Hi, I'm Dr. Michelle Louie,
a minimally invasive gynecologic
surgeon at Mayo Clinic.
And I'm here to answer some of
the important questions you might
have about uterine fibroids.
How do I pick the right treatment option?
There's no such thing as
the right decision as
there are many potential options
that may be available to you.
A fibroid specialist
will be able to tell you what
options are possible based on the size,
number and location of
the fibroids and your treatment goals.
You may want to consider
the severity of your symptoms,
your feelings about surgery,
your plans for pregnancy
and how close you are to menopause.
Should I have my fibroids removed before or after pregnancy?
Fibroids in the uterine cavity can cause
miscarriage or make it
more difficult to get pregnant.
So those are usually removed
before pregnancy is attempted.
If you're having bothersome symptoms now,
getting them removed before
pregnancy is possible.
But depending on the size
and location of the fibroids,
your doctor may advise
that you have a C-section in
a future pregnancy because
the scar on the uterus can open during labor.
And that would be very dangerous
for both you and the baby.
If you're not having severe symptoms now,
you could wait until after
pregnancy to have the fibroids removed.
But fibroids can grow during
pregnancy and about 20 to 30% of cases,
and that causes pain.
Large fibroids, usually those bigger than
3 to 5 centimeters
and cause issues with the placenta,
growth of the baby,
excessive bleeding during childbirth,
preterm labor, and sometimes
cause problems with delivery of the baby.
Can uterine fibroids come back after being removed?
Any treatment that preserves
the uterus means that
fibroids can occur in the future.
So a hysterectomy, in which
the uterus and cervix are removed,
is the only treatment that can actually
guarantee fibroids won't return.
Fibroids can reoccur in
about 60% of people who have them.
But just because they come back
doesn't mean they need to be treated.
Are there any natural medicines to shrink my fibroids?
There are some small studies looking into
possible dietary and environmental factors
that may promote fibroid growth.
Foods like red meat, dairy, soy products,
and exposure to BPA have been
shown to have a possible link
to fibroid development.
But this data is weak and furthermore,
avoiding these exposures has
not been shown to treat,
shrink or prevent fibroids.
It does appear that fibroid growth
is related to increasing weight.
So exercise and eating a nutritious diet
to maintain a healthy weight can help.
The best evidence we have for
vitamin supplements is for
vitamin D. Vitamin D deficiency,
which is very common in
people with dark skin,
has been associated with
fibroid growth in some studies.
But we don't yet have enough information to
recommend a certain dose
of vitamin D supplements.
Limited data does not support the use of
herbal supplements like
black cohosh or vaginal steaming.
Additionally, because these supplements
are not FDA regulated,
they may be dangerous to your health.
Acupuncture has shown promise for
improving fibroid outcomes in small studies.
And while there's not enough data to
promote its use as primary treatment,
it's very low-risk and would be
acceptable as an adjunctive treatment.
Do fibroids disappear after menopause?
Since fibroids are hormonally
responsive growths,
most people do experience
a decrease in fibroid size and
fibroid-related issues as they get
closer to menopause and beyond.
In fact, the whole uterus
decreases in size after menopause.
However, studies do show that
fibroids can continue to keep
growing after menopause because there are
other tissues in our body that produce
estrogen besides the ovaries.
This ongoing growth does not mean
the fibroids are cancerous or
that they even need to be treated.
But if you are having bothersome symptoms,
treatment is absolutely an option.
How much the fibroids grow and how
fast varies from person to person.
But it's more likely
with increasing weight or
obesity and more likely with
smaller rather than larger fibroids.
Are fibroids cancerous?
Fibroids have a very typical
appearance on an ultrasound,
and because they're so common,
they're almost always accurately diagnosed.
In some situations, your
doctor may recommend a biopsy of
the uterine lining or of
the mass if there's a concern for cancer.
If there's a concern for cancer,
you may be referred to a specialist
to discuss whether a hysterectomy
is the best option rather than
trying uterine sparing treatments.
If you have a myomectomy,
your surgeon may recommend using
a special containment bag to
remove the fibroids from your body
since this can limit the spread of any
cancerous or even noncancerous cells.
How can I be the best partner to my medical team?
Be upfront about
your treatment goals and concerns.
Don't be afraid to ask for a second opinion
or referral to a fibroid specialist.
If you feel like your doctor is advising
a more invasive therapy, then seeing
a fibroid specialist can help you ensure
that you're being given all the options.
Never hesitate to ask
your medical team any questions
or concerns you have.
Being informed makes all the difference.
Thanks for your time and we wish you well.