Female trouble

It's probably just my age, but I feel like I've heard about fibroids more in recent years. Have they become more prevalent?

No, we don't think the incidence has gone up. It's been a major problem for women for decades, but I think in the past we just dealt with them with hysterectomy. When you had your kids in your 20s and then had fibroids in your 30s and then a hysterectomy in your 40s, that was a reasonable solution. But fibroids may be having more impact now that women wait later to have children. These days many women have fibroids that may be a problem for getting pregnant or safely carrying a pregnancy, and as they seek alternatives to hysterectomy, women will deal with them more frequently, or at a later age.

Are there new treatments for fibroids?

Yes. Many women have good alternatives. Sometimes just using medications that we typically think of as just birth control can control symptoms; either pills or a progesterone-containing IUD can control the bleeding. But the only medicines that shrink them are drugs that shut down the whole reproductive system. Those can have pretty severe side effects, menopause-like side effects. Women also get rapid return of symptoms when they stop the drugs.

Also, there are some minimally invasive therapies that work for removing some fibroids. Some that are in the right location can be taken out with a hystroscope and telescope inside of the uterus. We can also decrease fibroid symptoms with a procedure called uterine artery embolization [which cuts the blood flow to the tumors]. It's not an ideal option for women who want children, but for women who have significant fibroid symptoms and no plans for future pregnancy, it's very good.

The other new option is an MRI-guided focused ultrasound, which uses strong ultrasound waves to destroy the fibroids. One of the disadvantages is that we don't have long-term information about outcomes, or good information for women who want future pregnancies. But at least the initial information we're getting seems to be encouraging.

And is there currently a lot of new research into fibroid treatment under way?

There are some big studies under way into the genetics. The real impediment for research is that there's not a lot of funding available in the NIH budget. There are some new private philanthropic organizations that are trying to raise funds, but compared to other diseases that affect similar numbers of individuals, funding is pretty limited. I think that some people feel that hysterectomy is an adequate solution and that new treatments really aren't necessary. Some have argued that because it's a disease that affects only women and preferentially minority women, that may be a factor in less priority of funding.

Short of medical intervention, are there changes women can make to decrease their symptoms or the size of their fibroids?

There are no good studies documenting that, though there are certainly women who find that changing diet and exercise does decrease their symptoms.

What about acupuncture?

Again, there aren't a lot of good studies, but acupuncture does seem to have an effect on menstrual cycles, and there is some evidence that it works for endometriosis, which is another gynecological disease found frequently with fibroids.

And for those who opt for surgery, are the fibroids likely to grow back?

Unless you're doing hysterectomy, you have a chance of having new fibroids form. The worst thing is to have surgery for fibroids and then wait a couple of years and when you're ready to have kids, they've grown back. It's optimal if you can have surgery close to the time you're ready to have a pregnancy. But that's not always possible because of severe symptoms.

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