Understanding Uterine Fibroids: Symptoms, Diagnosis, and Treatment

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. I am Deborah Howell, and today we'll be talking about the causes and symptoms of uterine fibroids. It's a common health issue for women as they age, and we'll also talk about some of the treatment options, too. Our guest today is Dr. Yen H. Tran, a physician who specializes in obstetrics and gynecology. Although Dr. Tran was born in Vietnam, she grew up in Torrance, California, and received her bachelor's degree locally at UC Irvine. Dr. Tran is currently part of MemorialCare Medical Group's new Women's Services Offerings, a group that includes OBGYNs and certified nurse midwives who provide care for women through all stages of life and health, located on the campus of the Orange Coast Memorial Medical Center. Welcome, Dr. Tran.

Yen Tran, DO: Thank you, Deborah.

Deborah Howell (Host): What is a uterine fibroid?

Yen Tran, DO: So, Deborah, uterine fibroids are the most common pelvic B9 tumor in women. Estimated lifetime risk of 70% in white and 80% in black women. They arise from smooth muscle of the uterine wall. They arise in reproductive age women and typically present with symptoms like heavy period, irregular period, pelvic pain, and pressure. And fibroids might cause infertility and adverse pregnancy outcome like recurring miscarriages.

Deborah Howell (Host): Okay. And what factors can increase a woman's risk of developing fibroids?

Yen Tran, DO: Okay. There are a couple of factors. So patients who started their period earlier than age 10, high BMI, significant consumption of beef and other red meat. Interestingly, vitamin deficiency has shown to be one of the risk factors. Consumption of alcohol, especially beer, genetic predisposition, high blood pressure, and also history of physical and sexual abuse have linked to increased risk of fibroids.

Deborah Howell (Host): When you're talking beer and beef, how much is a dangerous quantity?

Yen Tran, DO: You know, in life, everything should be balanced. So if a person claims that he or she is on a diet that, you know, has 60% to 70% beef or red meat, that's considered to be a lot. So it's best to have the usual amount, you know, try to eat more green vegetables and just make sure you limit down to one portion of beef or red meat a day or every other day is best.

Deborah Howell (Host): Okay, that's very helpful. And what are some of the symptoms of having fibroids?

Yen Tran, DO: So fibroids are brought to medical attention due to sometimes symptoms. So sometimes we found it incidentally on pelvic imaging. And some of the symptoms are longer, more frequent, heavier menstruation, leading to anemia, menstrual cramps, and large abdomen with pain in the lower back or pain during intercourse. Some women present with difficulty urinating or increased urinary frequency from the pressure of the fibroid present on the bladder. And some women even present with constipation. And as a gynecologist, I do see a lot of patients complaining of recurring miscarriage or inability to conceive.

Deborah Howell (Host): Boy, none of those symptoms are pleasant, are they? Now, do all women who have fibroids show symptoms?

Yen Tran, DO: Thanks to God, the majority of fibroids are small and asymptomatic.

Deborah Howell (Host): That is one blessing, as you said. And what complications can occur if you do have fibroids?

Yen Tran, DO: So heavy bleeding, as you know, may lead to severe anemia and I have seen people who have hemoglobin as low as 4 and in non-pregnant state, our hemoglobin as a woman should be 13. So 4, as you can see, is significantly lower than 13 and it could be very life-threatening. Another complication is infertility and recurring miscarriages, as well as urinary tract or bowel obstruction or venous compression from the mass compressing on the nearby organs.

Deborah Howell (Host): Understood. Can fibroids actually turn into cancer?

Yen Tran, DO: Rarely, but yes. Uterine fibroids are very common, and yet uterine sarcoma is rare. It's as rare as maybe there are 7 out of 100,000 U.S. women. So it's relatively rare. And the increase in age is a significant risk factor for uterine sarcoma. However, young age does not exclude the diagnosis of sarcoma. The incidence seems to be four times higher in women greater than age 50, And so postmenopausal women with a new growing uterine mass should go see their gynecologist to be evaluated.

Deborah Howell (Host): Okay. And Dr. Tran, how are fibroids diagnosed?

Yen Tran, DO: We basically have to talk to the patient, do a complete history of physical on the patient, and do a pelvic exam. Sometimes we also order ultrasound or a histoscope. Histoscope is a slender device that we insert inside the cervix to see the inside of the uterus. Sometimes we order hysterosapingogram, which is a special type of x-ray for the pelvis to see the texture inside the uterine cavity. And we could also do a laparoscopy, which is a little bit invasive. We basically insert the scope through the belly button of the patient while the patient is asleep so that we can take a look inside.

Deborah Howell (Host): Okay, got it.

Yen Tran, DO: Yeah, but majority of the time, we use the ultrasound.

Deborah Howell (Host): Okay. And when is treatment actually necessary for fibroids?

Yen Tran, DO: So, like we mentioned before, thanks to God, majority of the fibroid are asymptomatic. And if it's small, we can just basically follow it. But once a patient, you know, becomes symptomatic, like, severe anemia, if the fibroid is causing other complications just as urinary tract obstruction or inability to have bowel movement from the mass compressing on the nearby organs or the patient is unable to conceive or suffer from multiple miscarriages, then that's when the treatment is needed.

Deborah Howell (Host): Okay, and is there also medication that can be used to treat fibroids?

Yen Tran, DO: So if a patient presents with heavy bleeding and painful period, sometimes we put patients on birth control pill. Sometimes we also give patient injection, which is the Lupron injection, where we can inject it into the muscle layer either monthly or every three months to decrease the size of the fibroid. We sometimes could place an IUD. There are three types of IUD, the Skylar, the Mirena, and the Paragard. At this point, the five-year IUD, the Mirena, have shown to help with the heavy bleeding and the pain.

Deborah Howell (Host): I am a recipient of Lupron, and I tell you what, it is a lifesaver. What a difference in lifestyle. I mean, you can become comfortable, and you really shouldn't live in pain like this.

Yen Tran, DO: Yeah, and studies have shown that after three months of Lupron, the fibroid could potentially decrease up to 60% of its original size.

Deborah Howell (Host): Yes, and it's something you should definitely discuss with your physician. And lastly, what types of surgery may be done to treat fibroids?

Yen Tran, DO: We could do myomectomy, which is a fancy term we use to describe removal of the fibroids, and leave the uterus in place because most of these women still want to keep their uterus for future childbearing. However, fibroids do not regrow, but new fibroids could come back again. And in older patients who are no longer able to have children, or do not want to have any more children, hysterectomy could be an option. And I'm trained to do minimally invasive surgery. So when we talk about hysterectomy, we don't have to face with a big cut. Nowadays, we could get away with single-site incision. We can do the full hysterectomy procedure through one tiny little incision through the umbilical area.

Deborah Howell (Host): Exactly. I have a final question for you because we're running out of time. Are there other treatments besides medication and surgery?

Yen Tran, DO: Yes. So we have hysteroscopy, which is a procedure where we insert the scope through the cervix. And we also insert the resectoscope to destroy the fibroid with electricity or laser beam. Sometimes we can ablate or destroy the lining of the uterus so patients don't have to suffer heavy bleeding. And there's another procedure called uterine artery embolization. This is a procedure where an interventional radiologist inserts a tiny particle the size of the grain into the blood vessel that leads to the uterus. And this blocks the blood supply to the fibroid and causes it to shrink.

Deborah Howell (Host): Yes. So there are many, many options.

Yen Tran, DO: Yes, many options. The one that we are working with is still under study. It's called magnetic. It's the MRI-guided ultrasound surgery. But that one is not the standard of care just yet. It's still under more studies.

Deborah Howell (Host): Sounds good. Well, I thank you so much, Dr. Tran, for your time today. We learned so much, and we do appreciate you taking the time to be on the show.

Yen Tran, DO: All right. Thank you so much, Deborah.

Deborah Howell (Host): For more information or to listen to a podcast of this show, please go to MemorialCare.org. That's all for this time. I'm Deborah Howell. Thanks for listening and have yourself a great day.