Med, 27(9):299–303.
  5. Kim, Y. S., Han, K., Kim, M. D., et al. (2018). Uterine artery embolization for pedunculated subserosal leiomyomas: Evidence of safety and efficacy. J Vasc Interv Radol, Apr;29(4):497-501.

Meet UFE Pioneers Who Are Still Fighting for Your Uterus
It's been more than two decades since the first UFE, and the fight for awareness continues.

UFE Fibroid Pioneers Header

More than 20 years ago, the first uterine fibroid embolization (UFE) was performed in the U.S. for the treatment of uterine fibroids.1 Although an effective alternative to hysterectomy, this uterine-sparing, minimally invasive option was first met with some skepticism by the medical community. Since then, UFE has grown in popularity—but not without a fight.

Even today, uterine fibroids remain the number one reason women have a hysterectomy.2,3 To understand the struggle to get UFE on the list of possible treatment options for more women who suffer with fibroids, we spoke with two interventional radiologists who’ve advocated for UFE since day one.

“My initial experience with UFE was in the late-1990s working with the group of doctors at UCLA who first started performing the procedure,” explains Richard A. Reed, MD, interventional radiologist at Huntington Hospital in Pasadena, Calif. “Women were coming from all over the country, even outside of the country, to be treated. They wanted to avoid hysterectomy at all costs.”

UFE was a real game-changer for women who were told surgery was their only option for relief. Unlike hysterectomy that surgically removes the entire uterus, UFE allows women to be treated through a tiny puncture in the groin area. And currently, access site options have expanded to include being treated via the wrist.

Under conscious sedation, the UFE procedure begins with a doctor called an interventional radiologist inserting a catheter (thin tube) into the access site. Using specialized x-ray equipment, the catheter is guided to the uterine arteries that supply fibroids with blood. Tiny particles are then released that block blood flow to the fibroids, causing them to shrink over time and symptoms like heavy, painful periods to resolve.

“My actual first experience with UFE was as a patient. I was one of the first UFE patients at University of Southern California in 2001. After UFE, my symptoms resolved and never recurred,” recalls M. Victoria Marx, MD, FSIR, professor of clinical radiology at the Keck School of Medicine of University of Southern California in Los Angeles, Calif., and president of the Society of Interventional Radiology (SIR). “Shortly after that is when I performed my first UFE, and I’ve treated many patients over the years.”

As time went on, UFE was gaining awareness but was still viewed by the general medical community as new and investigative. This unfamiliarity often led to health insurance companies denying patients coverage for the procedure. “Many women were willing to pay cash to have the procedure done,” Dr. Reed tells Ask4UFE. “To help these patients, I met with the boards of several insurance companies who made decisions about whether procedures were considered investigational. Fortunately, around the early 2000s, most insurance companies were covering the procedure.”

According to both doctors, another major resistance point came from gynecologists. Along with hysterectomy, gynecologists are trained to perform myomectomy, a procedure that surgically removes fibroids from the uterus. UFE, on the other hand, is only performed by interventional radiologists, who specialize in nonsurgical procedures that treat disease by targeting specific blood vessels.

“For conditions like fibroids, the traditional source of information is a woman’s gynecologist, with whom she typically has a long relationship,” Dr. Marx says. “It has been a challenge because UFE is a treatment for a gynecologic condition that has come out of a completely different field of medicine.”

In 2008 the American College of Obstetricians and Gynecologists released a statement based on long- and short-term data that said UFE is a safe and effective option for women who want to keep their uteri and who are appropriate candidates for the procedure.4 According to Dr. Reed, despite this statement and its numerous clinical benefits, some gynecologists still don’t inform their patients about UFE.

To reach the patient community directly, interventional radiologists often get creative in their approach. Along with community women’s health talks, Dr. Marx and Dr. Reed used the power of the media to spread the word. “Our hospital worked with the LA Times and other local papers to do articles about the procedure,” Dr. Reed recalls.

“At the time, I was chairman of the SIR public relations committee, and I called our public relations consultant,” Dr. Marx adds. “She put me in touch with The Today Show, and I appeared with Katie Couric talking about UFE. It wasn’t all streaming like it is today, but UFE did get national airtime.”

And national airtime it deserved. UFE is a uterine-sparing, outpatient procedure that improves fibroid-related symptoms like heavy periods, pelvic pain, and urinary dysfunction—all with a nearly 90% success rate.5 In comparison to hysterectomy, UFE has virtually no blood loss and allows women to recover faster with a lower complication rate.6 Although the UFE procedure itself has changed little over the years, advances in pain management protocol and imaging techniques have only furthered UFE’s reputation as an effective, minimally invasive fibroid treatment option.

Given these advantages, it’s shocking to see that 600,000 hysterectomies are performed annually in the US, with the majority done to treat fibroids.2,7 What’s more, a recent Harris Poll surveying over 1,100 women found that among those diagnosed with fibroids, a staggering 44% had never heard of UFE.8 “We need to continue to educate women through community health talks and encourage gynecologists to offer UFE as an option,” Dr. Reed says. “When comparing fibroid-related symptom relief, UFE is comparable to the surgical options.”

“The ideal setting is where doctors of all specialties work together, offer all options, and advise the patient on which treatment is best for her,” Dr. Marx continues. “UFE is a highly researched fibroid treatment. It’s very effective and can help women get back to their normal lives with minimal down time.”

Although the road to widespread UFE awareness has been long, progress is being made. Large studies comparing the long-term clinical outcomes of UFE and different fibroid treatment options have provided valuable information. For example, 10-year outcomes of the EMMY Trial, a landmark trial that compared UFE with hysterectomy, showed that health-related quality of life after both procedures remained comparably stable and that in about two thirds of patients treated with UFE, a hysterectomy was avoided.9

A national registry to collect information from women undergoing fibroid treatment is also currently underway. Conducted by researchers at Duke University, “Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF),” is following 10,000 women from nine medical centers in the U.S. for about three years as they make decisions about their fibroid treatment.10 Researchers will use the registry information to compare treatment options and their ability to provide symptom relief, preserve reproductive function, and achieve patient needs and preferences.11 The goal is to help patients and clinicians make informed decisions about fibroid treatment.10

Given this progress, perhaps over the next 20 years, the vision of doctors working together to offer women the best fibroid care can become a reality.

 ABOUT THE DOCTORS

Victoria Marx, MD, FSIRis a professor of clinical radiology at the Keck School of Medicine of University of Southern California in Los Angeles, Calif., and president of the Society of Interventional Radiology (SIR). In addition to these positions, Dr. Marx leads an active clinical practice where collaboration of fibroid care is offered.

 Richard A. Reed, MD, is an interventional radiologist at Huntington Hospital in Pasadena, Calif. One of the first physicians in the US to perform UFE, Dr. Reed advocates for UFE public awareness and works to ensure women know all their fibroid treatment options.

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES

  1. Goodwin, S. C., Vedantham, S., McLucas, B, et al. (1997). Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol, Jul-Aug;8(4):517-526.
  2. The American College of Obstetricians and Gynecologists. (2015, Mar). Hysterectomy. Retrieved from https://www.acog.org/Patients/FAQs/Hysterectomy
  3. Broder, M. S., Kanouse, D. E., Mittman, B. S., et al. (2000). The appropriateness of recommendations for hysterectomy. Obstet Gynecol; 95:199-205.
  4. The American College of Obstetricians and Gynecologists. (2008, Aug). ACOG Practice Bulletin—Alternatives to Hysterectomy In the Management of Leiomyomas. Retrieved from http://www.mintir.com/page/pop_page1.pdf
  5. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  6. Spies, J. B., Cooper, J. M., Worthington-Kirsch, R., et al. (2004). Outcome of uterine embolization and hysterectomy for leiomyomas: Results of a multicenter study. Am J Obstet Gynecol, Jul;191(1):22-31.
  7. Centers for Disease Control and Prevention. (2017, Nov 20). Data and Statistics (Hysterectomy). Retrieved from https://www.cdc.gov/reproductivehealth/data_stats/index.htm
  8. Society of Interventional Radiology. (2017, Aug 29). The Fibroid Fix: What Women Need to Know. Retrieved from https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/patient-center/fibroid/sir_report_final.pdf
  9. de Brujin, A. M., Ankum, W. M., Reekers, J. A., et al. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol, Dec;215(6):745.e1-745.e12.
  10. Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF). (n.d.). Home. Retreived from http://www.compare-uf.org
  11. 11. U.S. National Library of Medicine. (2018, Feb 22). Patient Centered Results for Uterine Fibroids (COMPARE-UF). Retrieved from https://clinicaltrials.gov/ct2/show/NCT02260752

5 Self-Care Tips for Women with Uterine Fibroids

Practicing self-care is essential for a woman’s mental, emotional, and physical well-being. And yet, a recent Jean Hailes Women’s Health Survey found that more than one in four women aged 36-50 don’t get enough time to themselves each month.1 Between demands at work and home, finding that “me time” can be tough. It gets even more complicated if you’re a woman with uterine fibroids—a condition where the concept of self-care extends far beyond the occasional candlelit bath.

Uterine fibroids are the most frequently seen tumors of the female reproductive system.2 They become more common as women age, especially during the 30s and 40s through menopause—a time when self-care is so often placed on the back burner.3 It’s predicted that by age 50, up to 80% of women will develop fibroids.3

We sat down with Linda Bradley, MD, OB/GYN and professor of surgery, vice chair of the OB/GYN & Women’s Health Institute, and director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio, to discuss self-care tips that can keep women with fibroids healthy.

1. See Your Gynecologist Regularly

According to Dr. Bradley, this piece of advice is for all women with fibroids—with or without symptoms. “Staying in contact with your gynecologist will help monitor your fibroids and the development of any symptoms,” Dr. Bradley explains. “For women already with symptoms, it’s a good idea to see your gynecologist regularly to talk about improvement, no improvement, or worsening of symptoms.”

Open dialogue between gynecologists and patients can help to establish a partnership in care, which is especially important when discussing all available fibroid treatment options.

2. Keep a Symptom Journal

Fibroids are most commonly known for heavy, prolonged periods. As fibroids grow, a woman may also notice her belly getting larger. This growth can press on surrounding organs, like the bowel and bladder, resulting in constipation or urinary frequency. Other symptoms may include a chronic watery discharge and fertility issues.

Symptom journaling is a useful tool that can help a woman keep track over time of how she feels. By journaling symptoms with dates, it’s easier to be clear with your gynecologist about what you’re experiencing. “It’s important to notice trends,” Dr. Bradley clarifies. “If a woman has noticed her periods lasting longer or that she’s having increased discomfort and missing work, taking a moment to journal those dates and changes can help her be more objective with her doctor.”

3. Get Creative in the Kitchen

With blogs floating around encouraging women with fibroids to eat this and not that, it can get a bit confusing. Research has shown that eating a diet high in fruits and vegetables may be protective against fibroids—but to date we don’t have studies that definitively support any particular diet as a clear path to fibroid prevention or cure.4,5 “To put it simply, a healthy diet is good for everyone,” Dr. Bradley says.

Taking time to prepare a nutritious meal can count as self-care for both body and mind. Not only does cooking healthy meals at home help to ensure a diet full of the nutrients your body needs, it can also serve as a major stress reliever. Culinary therapy, or harnessing the calming therapeutic power of cooking, is now being used as part of treatment plans for conditions like anxiety and depression.6 And the best part? After all of the mindful meal prep, there’s always a delicious and nutritious meal that follows.

4. Move Your Body

Just like carving out the time to cook healthy meals, engaging in regular exercise can be a self-care practice that may help women with fibroids in several ways.

“Exercise may help with pain, cramping, and bloating,” Dr. Bradley says. “It can also help maintain a healthy weight.” Research suggests that being obese or overweight may potentially increase the risk of fibroids, so when it comes to weight management, both diet and exercise are important.

5. Find Ways to Reduce Stress

In addition to the physical symptoms fibroids may cause, the emotional toll they take can be a lot to handle and may impact other areas of well-being. “Fibroids can be quite symptomatic, and the stress that may follow can lead to poor sleep hygiene,” Dr. Bradley explains. “Without good sleep, it can be difficult for patients to deal with life’s uncertainties.”

Lack of sleep and the inability to cope may then contribute to an ongoing cycle of stress.

The American Institute of Stress explains in a recent blog that not getting enough sleep puts the body under additional stress, triggering an increase in stress hormones during the day.7 To help stay balanced, Dr. Bradley encourages self-care routines that include mindfulness practices, such as yoga, spirituality, and therapy.

Above all, it’s essential to notice if your periods are the source of your stress. “Menstruation can be a nuisance, but it should never interrupt a woman’s life or cause social embarrassment with bleeding through clothing. That’s not normal,” Dr. Bradley explains. “Patients get used to tolerating symptoms, but normal cycles shouldn’t derail your activities. It’s important to talk with your doctor to understand what’s normal and seek out the right care.”

ABOUT THE AUTHOR Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and well-being. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR  Linda Bradley, MD, is an internationally recognized gynecologic surgeon, professor of surgery, vice chair of the OB/GYN & Women’s Health Institute, and director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. As founder of the Celebrate Sisterhood program, Dr. Bradley is dedicated to empowering multicultural women to take charge of their health and embrace self-care.

REFERENCES

  1. Jean Hailes for Women’s Health. (2018). Women’s health survey 2018. Retrieved from https://jeanhailes.org.au/contents/documents/News/Womens-Health-Survey-Report-web.pdf
  2. UCLA Health. (n.d.). Fibroids. Retrieved from http://obgyn.ucla.edu/fibroids
  3. S. Department of Health & Human Services, Office on Women’s Health. (2018, Mar 16). Uterine fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
  4. Chiaffarino, F., Parazzini, F., La Vecchia, C., et al. (1999). Diet and uterine myomas. Obstet Gynecol, Sep;94(3):395-398.
  5. He, Y., Zeng, Q., Dong, S., et al. (2013). Associations between uterine fibroids and lifestyles including diet, physical activity and stress: A case-control study in China. Asia Pac J Clin Nutr, 22(1):109-117.
  6. Wasmer Andres, L. (2015, May 19). Kitchen therapy: Cooking up mental well-being. Retrieved from https://www.psychologytoday.com/us/blog/minding-the-body/201505/kitchen-therapy-cooking-mental-well-being
  7. The American Institute of Stress. (2018, Jul 9). 10 tips to boost your vitamin Z—sleep strategies. Retrieved from https://www.stress.org/10-tips-to-boost-your-vitamin-z-sleep-strategies/

The content in this article is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of a qualified physician regarding any medical questions or conditions. 

Radiologists Travel to Kenya to Provide Women with Life-Saving UFE


It’s well documented in medical literature that women of African descent develop uterine fibroids five to six years earlier and are more than 5 times as likely to have severe symptoms than Caucasian women of a similar family history.1

With the increasing number of women requiring fibroid treatment, hospitals in Kenya have welcomed international doctors to treat their patients with uterine fibroid embolization (UFE).

In July 2018, Dr. Darren Klass, interventional radiologist with Vancouver Coastal Health in Vancouver, British Columbia, Canada, traveled to Kenya with Merit Medical Systems Inc.—sponsor of Ask4UFE—to educate Kenyan gynecologists and radiologists on this uterine-sparing, minimally invasive option. By providing one-on-one UFE training to gynecologists—the doctors responsible for referring patients to radiologists for treatment—they can start recommending and providing this option to their patients.

In an intensive 10 days, Dr. Klass hosted a number of UFE training courses to several clinical teams in Karen and Kenyatta National Hospital in Nairobi and Aga Khan in Mombasa. Patients were also scheduled to undergo UFE in both cities. To help make this treatment possible, Merit Medical donated a portion of the embolic particles used for UFE procedures, called Embosphere® Microspheres. Dr. Klass observed and trained the clinical teams while they treated their own patients.

Traditionally, UFE has been performed through the femoral artery in the groin area. However, UFE can now be done via the radial artery in the wrist—a technique known as transradial access. This approach proved to be an eye-opener to both the Kenyan interventional radiologists and their clinical teams. Doctors observed how their patients were able to move and walk immediately post UFE and how patients could make themselves comfortable without having to lay still on their backs, which is required with femoral UFE.

All of the clinical skills taught and the education provided proved especially useful on the eve of the final day in Mombasa. Following a long day of training, Dr. Klass was called by a gynecologist to discuss an emergency case. A bedside consultation was done together with the referring gynecologist at around 8pm. The patient underwent a successful UFE procedure the following day and was discharged 24 hours post UFE. In this particular case, due to extenuating patient circumstances, UFE provided not only a uterine-sparing therapy for symptomatic fibroids but also a life-saving option. This experience was more than enough to show referring gynecologists that UFE is an effective fibroid treatment option. The gynecologist presented the case to an audience of doctors at a weekly Kenyan Medical Association meeting the night following the procedure.

The skills learned by the Kenyan radiologists can have a far-reaching impact, even beyond UFE. Because of the training with Dr. Klass, radiologists in both Mombasa and Nairobi can now also perform embolization for post-partum hemorrhage. Statistics show that 6,300 women die in Kenya each year during pregnancy and childbirth.2 A 2015 Kenyan policy document reported the maternal mortality rate at over 2,000 per 100,000 live births in North Eastern Kenya, and 212 per 100,000 live births in Nairobi, with hemorrhage accounting for 44% of those deaths.2

“Post-partum hemorrhage is an avoidable complication of childbirth and providing the radiologists here with the ability to treat this devastating complication with an effective therapy will hopefully have a dramatic impact on this shocking statistic,” Dr. Klass explains.

The time spent in Kenya was brief, but the main objective was achieved. Kenyan doctors can now provide these essential services to women.

“I arrived here wanting to improve the lives and care of women in Kenya,” Dr. Klass tells Ask4UFE. “I am pleased that by training radiologists in Kenya to perform this life-changing procedure, I saw this happening. Every single person I met in Kenya was grateful for the purpose of this trip.”

REFERENCES
1. Huyck, K. L., Panhuysen, C. I., Cuenco, K. T., et al. (2008). The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyoma among affected sisters. Am J Obstet Gynecol, Feb;198(2):168.e1-9.
2. National Council for Population and Development. (2015, Jun). Reducing Maternal Deaths in Kenya (Policy Brief No. 46). Retrieved from http://www.ncpd.go.ke/wp-content/uploads/2016/11/Policy-Brief-46-Maternal-Deaths-in-Kenya-1.pdf.

Is There a Link Between Uterine Fibroids and Polycystic Ovary Syndrome (PCOS)?
Alicia Armeli

Uterine fibroids and polycystic ovary syndrome (PCOS) are two common reproductive health concerns for women. Both are hormone-related diseases that can affect the menstrual cycle, incite pelvic pain, and affect fertility. But beyond a few common symptoms and complications, are these two conditions linked?

A landmark study found that among African American women, the incidence of fibroids was 65% higher among those who have PCOS compared to women without PCOS.1

What Are Fibroids?
Uterine fibroids are the most common tumors within the female reproductive system and grow within the muscle tissue of the uterus. About 20% to 80% of women develop fibroids by the time they reach age 50.2 Fibroids are non-cancerous and may cause no symptoms at all, but for many women they bring about severe symptoms like heavy periods, pelvic pain or pressure, and frequent urination.

The cause of fibroids is still unknown, but research suggests that genetics, hormonal imbalance (particularly estrogen and progesterone), and naturally occurring substances in the body called growth factors may play a role in fibroid growth.3

Some risk factors for fibroids include heredity, onset of menstruation at an early age, obesity, vitamin D deficiency, use of birth control, alcohol consumption, and a diet high in red meat and low in green vegetables.3 Race also plays a role, as black women have been found more likely to have fibroids than other racial groups, develop fibroids at a younger age, and to have more or larger fibroids.3

What Is PCOS?
Both women and men produce male hormones called androgens, but when a woman has PCOS, she produces more than normal. This occurrence along with an imbalance of female hormones, such as luteinizing hormone (LH) and follicle stimulating hormone (FSH), make it difficult for the ovaries to develop and release an egg each month, as seen during the ovulation phase of a healthy menstrual cycle. This leads to multiple cysts, or fluid-filled sacs, that develop on the ovaries.

Between 5% and 10% of women of childbearing age have PCOS.4 PCOS symptoms include an irregular menstrual cycle, acne, excess facial hair, male-pattern baldness, and weight gain.

The cause of PCOS isn’t clear, but factors include heredity, inflammation, and elevated levels of male hormones as well as high levels of insulin—a hormone that regulates how the food you eat is changed into energy and used by your body.5 Obesity may worsen PCOS symptoms.5

Fibroids and PCOS: What the Research Says
To investigate the possible connection between fibroids and PCOS, researchers at Boston University Slone Epidemiology Center examined findings collected from a large ongoing study that took place in 1995 called the Black Women’s Health Study.1 Within a 6-year period, over 23,000 African American premenopausal women with no history of fibroids were followed. To track participants’ health status, women were asked to complete mailed questionnaires every 2 years.

During this follow up, 3,631 new cases of fibroids were confirmed and reported.1 The researchers found that the incidence of fibroids was 65% higher among women with PCOS than women without PCOS.

What’s the Connection?
Given these results, the researchers concluded that PCOS was associated with an increased risk of fibroids, at least among African American women. But why?

Although we don’t know for sure, the researchers had a few theories. One possibility is that women with PCOS commonly have high levels of LH—a hormone that stimulates ovulation.1 LH may not only affect the ovaries but also directly influence the uterus and at high levels is associated with an increased risk of fibroids.1,6 What’s more, because LH levels are constantly elevated, ovulation often doesn’t happen.7

That being said, irregular ovulation is a hallmark of PCOS, and the researchers note that this also might influence the risk of fibroids.1 When the ovaries don’t release an egg during the menstrual cycle, they explain, estrogen continues to be released in the body without being balanced by progesterone. This imbalance may encourage the development and growth of fibroids.1

Our Thoughts
It’s important to note that although some research, as mentioned in this article, found a link between fibroids and PCOS, other research hasn’t found such a connection.8 For this reason, more research needs to be dedicated to this topic. However, if you’re experiencing any of the aforementioned symptoms, it’s important to educate yourself on both conditions and talk to your doctor about your medical history, risks and complications involved, and the possible treatments available.

ABOUT THE AUTHOR Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES
1. Wise, L. A., Palmer, J. R., Stewart, E. A., et al. (2007). Polycystic ovary syndrome and risk of uterine leiomyomata. Fertil Steril, May;87(5):1108-1115.
2. U.S. Department of Health and Human Services Office on Women’s Health. (2018, Mar 16). Uterine fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
3. Mayo Clinic. (2018, Mar 06). Uterine fibroids. Retrieved from https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288
4. U.S. Department of Health and Human Services Office on Women’s Health. (2018, May 22). Polycystic ovary syndrome. Retrieved from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
5. Mayo Clinic. (2017, Aug 29. Polycystic ovary syndrome (PCOS). Retrieved from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
6. Baird, D. D., Kesner, J. S., & Dunson, D. B. (2006). Luteinizing hormone in premenopausal women may stimulate uterine leiomyomata development. J Soc Gynecol Investig, Feb;13(2):130-135.
7. Center for Young Women’s Health. (2016, May 25). PCOS (polycystic ovary syndrome): General information. Retrieved from https://youngwomenshealth.org/2014/02/25/polycystic-ovary-syndrome/
8. Abdel-Gadir, A., Oyawoye, O. O., & Chander, B. P. (2009). Coexistence of polycystic ovaries and uterine fibroids and their combined effect on the uterineartery blood flow in relation to age and parity. J Reprod Med, Jun;54(6):347-352.

How Much Are Your Fibroids Costing You?
Alicia Armeli

Women with uterine fibroids pay thousands of dollars more each year in health care costs compared to their healthy peers, a collection of studies show.1

Uterine fibroids, a non-cancerous tumor that grows within the muscle tissue of the uterus, affects nearly 70% of white women and more than 80% of black women by age 50.2 Many women with fibroids won’t experience symptoms, but for those who do, heavy menstrual cycles, pelvic pressure, painful intercourse, and urinary dysfunction are common, causing as many as half to seek treatment.1

To understand what it means to have fibroids from a cost perspective, a team of researchers led by Ahmed M. Soliman, MD, PhD, associate director of Health Economics and Outcomes Research at AbbVie, Inc., analyzed a collection of studies from around the globe that were published between January 2000 and November 2013.1  Direct costs and indirect costs of uterine fibroids were recorded. Charges accrued as a result of direct patient care, such as drug costs, procedure fees, and medical service costs were considered direct costs. Indirect costs included those related to loss of work and productivity.

“Given the high prevalence of uterine fibroids, the associated debilitating symptoms that affect daily activities and the invasiveness of treatment options, the economic burden of uterine fibroids is considerable,” the team writes.1

Results showed the following:1

  • Direct costs in the year after fibroid diagnosis ran an average of over $9,000 per patient.
  • Indirect costs totaled approximately $2,400-$15,500 per patient.
  • Total costs—that included direct and indirect charges—ranged from about $11,700-$25,000 per patient per year after diagnosis or surgery.
  • Compared to their healthy peers, women with fibroids have an additional annual cost of $2,200-$16,000.

Although fees varied across the board, this information showcased the significant cost of uterine fibroids to health care payers and society. In the United States alone, total direct costs soared well into the billions, with a handful of studies estimating between $3.5 billion and $10.3 billion in a single year.1

A sizeable chunk goes to pay for fibroid treatments, which include hysterectomy or the surgical removal of the uterus. Myomectomy is another surgical option that involves keeping the uterus but removing the fibroids. A gynecologist performs both of these options.

Non-surgical treatments include uterine fibroid embolization (UFE), a minimally invasive procedure performed by an interventional radiologist. Tiny particles are injected into the uterine arteries, blocking blood flow to the fibroids. Once deprived of a blood supply, fibroids shrink and symptoms subside.

Endometrial ablation, another nonsurgical procedure that was investigated, is performed by a gynecologist and destroys the lining of the uterus. Ablation doesn’t treat fibroids, but it may help to decrease fibroid-related heavy menstrual bleeding. Medications that either control symptoms or temporarily reduce fibroid size were also discussed.

Not included in these numbers is the monthly cost of menstrual products, which can be a significant financial burden to women who experience heavy fibroid-related menstrual bleeding. Previous to successful treatment with UFE, a patient named Carmen, who wasn’t involved in the study, admitted to wearing multiple products at a time during her period to absorb her heavy flow. This included a tampon, pads, an adult diaper, and Spanx® to support it all.

“I would have a regular maxi-pad in the seat of the Spanx just in case the super absorbency tampon, the ultra long maxi-pads, and the Spanx couldn’t keep it together,” Carmen tells Ask4UFE. “I also had all that stuff in my bag just in case I had to change, which was about every hour.”

Several patient characteristics influenced cost.1  For example, increasing age and having other chronic conditions like heart failure, diabetes, obesity, high blood pressure, and pulmonary disease increased hospital length of stay and costs. Black women and those of Asian or Pacific Island race were also observed to have longer hospital stays.

The researchers concluded that although these results shed light on the cost of fibroids, more studies are needed to understand the true financial impact of this disease and “elucidate fully the economic burden…including burden to patients and the entirety of indirect costs.”1

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES

  1. Soliman, A. M., Yang, H., Du, E. X., et al. (2015). The direct and indirect costs of uterine fibroid tumors: A systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol, Aug;213(2):141-160.
  2. Baird, D. D., Dunson, D. B., Hill, M. C., et al. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol, Jan;188(1):100-107.
New Pain Management Protocol Decreases Need for Opioids Among UFE Patients
Alicia Armeli

Up to half of women with uterine fibroids will seek treatment for bothersome symptoms like heavy periods, severe bloating, and painful sex.1 One such treatment is uterine fibroid embolization (UFE). An effective nonsurgical approach, UFE has shown to offer relief to nearly nine out of ten women treated.2

Despite these advantages, a downside to UFE is reported pelvic pain and cramping that may follow the procedure. Typically lasting up to 12 hours, this post-UFE pain may require opioid medication, also called narcotics, to provide relief.3 A team of researchers at Pennsylvania Hospital in Philadelphia, PA, found that performing UFE from the wrist—an approach called transradial access—combined with a nerve block targeting nerves in the lower back that supply sensation to the uterus and trigger post-UFE pain may reduce the need for opioids after the procedure.4

The study involved 79 women who underwent the combined treatment.4 Results showed that transradial UFE had a 97% technical success rate. The nerve block—which targeted the superior hypogastric nerve plexus—was successful in all but one patient. Of these 78 patients, nearly half (49%) didn’t require opioid medications following the procedure. The researchers also found that by using this protocol, patients were discharged home in about two and a half hours. Six patients returned five days later, needing treatment for uncontrolled pain or nausea.

UFE has traditionally been performed through the femoral artery in the groin area, but now—with a transradial option—UFE can access fibroids from the radial artery in the wrist. Doctors called interventional radiologists begin by making a nick in the wrist and inserting a slim catheter into the radial artery. Under the guidance of magnetic resonance imaging (MRI), the catheter is then threaded into the uterine vessels that supply fibroids with blood. Tiny particles are injected, plugging these vessels. Without a blood supply, fibroids begin to shrink and die, and symptoms start to improve.

Using the wrist to perform UFE has been shown to boost patient comfort immediately after the procedure.5 Patients have reported that transradial advantages such as being able to sit up in a comfortable position and get out of bed to use the toilet after the procedure have improved the overall patient experience.5

UFE pain management protocols vary but involve medication, typically opioids, administered intravenously (IV), through patches, and/or orally. Opioids work by blocking pain signals sent from the body through the spinal cord to the brain.6 In contrast, a nerve block is a regional anesthesia. Using specialized X-ray equipment, a small needle is used to inject pain medication near a cluster of nerves along the spinal cord, numbing only the part of the body affected by pain.7 Research has shown that complications are rare.3

This combined approach to UFE has many patient advantages. But as with any medical procedure, it’s important to talk to your doctor about whether you’d make a good candidate for this line of treatment and about any risks involved.

ABOUT THE AUTHOR Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad, and volunteering in her community. She is a paid consultant of Merit Medical.

REFERENCES

  1. Soliman, A. M., Yang, H., Du, E. X., et al. (2015). The direct and indirect costs of uterine fibroids tumors: A systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol, Aug;213(2):141-160.
  2. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  3. Boucher, L., Bahir, A., Yoon, J., et al. (2016). Superior hypogastric nerve block for acute pain control in uterine fibroid embolisation. J Vasc Interv Radiol, March;27(3):S285-S286.
  4. Maratto, S., Alkhatib, S., Huang, J., et al. (2018). Trans-radial uterine artery embolization with superior hypogastric nerve block: Optimizing pain control and minimizing length of stay. [Abstract]. J Vasc Interv Radiol, Apr;29(4):S184.
  5. Resnick, N. J., Kim, E., Patel, R. S., et al. (2014). Uterine artery embolization using a transradial approach: Initial experience and technique. J Vasc Interv Radiol, Mar;25(3):443-447.
  6. American Society of Anesthesiologists. (n.d). What are opioids? Retrieved from https://www.asahq.org/whensecondscount/pain-management/opioid-treatment/what-are-opioids/
  7. American Society of Regional Anesthesia and Pain Medicine. (n.d.). Regional anesthesia for surgery. Retrieved from https://www.asra.com/page/41/regional-anesthesia-for-surgery
10 Questions You’ve Always Wanted to Ask About UFE
Alicia Armeli

If you have uterine fibroids and are nervous about treatment, you’re not alone. A recent survey revealed a staggering 90.5% of women with fibroids reported fears and concerns about their condition and their treatment options.1

To put some of these worries to rest, we sat down with Dr. Richard A. Reed, interventional radiologist at Huntington Hospital in Pasadena, Calif., to answer your top 10 questions about uterine fibroid embolization (UFE). It’s important to keep in mind that this blog doesn’t replace visiting your doctor.

 I heard UFE hurts. What type of pain can I expect during and after the procedure?

You’ll be under conscious sedation during the procedure. The pain occurs after the procedure and varies from woman to woman. The pain is typically crampy like a menstrual period and can be quite severe. It commonly begins minutes after the procedure is completed and is most intense the first night. This discomfort generally lasts one to three days. Medications are available to help control the pain.

What causes the pain after UFE?

 UFE works by blocking blood flow to the fibroids, causing the tumors to die. This is accomplished by injecting an embolic agent, such as tiny microspheres, into the uterine arteries that supply fibroids with blood. Without a blood supply, fibroid tumors die, and pain occurs.

What is the embolic agent used for UFE and is it safe?

The embolic material I use in my practice is made up of tiny, biocompatible beads, meaning they don’t react with the body. This type of embolic material, Embosphere® Microspheres, has been used for over two decades in many types of embolization procedures in different parts of the body.

I’m worried these particles will travel to other places in my body, like my heart. Is that possible?

The embolic material is delivered to the uterine artery using a slim tube called a catheter. The tip of the catheter is positioned within the uterine artery and the particles travel via the blood flow to the uterus. The only way particles can go anywhere else in the pelvis is if the catheter tip isn’t in the correct position or if more embolic is injected than needed. If not done properly, reflux can occur, which means the particles move backwards and into other arteries in the pelvis, such as the bladder. This complication is very rare and has more to do with the experience of the doctor doing the procedure than the type of embolic.

I know I have a lot of fibroids. Can UFE treat each fibroid?

 UFE embolizes the entire uterus. By doing so, all of the fibroids should be treated. I’ve had many women ask why the uterus isn’t affected as well.  The reason UFE treats fibroids and doesn’t affect the uterus is because there’s collateral or additional blood flow from other vessels to the normal uterine tissue, allowing a doctor to selectively treat the fibroids while maintaining the viability of the uterus.

Is it safe for a fibroid to die inside of me, and what can I expect this to feel like?

Embolizing the fibroids causes them to shrink and die over time. This is what leads to symptoms improving. Before treatment, fibroids feel hard, which is why a common symptom is pelvic pressure. Once fibroids are treated, even without significant size change, they become softer. They no longer press on other organs or cause a woman’s belly to protrude. Fibroids can shrink to varying degrees—up to 50%.  Occasionally, fibroids will spontaneously die without any treatment. This may be seen on a magnetic resonance imaging (MRI) scan, and it’ll look the same as when images of fibroids are taken after UFE. There are typically no problems related to the presence of this type of fibroid in the uterus, whether it’s spontaneous or related to embolization. Fibroid expulsion, or the fibroid detaching from the uterus and passing from body, is an unusual occurrence post-UFE.

Is it necessary to have an MRI after UFE?

Many women will ask if an ultrasound will be sufficient, but an MRI provides crucial information—before and after the procedure.  An ultrasound shows the presence of masses, so you see where the fibroids are, but you can’t determine whether or not the treatment was a success. You also can’t tell if a woman has another condition with symptoms similar to fibroids called adenomyosis. With an MRI, doctors can get that information before the procedure to see if a woman is even a candidate for UFE. The 6-month follow-up MRI can show if all fibroids have been treated and the extent of the shrinkage. If a woman is having symptoms after UFE and the follow-up MRI shows viable fibroids, a repeat UFE may be helpful. On the other hand, if there are no viable fibroids on the follow-up MRI, I can counsel a woman that her symptoms most likely aren’t due to fibroids and that a repeat embolization won’t be helpful.

Will I stop getting my period after UFE?

A common reason women have UFE done is because of excessive bleeding during their menstrual cycle. The goal is to get their periods back to the way they were prior to having the severe bleeding. The majority of women will menstruate after the procedure, and it’ll come pretty close to the time they expect it. Any stress for women can cause the menstrual cycle to be a bit off, including the UFE procedure. It may take a few months after UFE for a woman’s cycle to regulate. There’s a small chance—under 10%—for women over 40 to go into early menopause after the procedure, causing them to stop menstruation all together.

Do I have to use birth control after UFE?

A woman having her cycle can become pregnant. If she wants to avoid pregnancy, then some kind of birth control should be used, for example condoms, an IUD, or birth control pills. Once a period comes back and is regular, it means a woman is ovulating, and she can become pregnant, so some kind of birth control is necessary if she wants to avoid that.

I want to have children. Is UFE the right treatment for me?

It’s possible for women to get pregnant following the procedure. But it’s controversial whether UFE is the right treatment for women who desire pregnancy. Traditionally, myomectomy—or the surgical removal of fibroids—has been the treatment of choice. There’s currently a larger body of research supporting myomectomy for women who have symptomatic fibroids and a strong desire to have children. There are randomized trials that suggest UFE is comparable to myomectomy for women who desire future fertility with more studies coming in the future.

Initially, UFE was only performed on women who weren’t interested in future fertility. These women were followed, and some became pregnant and did quite well with the pregnancies. Doctors realized that it is possible to conceive and deliver a healthy child. Over time, UFE was also offered to women who didn’t want to completely eliminate future fertility, as they would with hysterectomy, but wanted a less invasive procedure that has a high likelihood of eradicating fibroid-related symptoms.

It also depends on each individual woman. For someone young who wants to start a family, I would recommend myomectomy. And then there are women in their mid-to-late 40s who know they probably aren’t going to get pregnant but don’t want to completely eliminate future fertility with hysterectomy. These women really benefit from UFE.

The foregoing is not intended nor recommended as a substitute for medical advice, diagnosis or treatment. Always seek the advice of a qualified physician regarding any medical questions or conditions.

ABOUT THE DOCTOR Richard A. Reed, MD, is an interventional radiologist at Huntington Hospital in Pasadena, Calif. One of the first physicians in the US to perform UFE, Dr. Reed advocates for UFE public awareness and works to ensure women know all their fibroid treatment options.

 ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

 REFERENCES

  1. Knudsen, N. I., Wernecke, K. D., Siedentopf, F., et al. (2017). Fears and concerns of patients with uterine fibroids – a survey of 807 women. Geburtshilfe Frauenheikd, Sep;77(9):976-983.

Could Choosing Your Embolic Mean Less Post-UFE Pain?
Alicia Armeli

Minimally invasive uterine fibroid embolization (UFE) is a safe and effective treatment option for women with symptomatic uterine fibroids. In addition to avoiding surgery, UFE offers benefits that include low rates of serious complications, a faster recovery, an approximate 90% symptom improvement rate—and you get to keep your uterus.1

A drawback associated with UFE is cramping that patients reportedly experience within the first 24 hours after the procedure that often requires pain medication for relief.2 To help women be as comfortable as possible post-UFE, different pain management regimens have been designed.

But what if something as simple as choosing a specific type of embolic for UFE could make a substantial difference? Researchers at Saiseikai Shiga Hospital in Japan compared two embolics: Embosphere® Microspheres and gelatin sponge particles.3 They found that patients who underwent UFE with Embosphere Microspheres experienced significantly less post-procedural pain.

To understand why these results are so significant, we first need to understand the UFE procedure and what an embolic actually is. Under conscious sedation, a doctor called an interventional radiologist makes a nick in the wrist or groin area to gain access to the uterine arteries that supply fibroids with blood. A slim tube called a catheter is inserted and guided to these arteries. Once the catheter reaches the uterine arteries, tiny particles called embolic are released that then block blood flow to the fibroids. Deprived of blood, fibroids shrink over time and die, relieving women of fibroid-related symptoms, such as heavy menstrual bleeding and pelvic pain and pressure.

Although the UFE procedure is effective, the way it treats fibroids can also be a source of pain. To tackle this clinical problem from a different angle, Dr. Tetsuya Katsumori and a team of researchers decided to study how using different embolic material affected post-UFE pain in 101 patients over a span of approximately eight years.3 Overall, 52 patients underwent UFE with Embosphere Microspheres and 49 patients were treated with gelatin sponge particles. Post-UFE pain was measured using a Visual Analog Scale where patients were able to choose a number that reflected the intensity of their pain. Dosages of pain and conscious sedation medications were also recorded.

Findings showed that not only were pain scores significantly lower among patients treated with Embosphere Microspheres within the first 24 hours, but hospitalization time was shorter and lower doses of pain and conscious sedation medications were required.3

Why did the patients treated with Embosphere Microspheres experience less discomfort? The researchers noted that pain directly after UFE may be linked with blood restriction to normal uterine tissue. Uniform in size, hydrophilic, and spherical, Embosphere Microspheres better target the arteries that supply blood to the fibroids while still preventing severe blood restriction to normal uterine tissue.3 Gelatin sponge particles don’t have these same advantages. Given these outcomes, Katsumori and his team considered this information useful when selecting an embolic for UFE.

This advancement in UFE can aid doctors when choosing an embolic to use and—more importantly—can help women make informed decisions about their care. Because when it comes to fibroid treatment, the only place to be is in the know.

ABOUT THE AUTHOR   Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English education and nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. She is a paid consultant of Merit Medical.

REFERENCES
1. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.

2. Kim, H. S., Czuczman, G. J., Nicholson, W. K., et al. (2008). Pain levels within 24 hours after UFE: A comparison of morphine and fentanyl patient-controlled analgesia. Cardiovasc Intervent Radiol, Nov-Dec;31(6):1100-1107.

3. Katsumori, T., Arima, H., Asai S., et al. (2017). Comparison of pain within 24 h after uterine artery embolization with tris-acryl gelatin microspheres versus gelatin sponge particles for leiomyoma. Cardiovasc Intervent Radiol, Nov;40(11):1687-1693.

Is Dairy a Fibroid-Friendly Food? Not If You’re Lactose Intolerant. Here Are Some Alternatives.
Alicia Armeli

Eating more dairy may reduce your fibroid risk.1 If you’re a woman with uterine fibroids—a type of noncancerous growth found in the wall of the uterus—you may be familiar with this piece of medical advice. But before you add milk to your grocery list, there may be something standing between you and the dairy aisle: lactose intolerance.

If you’re lactose intolerant, your body has a hard time digesting lactose—a type of sugar naturally found in dairy products. Eating or drinking dairy products (or foods made with dairy) can lead to uncomfortable symptoms like stomach cramps, bloating, gas, diarrhea, and bouts of nausea.

Studies show that more than one out of five Caucasians, over half of the Hispanic population, 70-90% of individuals of African descent, and 80-100% of Asian people are lactose intolerant.2 For these women, eating dairy can seem impossible—even though these are groups who may need this fibroid-fighting food the most. Some data indicates that nearly 70% of White women and more than 80% of Black women will develop fibroids by the time they reach 50.3 Although findings differ, Asian women may have similar fibroid rates as White women.4 In comparison to White women, some research estimates Hispanic women to have over twice the fibroid risk, whereas other studies estimate lower.4,5 Not all women experience fibroid symptoms, but for those who do, heavy periods, pelvic pain and pressure, and urinary incontinence can encroach on everyday life.

Given the gravity of these statistics, it’s time for the conversation to change. In addition to encouraging women with fibroids to increase their dairy intake, we also need to talk about fibroid-friendly, healthy alternatives, so as to include a large number of women who are lactose intolerant.

Nut Milks
Dairy is believed to be protective against fibroids, in part, because of its calcium content.1 Nut milks such as almond milk, macadamia milk, and pecan milk are healthy alternatives to cow’s milk because they’re fortified with calcium, often with a content much higher than dairy. Other plant milks such as hemp seed milk can be a great option, as it also contains omega-3 fatty acids, a natural anti-inflammatory agent.

Lactose-Free Milk
Although still cow’s milk, lactose-free milk has an enzyme called lactase added to it while it’s processed, helping to breakdown lactose. Manufacturers then test for lactose content before products end up on store shelves. Keep in mind lactose-free labeling can’t guarantee that a product has no lactose.5 There aren’t federal regulations tracking lactose-free labeling, so manufacturers can set their own “lactose-free” thresholds.6

Plant Yogurts
Some dairy foods may be easier to digest for people with lactose intolerance, and yogurt is one of them. But for those who can’t, plant yogurts are an exciting new group of dairy alternatives to try. Made from coconut to flax seed to pea protein, these yogurts are a girl’s best friend. Fortified with calcium, switching over to plant yogurts will still help you consume this essential mineral. Some plant yogurts also contain vitamin D—another nutrient believed to reduce fibroid risk.

Fruits and Vegetables
We know what you’re thinking. Fruits and vegetables as a dairy alternative? YES.

Milk fat contains butyric acid, a type of fatty acid found in dairy products like butter. Butyric acid is thought to slow the replication of tumor cells and may be protective against fibroids.1 Fortunate for lactose intolerant ladies, our bodies can produce butyric acid in our intestines, given we eat a balanced whole foods diet packed with probiotics (yogurt!) and fiber to help nourish our gut bacteria.7

Olive Oil
Instead of butter, try sautéing your veggies with olive oil. Rich in monounsaturated fats, olive oil is a heart-healthy alternative to butter, which is important for women with fibroids. Studies show women with fibroids may be at an increased risk for heart disease, so making small changes like switching to healthier alternatives could help make a difference.

Sorbet
Summer is just around the corner, and if you live in the northern hemisphere that means sweltering heat that demands ice cream. Fruit sorbets can stand in as a cool treat. Store-bought sorbets may not be the best option, as they can be loaded with sugar and fake flavorings. But making your own at home can be fun, quick, and easy and will contain all that fruity fiber goodness as well as other beneficial nutrients.

Helpful Tips When Going Lactose-Free
1. Pass on soy (for now). Soy contains phytoestrogens, and it’s still unclear how soy impacts fibroid growth.
2. Steer clear of hidden sugars. Go for products that are labeled “unsweetened.” Try sweetening your yogurt naturally with fresh fruit.
3. Read ingredients. Make sure your lactose-free goodies are fortified with calcium and vitamin D.
4. Make your own plant milks and yogurts. These won’t offer the benefit of calcium and vitamin D fortification, so make sure you’re getting these nutrients in other ways.
5. Don’t give up! Not all lactose-free foods will please your palate. Try different products to see which ones you like best.

Dairy products can be a fibroid-friendly food—if you can digest it. For those who can’t, going lactose-free doesn’t have to mean giving up dairy’s potential fibroid-fighting benefits. Incorporating lactose-free foods as part of a well-balanced whole foods diet can help you get these nutrients and more—minus the digestive discomfort.

ABOUT THE AUTHOR Alicia Armeli is a freelance writer and editor, registered dietitian nutritionist, and certified holistic life coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad, and volunteering in her community. She is a paid consultant of Merit Medical.

REFERENCES
1. Wise, L. A., Radin, R. G., Palmer, J. R., et al. (2010). A prospective study of dairy intake and risk of uterine leiomyomata. Am J Epidemiol, Jan 15;171(2):221-232.
2. ProCon. (2010, Feb 23). Lactose Intolerance by Ethnicity and Region. Retrieved from https://milk.procon.org/view.resource.php?resourceID=000661
3. Baird, D. D., Dunson, D. B., Hill, M. C., et al. (2003). High cumulative incidence of uterine leiomyoma in black and white women: Ultrasound evidence. Am J Obstet Gynecol, Jan;188(1):100-7.
4. Chibber, S., Mendoza, G., Cohen, L., et al. (2016). Racial and ethnic differences in uterine fibroid prevalence in a diverse cohort of young asymptomatic women. Fertil Steril, Sep;106(3):Supplement,e97.
5. Othman, E. E., & Al-Hendy, A. (2008). Molecular genetics and racial disparities of uterine leiomyomas. Best Pract Res Clin Obstet Gynaecol, Aug;22(4):589-601.
6. Organic Valley. (2018). How do we eliminate lactose from Organic Valley Lactose Free Milk and Organic Valley Lactose Free Half & Half. Retrieved from http://organicvalley.custhelp.com/app/answers/detail/a_id/201/~/how-do-we-eliminate-lactose-from-organic-valley-lactose-free-milk-and-organic
7. Zaleski, A., Banaszkiewicz, A., & Walkowiak, J. (2013). Butyric acid in irritable bowel syndrome. Prz Gastroenterol, Dec 30;8(6):350-353.