- Hi, I'm Dr. Linda Bradley.
I'm passionate about seeing women with uterine fibroids
and abnormal uterine bleeding.
I'm currently director for The Center of Menstrual Disorders
at the Cleveland Clinic in Cleveland, Ohio.
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So uterine fibroids are a growth within the uterus.
A normal uterus is about the size of a lemon
and these benign, rare cancerous cells,
we call them fibroids or leiomyomas,
these are growths within the muscle of the uterus,
the outer wall of the uterus,
or actually inside the space where a baby grows.
Fibroids can grow and grow and grow
until they get to be the size of an orange,
a grapefruit, a turkey, a basketball.
So size, number, and location of the fibroids
will determine the symptoms.
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Patients may have heavy bleeding, prolonged bleeding,
bleeding after intercourse.
You have your period and you stop
and then two weeks later, you bleed again.
Sometimes women will have bad menstrual cramps,
difficulty getting pregnant, miscarriage, infertility, pain.
And as the fibroid grows, it can stretch the uterus.
When they get really big, sometimes it's like a pregnancy.
You can look pregnant, cosmetically.
It can push on your bladder
that makes you either go to the bathroom frequently,
lose urine when you cough or sneeze,
or sometimes you can't void at all.
Some women get constipation
if the fibroid is more on the back wall of the uterus.
Never should your period be so problematic
that you have to miss work or activities.
You should never be socially embarrassed
because you bleed through clothing, through your mattress.
You shouldn't be taking an extra set of clothing to work
because you're going to bleed through things.
You shouldn't have a craving for ice
or iron deficiency or need blood
or blood transfusions or IV infusions of iron.
The days of the only treatment for fibroids
being a hysterectomy are days long ago.
If you're given that option, I would strongly advise
that you get a second opinion with a physician
and if you need surgery to make sure
your physician is a high volume surgeon
at a high volume center.
The more we do as surgeons, the better we get.
And so you want a physician that is highly trained
in all the new technology.
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There's a new array of medications,
they're called GnRH antagonists.
What they do is lower the estrogen levels
and stop the period,
also can decrease the size of the uterus.
There are also some medicines called tranexamic acid,
or Lysteda, over the counter in other countries,
but here is a prescription, it's not a hormone,
you only use it during your menstrual cycles.
There are some safeguards, you could not take it
if you have had a blood clot in your legs or lungs
or heart attack or stroke.
And another great medication
is also under the category of antifibrinolytics,
which decrease clotting, the amount of bleeding,
even the duration of bleeding.
Then we have progesterone IUDs,
it's medicated with progesterone,
it can go inside the uterus for contraception,
but also treats heavy bleeding
and right now we use it for up to six years and take it out
if someone wants to get pregnant.
And then the standby that we've had since the 1960s
is low dose birth control pills.
If you need surgery, it really should be
a minimally invasive gynecologic surgery
with small incisions, the size of a thumbnail.
If the fibroid is just in the space where a baby is,
we use a hysteroscope.
We go through the vagina
to shave off or remove the fibroids.
In women who don't want children,
we may work collaboratively
with our interventional radiologists
and they can guide certain wires or catheters
into the uterine artery in a 60 minute procedure,
block the flow of blood to the fibroids,
starving the fibroids.
As the size of the fibroids decreases,
bleeding gets better, pressure gets better.
One size doesn't fit all.
So you'll need to tell your story
to your healthcare provider and help
to look at the algorithm.
What works if you don't want to be pregnant,
what works if you want to be pregnant.
And then at some point, do you actually need surgery
and if so, what type?
Rarely is a hysterectomy an emergency surgery.
You have time to get opinions.
My take-home message to you today
is that if you have symptoms,
you should see a physician
who can offer you the whole palette,
the whole array of options for the treatment
of fibroid related symptoms.
Hysterectomy should never be your first choice.
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