January 15, 2021 by John Fernandez
Uterine Fibroids: Campaign to Grow Awareness and Research Intensifies
A bill making its way through Congress aims to create awareness of and fund research on uterine fibroids, non-cancerous tumors that grow on or in the uterus and cause heavy menstrual bleeding, debilitating pain and sometimes infertility. Introduced by U.S. Rep. Yvette Clarke of Brooklyn, who suffered with uterine fibroids in 2007 before undergoing surgery to treat them, the Uterine Fibroid Research and Education Act of 2020 is co-sponsored by Rep. Alcee Hastings and has also been introduced in the Senate by Sen. Kamala Harris of California.
According to a 2018 study published in the American Journal of Obstetrics & Gynecology, uterine fibroids affect nearly 10 percent of women in their reproductive years, and rates among Black women, like Rep. Clarke, were 19 percent, versus about 11 percent for Hispanic women and 10 percent for Caucasian women. Furthermore, fibroids occurred in younger age groups among Black women.
“About half of our patients are Hispanics,” said Rafael Perez, M.D., an OB-GYN and co-medical director of the Fibroid Center, located at South Miami Hospital. “But our Black patients tend to have suffered longer with the telltale symptoms of fibroids.”
Symptoms of Uterine Fibroids
Dr. Perez says that most patients come to the Fibroid Center with a diminished quality of life due to the symptoms of uterine fibroids, which include:
- Intolerable menstrual cramps
- Pain or pressure in the abdomen or lower back
- Heavy bleeding that may cause anemia
- Bleeding not related to a menstrual cycle
- Painful sexual intercourse
- Frequent or difficulty with urination
- Miscarriages or infertility
- Enlarged uterus or abdomen
“The fibroids were affecting my life by extreme heavy bleeding. There was miserableness. There was bloating. I could not stand without accidents happening,” said Brenda Walker, a patient at the Fibroid Center.
But, Dr. Perez notes that fibroids may cause no symptoms at all.
“If you’re not experiencing symptoms, often, we leave the fibroids alone,” he said. “It’s when they affect your quality of life, we have treatment options to discuss, and they’re not always a hysterectomy.
Consultation for Fibroid Treatment
At the Fibroid Center, Dr. Perez and his co-medical director Adam Geronemus, M.D., a vascular interventional radiologist who treats fibroids with uterine fibroid embolization, or UFE, meet with women to discuss treatment options that consider their lifestyle, their age and their fertility goals.
“Dr. Perez and I sit down with the patient, look at her MRI together and ask her what her goals are for treatment,” Dr. Geronemus said. “Based on her wishes, her lifestyle and other physical factors, we explain the treatment options that would net the best results and improve her quality of life.”
Dr. Geronemus says that they often call upon a fertility specialist to join the conversation if the patient has concerns about conceiving later in life.
“They gave me the options. They did not push one way or the other,” Ms. Walker said. “I think it was helpful to have two doctors there.”
Treatment Options for Uterine Fibroids
Treatment for uterine fibroids includes medical management with hormone therapy, using oral hormones, birth control pills or intrauterine devices (IUDs). These least invasive options, Dr. Perez says, usually help women with smaller or fewer fibroids whose symptoms aren’t debilitating.
As a gynecologic surgeon, Dr. Perez also talks to patients about endometrial ablation, which involves burning the lining of the uterus to reduce bleeding. This is not an option for women who want to have children, as it permanently damages the womb.
Another surgical option that Dr. Perez offers as a treatment is the removal of just the fibroids in a procedure called a myomectomy. This procedure can often be performed robotically, through small incisions in the abdomen. Through those incisions, Dr. Perez and other surgeons place robotic arms, which hold surgical instruments and a camera and are controlled remotely by the surgeon sitting at a console in the operating room.
“Most of the time, we can remove fibroids up to 10 centimeters in diameter robotically without opening the abdomen, which can add to recovery time and increase the chance for complications,” Dr. Perez said. “And we’re able to remove multiple fibroids at the same time.” What’s more, he says, the recovery takes only two weeks, compared with four to six weeks, with an open procedure.
If fertility is not a concern for women who have reached the end of their childbearing years, a hysterectomy may be their preferred surgical treatment option. Hysterectomies, once thought to be the only way to treat fibroids, are also most often performed robotically at the Fibroid Center. Recovery from a robotic hysterectomy takes about two weeks as well.
Uterine Fibroid Embolization
Another option for women concerned about their fertility or who prefer a non-surgical treatment is uterine fibroid embolization, or UFE.
During this procedure, Dr. Geronemus and other vascular interventional radiologists thread a catheter through an artery in the wrist or groin to the fibroid’s blood vessels. There, they deploy particles about the size of grains of sand to block blood flow to the fibroids. Without blood, the fibroids die. By using the approach through the wrist, Dr. Geronemus and his colleagues make the recovery quicker and more comfortable for the patient. As with myomectomies, multiple fibroids can be treated at one time with UFE.
“The recovery time following a UFE is one night in the hospital, and most patients can return to work by the sixth day following the procedure,” Dr. Geronemus said.
Ms. Walker chose to have UFE with Dr. Geronemus to treat her fibroids.
‘A One-Stop Shop’ for Fibroid Treatment
The Fibroid Center at South Miami Hospital has been operating for more than 10 years and is one of a kind in the nation, Dr. Perez says.
“We’ve treated more than a thousand women over the past decade and have been able to collect valuable data about what treatment works best in different situations,” he said. “No other center that we know of has our experience and gives patients the chance to meet with two to three doctors in one appointment.”
“With politicians now paying attention to and calling for more education and research on uterine fibroids and their treatment, I am hopeful that women of all ages and ethnic backgrounds will seek treatment, instead of enduring unnecessary symptoms that diminish their quality of life,” Dr. Geronemus said.
“My life is absolutely wonderful following this treatment,” Ms. Walker said. “There’s no more heavy bleeding – matter of fact, it is extremely minimal bleeding. There’s no bloating. The frequent urination is gone, and the freedom is absolutely outstanding. You are just free to live your life to the fullest.”