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Maryland Discoveries
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April 25, 2000

A New Technique to Shrink Tumors. . .


FACTS


The majority of fibroids cause no symptoms. When symptoms do occur, they can include:
•  Heavy menstrual period.
•  Abdominal distortion.
•  Pelvic Pressure.
•  Pain.
•  Infertility.
•  Repeated miscarriage.
•  Premature labor.
•  Frequent urination.
•  Constipation.
(The Fibroid Corner)

Fibroids

Fibroid tumors affect one out of every three women in her 30s or 40s. Although the majority of patients have no symptoms, uterine fibroids can cause pain and heavy bleeding that can lead to anemia.

Until recently the only treatment for fibroid tumors was a hysterectomy in which the uterus is surgically removed. But more and more doctors and medical centers are offering new alternatives to hysterectomies that are less invasive and can preserve a woman's ability to bear a child.

No one knows for sure why some women get fibroids and others don't. Genetics is likely to play a role, meaning that if your mother or sister has fibroids, you should be examined for them, says Dr. Jean Hundley, an OB/GYN at Mercy Medical Center in Colombia. African American women are more likely (40 to 50 percent) to develop fibroids than Caucasian women (30 percent.)

Other factors such as hormonal interactions could play a role as well, says Dr. James Spies of Georgetown University Medical Center's Interventional Radiology Department.

What to do if you suspect you have uterine fibroids?

First, talk with your gynecologist who will confirm the diagnosis with a physical exam and likely an ultrasound, says Dr. Spies. Most gynecologists will try a medical approach first, such as birth control pills or hormone therapy, or even a change in diet.

The role of diet is gaining increasing attention as a way to regulate hormone levels, particularly estrogen. Some diet advocates say switching to a low-fat vegetarian diet can curb the growth of fibroids and bring relief within a matter of months. If you can't give up animal products such as eggs, dairy and meat completely, try to cut down on the amount you do eat.

Avoiding salad dressing with oil (a major source of fat for women) is an easy way to reduce fat intake, says Judy Knapp, a licensed dietician at St. Joseph Medical Center in Baltimore. Eating a strongly-plant-based diet can help decrease fibroid growth, she says. A number of plant-based foods can affect hormone levels, especially soy products, which contain substances that lower estrogen levels.

Switching to a vegan diet has proven effective in studies of other gynecologic conditions affected by estrogen, such as Pre-Menstrual Syndrome (PMS).

If medical approaches don't work, there are a number of alternatives to hysterectomy, says Dr. Hundley. Depending on the location within the uterus, fibroids can sometimes be removed via laparoscopic or hysteroscopic surgery, or myomectomy, which removes the fibroids but leaves the uterus intact.

A new approach, first practiced in Europe about five years ago, is uterine fibroid embolization (UFE), which blocks the blood supply to the fibroids, causing them to shrink and die. In a Georgetown study of the technique on 61 patients with uterine fibroids, Dr. Spies found that 81 percent of patients showed moderate to marked improvement in menstrual bleeding, and that 79 percent had moderate to marked improvement in pelvic pain.

In UFE, a catheter is inserted into the femoral arteries; then small particles are injected into the uterine arteries where they travel to the fibroids and block the blood supply needed for their growth. The procedure requires an overnight stay in the hospital.

What's the best approach for you?

Factors to consider in what treatment is best for you include your future childbearing plans, and the type of symptoms you are experiencing, says Dr. Hundley. Treatment should be individualized to each patient.

Ask you doctor if you need treatment at all, says Dr. Spies. Many times physicians will take a wait and see approach to treatment. Ask your physician why the proposed treatment is the best for you, and what other options are available. If you feel you are not given a wide range of options, seek a second opinion. Despite all the alternatives around today, sometimes a hysterectomy is still the best solution.

For more information on UFE, call James B. Spies, M.D., of Georgetown Interventional Radiology at 202-784-3420 to make an appointment or e-mail him at spiesj@gunet.georgetown.edu.

Gynecologists interested in information on the UFE procedure can review Georgetown Interventional Radiology's Physician's Resource.

To locate a physician who performs UFE in your region, visit the website of the Society of Cardiovascular and Interventional Radiology.

The Related Sites are provided for information purposes. NM is not responsible for the accuracy of their content.
 RELATED  SITES


• Community
  >  St. Joseph Medical Center, a member of Catholic Health Initiatives, is a regional medical center providing comprehensive acute care with diversified specialty services & featured panelist.
  >  Maryland Department of Aging, state agency for the delivery of programs, services and benefits for the aging.
  >  Georgetown University Medical Center, Division of Vascular and Interventional Radiology, information on uterine fibroid embolization (UFE) procedure & featured panelist.
  >  Maryland Department of Mental Health & Hygiene, state agency for healthcare policy.
  >  Center for Women's Health and Medicine at Mercy Medical Center, gives women access to one-stop health care, resources, and education on all women's issues & featured panelist.
• General
  >  American College of Obstetricians and Gynecologists, women's health advocates.
  >  Journal of Obstetrics and Gynecology, a journal of diagnosis and treatment in obstetrics and gynecology.
  >  The Feminist Foundation, provides annotated links to an extensive range of information resources on women's health.
  >  Body Matters, understanding your body through your reproductive years.
  >  Food and Drug Administration (FDA), nation's foremost consumer protection agency.
  >  American Journal of Obstetrics and Gynecology, nation's foremost journal of diagnosis and treatment in obstetrics and gynecology.
  >  National Institutes of Health (NIH), acquire new knowledge to help prevent, detect, diagnose, and treat disease and disability, from the rarest genetic disorder to the common cold.
  >  JAMA Women's Health Information Center, women's health resource.
• Other Information
  >  Women's Health Interactive, online gynecologic health center.
  >  National Women's Health Resource Center, online resource for women's health.
  >  Body Matters, understanding your body through your reproductive years.
  >  OBGYN.net, online resource on women's health issues.
  >  Museum of Menstruation & Women's Health (MUM), history of menstruation and women's health.
  >  HealthGate, women's health factsheet about fibroids.
  >  drkoop.com, article on new procedures to improve outcome of uterine fibroid removal.
  >  The FibroidCorner, provides information on the diagnosis and management of uterine fibroids for patients and health care providers.


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