Uterine fibroids common, but treatment has options

URBANA — The discomfort crept up so gradually on Whitney Bauman, she thought her symptoms were just part of getting older.

Over time, she noticed she was getting a bloated abdomen and longer, heavier menstrual periods.

She had become anemic, and was getting up more at night to use the bathroom, she said.

After an ultrasound exam earlier this year, Bauman learned the source of her discomfort was actually four fibroid tumors in her uterus — one the size of a softball and three more that were about walnut-size.

"The symptoms for this problem come on kind of gradually, so it's kind of hard to pinpoint" recalls Bauman, 44, of White Heath.

Had an advanced practice nurse not pushed on her stomach and told her "this feels like a pregnant belly," and ordered the ultrasound, she might not have learned the fibroids were there, she says.

"I just thought that I was getting old and fat and this was how I was going to have to live," she says.

The cause of uterine fibroid tumors, which are not cancerous, is unknown. Women of any age can get them, but they are most common among women in their 30s and 40s, according to the American Congress of Obstetricians and Gynecologists .

Uterine fibroids don't always produce symptoms. Of the 25 million women in America who develop them, only about 20 percent are troubled enough to seek treatment, according to the specialist who performed a fibroid-shrinking procedure on Bauman, Dr. Michael Neuwirth, head of interventional radiology at Carle.

But for some women, they can cause pain and discomfort, Neuwirth says.

The top symptom is excessive menstrual bleeding, he says. Others include pelvic pain, along with pain in the back and legs, pain during and after sex, pressure on the bowels and bladder, abdominal swelling and anemia.

Uterine fibroids can shrink on their own after menopause, Neuwirth said. But for Bauman, that was going to be way too long to wait.

"My mom didn't hit menopause till she was almost 60. That's a lot of years for me to suffer," she said.

Treatment options

Bauman said she knew a hysterectomy, the surgical removal of the uterus, was one option to relieve her discomfort.

But, she says, "I still have all my original parts, and I'd like to keep it that way."

So she did some research on other fibroid treatments and then made an appointment with Neuwirth to see if she was a candidate for the one she chose, a uterine fibroid embolization.

In that procedure, particles are injected through a catheter into the vessels that supply blood to the fibroids. The particles cut off the oxygen supply fibroids need to grow and cause them to shrink.

Bauman had the procedure in late August, and nearly four months later, says she has seen a gradual flattening of her abdomen. Her menstrual periods were shorter and lighter almost immediately, and now last about 3 1/2 days, and all her other symptoms have eased, she said.

For Neuwirth, it's important for women to know they have options for treating uterine fibroids, and he advises consulting both a gynecologist and an interventional radiologist for a second opinion.

Women tend to get a list of treatment options from their gynecologists, and some gynecologist may be unfamiliar with more recent data on the treatment Bauman had, he said. More than 200,000 of these procedures have been done worldwide in 20 years, he said, and 85 percent to 90 percent of women have improved symptoms in three to six months,

"I see this as empowering women to make the best choice for them in knowing what's out there," he says.

Medications, including contraceptive steroids and nonsteroidal anti-inflammatory drugs, are often used for short-term relief for women suffering from painful menstruaton — both with or without uterine fibroids — according to the American Congress of Obstetricians and Gynecologists in a 2008 update on alternatives to hysterectomy to manage uterine fibroids.

The ob-gyn organization updated its position on uterine fibroid embolization in those guidelines, calling the procedure a "safe and effective option" for an appropriately-selected woman who wishes to retain her uterus, based on short- and long-term outcomes.

However, the organization also emphasized a strong collaboration between the ob-gyn and interventional radiologist to make sure a woman undergoes the appropriate therapy, and that her reproductive wishes are taken into account.

Christie Clinic obstetrician-gynecologist Dr. Mildred Nelson says she's not a big fan of the fibroid embolization procedure.

It isn't offered at Christie Clinic, she said, and she's referred only two patients to it outside the clinic.

Some reasons for her reservations:

"It would never be a candidate for anyone who would want to have children," Nelson says.

She also contends it's an expensive procedure; it can lead to an early menopause, and it will only destroy those fibroids that are in the process of growing.

Plus, Nelson says, "it comes with a lot of pain, a lot. It requires at least an overnight stay at the hospital."

Women should also be aware that there are new and improved treatments coming along for uterine fibroids, and minimally invasive robotic procedures are available for hysterectomy and fibroid removal, she said.

And for large fibroids, most patients will choose a hysterectomy, Nelson said.

Neuwirth said hysterectomy remains the most common treatment for fibroid tumors, and that's one reason women are looking for alternatives.

"I think women get online and do research and give us a call," he says.

He also contends there remain many misconceptions about the uterine fibroid embolization procedure. Available in the U.S. for 16 years, it's now covered by most insurers, he says.

He also says women experience cramping after the procedure, but many are back to work on light duty within days.

Neuwirth further contends there have been women who have become pregnant after this procedure, though "we say we can't promise it," he says.

Neuwirth said he would guide women who want to undergo a procedure to treat uterine fibroids and still become pregnant to consider a myomectomy, a surgical removal of the fibroids that often preserves a woman's fertility.

Women who choose myomectomies, however, face the risk of recurring fibroids, according to the ob-gyn organization.

Her choice

For Bauman, it came down to choosing a procedure that seemed to be the least invasive with the shortest recovery time, she said.

It was covered by her insurance, she said, and she was off from work "not even 10 days."

Afterward, she experienced pain and cramps, and "the first few days were rough," she recalls. "But they give you good drugs."

By the third day, she was out of bed and doing things around the house, Bauman said.

Given the relief she feels now, she says, she hopes other women will check out fibroid treatment options, rather than go on living with discomfort.

"You've got lots of choices," she advises.

You can read more about uterine fibroids at the American Congress of Obstetricians and Gynecologists website, http://bit.ly/u1AhCH, or at the Society of Interventional Radiology site, http://bit.ly/sqokLx.

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