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Dr. Dorette Courtar Speaks About Fibroids

Dr. Dorette Courtar Speaks About Fibroids

What are uterine fibroids?

 Fibroids are growths of the uterus, or womb. They are also called uterine leiomyomas or myomas. The uterus is made of muscle, and fibroids grow from the muscle. Fibroids can bulge from the inside or outside of the uterus. They are not cancerous and are not thought to be able to become cancerous.


What causes fibroids?

Fibroids seem to respond to the female hormones estrogen and progesterone; some women have specific genes that may predispose them, and lifestyle and reproductive factors also influence fibroids. Some fibroids grow with time and others shrink.


What are the symptoms of fibroids?

Not all fibroids are problematic. Fibroids can range in size from the size of the pea to the size of watermelon, but the location of the fibroid is the more problematic factor than size. An apple size fibroid on the outside of the womb may give no problems while another person with a pea sized fibroid may have more symptoms.

Most complains are increased menstrual bleeding and pelvic pressure and pain. Larger fibroids can cause a sense of pelvic pressure or fullness in the abdomen. If a fibroid is pressing on the bladder, the woman may feel like she needs to urinate frequently. Similarly, a fibroid pressing on the rectum can cause constipation.

Fibroid symptoms tend to get better when a woman no longer has menstrual periods, at menopause.


Do fibroids affect fertility or pregnancy?

Most women with fibroids are able to become pregnant without a problem. However, certain fibroids that change the inside of the uterus can cause trouble becoming pregnant or miscarriage. Removing these fibroids can optimize fertility. Women with fibroids and reproductive problems should go through a basic infertility evaluation before concluding the fibroids are responsible for the problem.

Most women with fibroids have a completely normal pregnancy without complications. However, women with a large fibroid (greater than 5 to 6 cm) or more fibroids might have an increased risk of specific pregnancy complications, for example premature delivery.


How does the doctor know if a woman has fibroids?

A doctor may suspect fibroids if the womb is enlarged or has an irregular shape. A pelvic ultrasound is needed to confirm that fibroids are present.


How are fibroids treated?

The treatment of fibroids is decided by the patient. Fibroids can be treated with medication or with surgery. Most medical treatments are used to reduce the heavy menstrual bleeding. A few medical treatments also shrink the fibroid and some are focused on reducing pain or correcting anemia.

Medical treatments are often recommended before surgical treatments.

    Some medical treatments we offer at SMMC are:

  •          Iron and vitamins—For women who are anemic, the combination of iron supplements and a multivitamin will help the body effectively use the iron
  •        Nonsteroidal anti-inflammatory drugs (NSAIDs)—such as ibuprofen (sold as Advil) and naproxen (sold as Naprosyn or Aleve), can help reduce menstrual cramps and decrease menstrual flow in some women. However, NSAIDs do not reduce bleeding as well as most other medical treatments do.
  •        Hormonal birth control—Hormonal methods of birth control include the pill, skin patch, vaginal ring, shot, hormonal IUD, and implant. These treatments reduce bleeding, cramps, and pain during your menstrual period and can correct anemia. It might take three months for bleeding to improve after you start taking hormonal birth control.
  •        Hormonal intrauterine device– There is an intra uterine device (IUD) that slowly releases a form of a progesterone-like hormone called a progestin, into the uterus. There is no estrogen in the IUD. The IUD prevents pregnancy and reduces menstrual bleeding for up to five years.
  •        Implant–There is an implant that slowly releases a progestin into your bloodstream. It prevents pregnancy and reduces menstrual bleeding for up to three years. A doctor places the implant (which is about the size of a match stick) under the skin in the upper inner arm. It is called Implanon.
  •        Shot–Depot medroxyprogesterone acetate is a long-acting form of a progesterone-like hormone called a progestin. It is a shot given once every three months. This treatment prevents pregnancy and can reduce heavy menstrual bleeding.
  •        Antifibrinolytic medicines—Antifibrinolytic medicines do not contain hormones and can help to slow menstrual bleeding quickly. These medicines work by helping blood to clot. Antifibrinolytic medicines do not shrink fibroids or correct anemia.
  •        Gonadotropin-releasing hormone agonists—Gonadotropin-releasing hormone (GnRH) agonists are a medicine given by injection once every one to three months that can be used to temporarily shrink uterine fibroids and temporarily stop menstrual bleeding. This treatment works by "turning off" the ovaries, causing a temporary and reversible menopause.


What surgical or interventional treatment is available at SMMC and when is this recommended?

Surgical or interventional treatment is recommended to preserve the fertility of a woman if the fibroid is located inside the womb.

It may also be recommend if a woman has fibroid-related heavy menstrual bleeding, pain, or pressure that does not get better with medical treatments.

 At the SMMC we offer the following:

  •          Myomectomy—a surgery done to remove fibroids which can reduce both bleeding and size related symptoms. Most women who have myomectomy are able to have children afterwards. However, there is a risk that fibroids will return.
  •          Endometrialablation—Endometrial ablation destroys the lining of the uterus. The treatment does not shrink the fibroid(s) but can help to decrease heavy menstrual bleeding caused by fibroids. Some women who have endometrial ablation stop having menstrual periods. Endometrial ablation is not a form of birth control, but pregnancy is not recommended after treatment and often not possible.
  •          Hysterectomy—Hysterectomy is a surgery that removes the womb. The ovaries and cervix may be left in place when the hysterectomy is for uterine fibroids. Hysterectomy is a permanent treatment that cures heavy menstrual bleeding and the bulk of related symptoms of fibroids. However, it is major surgery, and you will need up to six weeks to fully recover.


Can fibroids be prevented?

The cause of fibroids is unknown so there is no sure way to prevent them. What is known is that fibroids are negatively influenced by female hormones. Depending on your nutrition you can surge your hormones more than necessary. In my clinic, I confront the patient with her own responsibility. Living a healthy and balanced life contributes to a good overall health and influences the growth of fibroids. Regular exercise and reducing BMI, reduces the amount of circulating estrogens.

If you strive to achieve optimal health then you will ultimately reduce the positive environment needed for fibroids to grow. 


| Categories: Press Releases | Tags: Dr. Courtar, Uterine fibroids, GYN, OB | View Count: (4263) | Return
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