Fibroids overview

Uterine fibroids are non-cancerous tumors on the uterine muscle . 99.95% of fibroids are benign & remain benign, even if they grow in size. Not all fibroids become very large & they vary in size from microscopic sizes to Watermelon size. The Authors grew to 8 months pregnancy size & weighed 11 pounds when it was removed. It was 22cm high & 33cm in diameter. It is not unusual for women to have more than 1 fibroid . (The author had 4). One US Doctor informed me that he’d removed 200 from 1 patient & still managed to retain preserve her womb. A myomectomy is the removal of just the fibroids, its similar to shelling peas from a pod if they are numerous. There are many types of Myomectomy. Open Myomectomy has the best results for symptomatic Large or Multiple Fibroids. This article is an overview of Fibroid Research in relation to Diet, Treatments, Black women & fibroids, statistics, fertility and social issues involving fibroids.

Because of the size, location & number of fibroids the traditional myomectomy , can take longer to perform than a hysterectomy. This has led some Drs to prefer the quicker option of either a minimal surgery myomectomy or a minimal or open surgery hysterectomy, as it solves in their minds , all of the women’s problems. Drs have used Minimal Surgery to clear their waiting lists quicker & perform more operations per day. Hysterectomies are used to train Junior Doctors on female anatomy, which they could not obtain if the womb remained in the body.

I attended a Fibroid conference for Drs in approximately 2000, where a Senior consultant Obstetrician was complaining that the Junior Drs couldn’t persuade as many women as previously to undertake hysterectomies, so they were having to send them to Third World Countries to get their training. In the same conference the Dr also complained that there were some feminist women who wanted to keep their wombs for no reasoThe National Institutes of Health in America have carried out very large studies of Black Women in Fibroids, involving reviewing the patient details of over 50,000 women. This has provided a lot of information on issues for Black Women & Fibroids. In the US, it is a requirement of research to include the race of participants. It is not a requirement in the UK, which is why in the last 8 years, information on specific UK Black Women’s health statistics is limited. Another Problem in the UK is auditing of treatments for Heavy Menstrual Bleeding stopped in 2014. This has made it difficult to estimate the success or failure of current fibroid treatments. There is also No specific guideline for the condition of fibroids. Patients are often receiving multiple treatments, with no benchmark of care.

Fibroids are still the leading reason for hysterectomies for Black women in the UK. A Heavy Menstrual Bleeding Guideline Update, disappointingly, brought in the use of Hysterectomy as a 1st line treatment.

UK Fibroid Statistics
In the UK in NHS hospitals during 2012-3, there were 30,929 diagnosed with fibroids by hospital consultants. It is not clear what the current position is because Drs do not record the reason, surgeries are used ie the statistics may show, there were 500 hysteroscopies. But that doesn’t explain what condition, they were used to treat ie fibroids, adenomyosis, Endometriosis ovarian cysts or fibroids etc. It is therefore difficult to obtain figures. The same is true for Hysteroscopy procedures, which have never been audited.

Parallel to the poor coding & lack of audits, has been an exponential growth in treatment harmed Patient Groups. Particuarly for Endometrial Ablation, Hormonal IUDs used to treat Heavy Menstrual Bleeding. There are also no drugs that permanently prevent or cure fibroids. There are only drugs that may reduce heavy periods but often with significant side effects &/or reduce fertility during treatment. There is no evidence that use of any of the drugs used to “treat” fibroids or suspected symptoms of fibroids such as heavy periods improve womb or ovary health. In fact the contrary can sometimes be the case. There is also no evidence that any birth control cures or prevents fibroids or stops their growth. At most, many seem to mask symptoms temporarily. Some women have found that their symptoms are worse than before they started, within 6 months of medical treatment & often the fibroids return to the original size.

It is estimated that 50 % of UK women of all races will have fibroids at some point in their childbearing years. Many will not require any treatments as they often remain without symptoms. Some remain small & women only become aware of them due to having pregnancy scans or general check ups, where they may be found incidentally.

Many women have complained to our organisation & Femisa (a voluntary patient led org, advising women re fibroid embolization) that they are ony offered “castration” (Hysterectomy) as a solution to their fibroids & they’re not being offered less invasive treatments which preserve the womb, whether or not they intend to have children. Women expressed the desire not to have the option of having to go into an early surgical or medical drug induced menopause because Hysterectomy is still being offered by some Drs as the 1st resort, rather than the last.

Frequency of Fibroids

The vast majority of hysterectomies are performed for benign indications & thus to improve the quality of life rather than save lives.

Patients have indicated however that hysterectomies are the Dr’s choice rather than the patients choice. Few are offered any other options. Unfortunately, Drs are not being trained to perform Open Laparotomy myomectomy as part of their basic training, which is often the best option for women with Large ie over 10cm Fibroids & / or Multiple Fibroids. This restricts patients choice.

50% of women with fibroids have no symptoms.

Those with Symptoms include:
Heavy menstrual bleeding
Period pain
Bloated Sensations
Increased urinary frequency
Bowel disturbance

However, these symptoms are also common to other conditions, so other issues should be ruled out 1st before Fibroids are treated ie. New Heavier Period or even daily Bleeding can be induced by other prescribed medicines:

  • Anticoagulants /blood thinners. Medications to prevent blood clots (non-steroidal anti-inflammatory drugs, aspirin, coumadin, heparin)
  • Antidepressants / SSRI’s
  • Antipsychotics
  • Corticosteroids
  • Herbs: ginseng, chasteberry, danshen
  • Hormonal contraceptives & Displaced or IUDs perforating the Womb lining
  • Tamoxifen
  • Statins, Fluvastatin

Some symptoms can also arise from damage from previous surgery causing new Complications. So it’s important to get your Dr, to review all of your other medications & your previous surgeries.

Black women are more likely to have Large & symptomatic fibroids, at younger ages, which may be why they are diagnosed more frequently.

Hysterectomy

Fibroids is the most common reason for a Hysterectomy. 40 % of Hysterectomies are for fibroids.

Black-white differences in factors related to hysterectomy. 53,159 hysterectomies were reviewed in Maryland, USA
Findings:
The average annual age-adjusted hysterectomy rate was higher for black women (49.5 per 10,000) than for white women (41.2 per 10,000). For 65.4% of the hysterectomies in black women, the principal diagnosis was uterine fibroids, compared to 28.5% for white women. In comparison to white women, black women having hysterectomy were found to have an increased risk of one or more complications of surgical or medical care . This may be due to poor, Drs Surgical Skills in the management of large / multiple fibroids.


In a study of more than 53,000 hysterectomies, black women were more than twice as likely to have a diagnosis of uterine fibroids as white women, were more likely to have complications, had a longer hospitalization, and had more than three times the in-hospital mortality rate. (Hysterectomy and race study). This may be a racial bias in detection ie due to an assumption that fibroids mostly affects black women.


A 2013 study, however found that up to 70% of white women had fibroids vs up to 80% of black women, when ultrasound was used. The fibroids ranged from microscopic size to watermelon size. Clearly, Uterine Fibroids is an all women condition. The issue for healthcare should be finding it out what triggers fibroids to become symptomatic or larger. Research has started to look at this. The most promising research is looking at Environmental Endocrine (Hormone) Disruptors ie looking at chemicals that women are exposed to, throughout their lives, that change their hormone levels, which may lead to higher severity of the condition.

This is important research as a study found that close to one-third of working Women with Fibroids, said they missed work because of symptoms, including heavy or prolonged menstrual bleeding, cramping and fatigue.


In 1 Patient Survey, many women wanted to preserve their uterus, and younger women were often focused on preserving their fertility.


“I was impressed by how strongly women felt about uterine preservation,” said study author Dr. Elizabeth Stewart, a professor of obstetrics and gynecology at the Mayo Clinic in Rochester, Minn. “For many women, even if they don’t want fertility, preservation of their uterus is an important goal.” Fortunately, fibroids won’t necessarily require a hysterectomy, especially if women get medical care early, she said.


The 968 women surveyed were aged 29 to 59 and had reported fibroid symptoms. Fibroids often present no symptoms, but one-quarter of women with fibroids say their day-to-day life is affected by the growths.
Among the other findings: 24 percent of the working women said fibroid symptoms kept them from reaching their career potential, and 41 percent of women saw two or more health care providers before getting a diagnosis.


A sub-study found that black women are more likely than white women to have severe symptoms, and 32 percent of black women waited more than five years before seeking medical treatment compared to 17 percent of whites.

Physical Risk factors

Black women are more likely to be diagnosed with fibroids than other races. They are also more likely to diagnosed with larger & more numerous fibroids, at a younger age. Ie some studies show they are often diagnosed 10-15 yrs earlier. They are more likely to have symptomatic fibroids

Psychological studies
In a cross-sectional study of Black Women , a positive association was found between Fibroids prevalence and both the number of major life events and stress intensity.16 There was a higher Fibroid prevalence in women who felt racial discrimination & in the Black Women’s Health Study (BWHS), a prospective cohort study. UF incidence was positively associated with greater levels of “everyday” racism and lifetime occurrences of major discrimination, with weaker associations found among those with higher coping skills.

Endocrine Disruptors & Environmental Exposures

Exposure to plastic products, cosmetics, & other chemicals including BPA Bisphenol A, consumption of soybean milk, food additives, sweetener & preserved foods may be risk factors for fibroids (Environmental exposure & risk of uterine leiomyoma: an epidemiologic survey). China 2013

Chemicals in many Hair & Beauty products including Hair Relaxers are also believed to be linked to the development of Fibroids.

Fibroids & Pregnancy

The majority of women with uterine fibroids will have normal pregnancy outcomes.

Over 80% of fibroids observed during pregnancy remain the same size or reduce during pregnancy (Muram & El Toaffe)


Pregnancy rate after Myomectomy was 50-68% & a Live birth rate of 57-93%. Caesarian birth was more likely after a myomectomy. Fibroids , Infertility & pregnancy wastage (2000) N.Bajekal)

50% of women with infertility/reproductive wastage , conceive after myomectomy. (Verkauf 1992. Vercellini 1998)

Miscarriage rates are significantly reduced after Open myomectomy. If there is a previous history of recurrent miscarriage. There are no clear figures for Live Birth Rates after Hysteroscopic Myomectomies or the use of Dilation & Curretage (which used to be called Blind D&C or “the scrape”). It is believed that regularly removing endometrial lining can increase the risk of adhesions (scar tissue) & may results in more damage & so it is not encouraged if preserving fertility is the goal. There is also a high risk of complications.

The UK (NICE ) Hysteroscopic Morcellation Guideline has never been audited. UK Fibroids Patients report that some have had 4-8 Hysteroscopic Morcellation procedures, each. They have developed more fibroids after treatment. This may be due to the fact that removed fibroid tissue is not always fully removed from the abdomen. Even benign fibroid tissue can reseed & regrow in other parts of the womb or abdomen if left in by the Dr. It is therefore difficult therefore to confirm whether this minimal procedure is cost effective or improves quality of life, if it leads to multiple reoperations.

Women with fibroids are as fertile as the general population of women ie approximately 70% of all women. The presence of fibroids did not increase the risk of pre-term birth, however, subserous and submucosal fibroids slightly increased the risk of an earlier pre-term birth. The mean time to conception was similar between women with and without uterine fibroids. African American women were more likely to have a uterine fibroid, to have more than one fibroid, and to have a larger uterine fibroid than their Caucasian counterparts.

Diet & Exercise

General Fibroid Studies
Vitamin D reduces the risk of fibroids. A US Womens’ study found that Only 10% of blacks & 50% of white women with fibroids had sufficient levels of Vitamin D. (Halder, NIEHS Uterine Fibroid Study).

Eating Fruit & Vegetables, particularly fruit lowers the risk of Fibroids.

Exercise reduces the risk of fibroids.


In the Black Womens Health Study involving 21,885 african american women. Risk of fibroids was positively associated with years of alcohol consumption and current consumption of alcohol, particularly beer.
Red Meat , particularly beef & ham consumption increases the risk of fibroids. Research is undergoing to see if it may be due the chemical growth factors used in modern farming to speed up the growth of animals to bring them to the market which may be the underlying problem with some red meat


Early Life Exposures
Data from 3,534 black women was analysed aged 35–59 , in the Sister Study, who self-reported information on early-life and childhood exposures. Early-onset fibroids were assessed based on self-report of a physician diagnosis of fibroids by the age of 30 years

Results: Factors most strongly associated with early-onset fibroids were:

-their mothers being given a synthetic estrogen called DES or diethylstilbestrol / Stilbesterol to prevent miscarriage

-maternal pre-pregnancy diabetes or gestational diabetes

-monozygotic multiple birth ie Identical Twins

-Being taller or thinner than peers at the age of 10 years

– having been fed soy formula.

Bibliography
Racial differences in women who… [Womens Health Issues. 2009 May-Jun] – PubMed – NCBI. 

Early-life exposures and early-onset Uterine Leiomyomata in Black Women in the Sister Study [Environ Health Perspect. 2012] – PubMed – NCBI.

Risk of uterine leiomyomata in relation to tobacco… [Hum Reprod. 2004] – PubMed – NCBI. 

Comparison of characteristics of fibroids in A… [Fertil Steril. 2013] – PubMed – NCBI.

Uterine leiomyoma among women who conceive. [Arch Gynecol Obstet. 2005] – PubMed – NCBI.

The burden of uterine fibroids for… [J Womens Health (Larchmt). 2013] -Elizabeth Stewart PubMed – NCBI.

Lifetime abuse victimization and risk of… [Am J Obstet Gynecol. 2013] – PubMed –

Uterine leiomyomas. Racial differences in severity. [J Reprod Med. 1996] – PubMed – NCBI.

Ovary and uterus related adverse events associated with statin use: an analysis of the fDA Adverse event Reporting System

Proceedings from the Third National Institutes of Health International Congress on Advances in Uterine Leiomyoma Research: comprehensive review, conference summary and future recommendations.

Diet & Uterine Myoma . Parazzini 1999.

Other Weblinks for more info:

Author: Bridgette York
Fibroid Network https://www.fibroid.network
Twitter UK @fibroidsupport

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Have your Say- UK Parliamentary Group Fibroid Patient Survey on Informed Choice

Fibroid Network UK Patient Survey

All Party Womens Group Survey- Informed Choice for Fibroids Patients

The All-Party Parliamentary Group on Women’s Health is a cross-party group of MPs and Peers in the UK Parliament of Westminster. The group aims to empower women to ensure that they can make an informed choice about the best treatment for them and that they are treated with dignity and respect.

The survey is available here: Click to go to the Anonymous Survey.

Link: https://www.surveymonkey.co.uk/r/fibroids-informed-choice#

The group has launched an inquiry into whether women are given an informed choice about the treatment options available for particular conditions. The group aims to produce a report which will assess if women are given an informed choice about treatment options and outline what further improvements might need to be made.

Fibroids is a condition the group would like to shine a particular spotlight on in this report and so would like to hear from patients about their own experience of living with and accessing treatment for fibroids.

We would be really grateful for your help in responding to this anonymous survey about your personal experience. Your responses will remain anonymous, but will help to ensure that women in the future are given full information about their treatment options and a fully informed choice about the treatment that suits them.

If you would like any further information about the report or the group’s work more generally please contact the group secretariat by emailing appgwh@pbpoliticalconsulting.com or calling 020 7735 6963. Completing the survey, is a rare opportunity to have your say about your care. You can add , how it can be improved? Whether you feel fully informed about the many fibroid treatments available. Did you understand the treatment options and outcomes. Did you meet your treatment goals? What info would help you in your treatment decisions.

 

PATIENT SURVEY HERE

 


Italian researchers have found a link between fibroids & diet

An Fibroid Study in Italy found that fibroids were more common in women who ate beef and ham frequently, and less common in women who ate more green vegetables & fruit had a lower risk of fibroids. Abstract of the Medical Paper Objective: To analyze the relation between selected dietary indicators and the risk of uterine myomas. Methods: They used data from a case-control study on risk factors for uterine myomas conducted in Italy between 1986 and 1997. Cases included 843 women with uterine myomas whose clinical diagnoses dated back no more than 2 years. Controls were 1557 women younger than age 55 who had not had hysterectomies and were admitted for acute nongynecologic, nonhormonal, nonneoplastic conditions. Results: Women with uterine myomas reported more frequent consumption of beef, other red meat, and ham and less frequent consumption of green vegetables, fruit, and fish. The multivariate odds ratios in the upper tertile were 1.7 for beef and other red meat (95% confidence interval [CI] 1.4, 2.2), 1.3 for ham (95% CI 1.0, 1.6), 0.5 for green vegetables (95% CI 0.4, 0.6), and 0.8 for fruit consumption (95% CI 0.6, 1.0). Parazzini, MD Istituto di Ricerche Farmacologiche “Mario Negri” Francesca Chiaffarino ScD, Fabio Parazzini MD, Carlo La Vecchia MD, Liliane Chatenoud ScD, Elisabetta Di Cintio ScD and Silvia Marsico MD “Diet and uterine myomas” Istituto di Ricerche Farmacologiche “Mario Negri,” Milan; and the Prima Clinica Ostetrico Ginecologica and Istituto di Statistica Medica e Biometria, University of Milan, Milan, Italy Alcohol especially Beer is also a Risk Factor for Fibroids . This Study involved 22,000 women.

References

  • Chiaffarino F1, Parazzini F, La Vecchia C, Chatenoud L, Di Cintio E, Marsico S. Diet and uterine myomas. Obstet Gynecol. 1999 Sep;94(3):395-8. PMID: 10472866.


Use of medical, surgical and complementary treatments among women with fibroids

Jacoby VL, Jacoby A, Learman LA, Schembri M, Gregorich SE, Jackson R, Kuppermann M

Eur. J. Obstet. Gynecol. Reprod. Biol. 2014 Nov;182:220-5

PMID: 25445104

Abstract

OBJECTIVE: To examine the use of medical management, uterus-preserving surgery (UPS), and complementary treatments among women with uterine fibroids.

STUDY DESIGN: Prospective cohort study of 933 premenopausal women ages 31-54 years with symptomatic fibroids who participated in the Study of Pelvic Problems, Hysterectomy, and Intervention Alternatives (SOPHIA) for an average of 4.3 years (SD 2.5 years). Incident use of fibroid treatments was determined through annual interviews. Linear regression models were used to compare changes in fibroid-related symptoms among women who underwent UPS versus those who did not undergo surgery.

RESULTS: Participants were racially and ethnically diverse, with a mean age of 43 years. During study follow-up, 531 participants (57%) did not undergo UPS or hysterectomy, 250 (27%) had at least one UPS, and 152 (16%) underwent hysterectomy. Complementary and alternative treatments were commonly used, including exercise (45%), diet (34%), herbs (37%), and acupuncture (16%): participants reported significant symptom improvement and few side effects with these interventions. In multivariable linear regression models, women who did not undergo surgery during the study reported improvement in dyspareunia (p<.001), pelvic pain (p<.001), and menstrual cramps (p<.001). However, women who underwent UPS reported greater overall resolution of "pelvic problems" compared with women who did not have surgical treatment (difference in change score 1.18 on a four-point Likert scale, p<.001).

CONCLUSION: UPS are effective treatments for women with fibroids, but many women use hormonal or complementary treatments and report significant symptom improvement without surgical intervention.