Fibroids Get New Treatments, Funding Bill

(WOMENSENEWS)–Karlene King shrugged off her pain.

For three years, this Harrisonville, Mo., mother experienced heavy periods, abdominal cramping and other symptoms that were sporadic but never spurred her to seek medical attention.

"My doctor told me I might have benign uterine growths called fibroids," says King. "But I only started to worry when my pelvic tenderness got so bad that it hurt to lay my hand on my stomach. I only went to the doctor after waking up one night and discovering my sheets were soaked in blood. My doctor told me I had a fibroid that had grown outside my uterus and required immediate hysterectomy. I only wish I had stayed on top of this problem so I might have avoided surgery."

Like an estimated 75 percent of American women, King had developed fibroids: tangles of muscle fiber and collagen that grow in or protrude from the uterus. Like 40 percent of women, she suffered adverse effects. And like 25 percent of sufferers, she had such severe symptoms that she decided to have a hysterectomy.

Though the removal of the uterus–and thus the removal of all uterine growths
–may be the only sure-fire cure for fibroids, health advocates hope this will change thanks to two recent developments.

The first is the recent reintroduction of the Uterine Fibroid Research and Education Act of 2003, sponsored by Sen. Barbara A. Mikulski, D-Md., and authorizing $150 million in federal funding for research and education on fibroids.

The second is the creation of new, non-invasive treatments such as focused ultrasound, approved by the Rockville, Md.-based U.S. Food and Drug Administration in October 2004 and using magnetic resonance imaging, or MRI, to locate fibroids and high-energy sound waves to destroy them.

Health advocates hope these changes–and the greater awareness they are trying to raise about fibroids–will prompt women to be more proactive about treatment instead of waiting until fibroids grow too large to be treated with non-invasive means.

Fibroids Create Uterine Masses

Also called fibromyomas, myomas or leiomyomas, fibroids develop when a single cell in the smooth muscular tissue of the uterus starts to replicate in a rapid-fire way, creating a mass that can be as small as a seed or large as a melon.

Though scientists are not always sure what causes fibroids, they believe the culprits may include surges in the female hormone estrogen (which could explain why fibroids tend to shrink after menopause, when estrogen levels drop) and exposure to toxins, a problem currently under study by the National Institute of Environmental Health Sciences in Bethesda, Md.

Genes may also play a part. Having a mother or sister with fibroids is a risk factor. Black women are two to three times more likely to get fibroids than other women and often develop them in their 20s, a decade or two earlier than most fibroid sufferers.

"The majority of fibroids don’t fall into one simple category," says Dr. Bruce McLucas, a professor of obstetrics and gynecology at the University of California-Los Angeles. "Some are singular and some are multiple. Some are small and some are large. Some grow on the inside of the uterus and cause heavy menstrual bleeding. Some grow on the outside of the uterus and trigger pelvic pain and pressure."

Fibroid symptoms vary widely. "Most women don’t have any adverse effects at all," says Dr. Clare Tempany, a professor of radiology at Harvard Medical School in Boston. "But some patients have 10-day periods and have to stay home for days because they are so weak. They have chronic back pain and so much pressure on their bladders that they have to go the bathroom at least once an hour. They feel so bloated and swollen that it’s like they are pregnant all the time."

When fibroids grow unchecked, the normally pear-sized uterus can swell to the size of a basketball. When the growths hang from the uterus by a stalk and the stalk twists, this can cause pain, nausea and fever.

Interferes With Fertility and Pregnancy

Fibroids can interfere with fertility because they prevent eggs from traveling down the fallopian tubes and sperm from traveling up them. They can complicate pregnancy by increasing the risk of abnormal fetal positioning, miscarriage, and premature labor and delivery.

Other common symptoms include anemia, constipation, headaches, loss of sensation in the legs, pain with intercourse and urinary incontinence.

Usually detected during a routine pelvic exam and diagnosed via ultrasound–in which sound waves are used to take a picture of the uterus–fibroids can be vanquished with a wide array of treatments.

Medications attack uterine growths by changing the hormone levels that affect them. Drugs called androgens (synthetic male hormones) and gonadotropin-releasing hormones both lower estrogen levels, easing anemia and shriveling fibroids. Oral contraceptives can help control bleeding, but unlike other medications, don’t reduce fibroid size.

In myomectomy, individual fibroids are surgically removed, sometimes with the aid of electric currents that destroy them and sometimes with the aid of liquid nitrogen that freezes them.

In uterine artery embolization–also called uterine fibroid embolization–small particles of gel or plastic are injected into arteries surrounding a growth, cutting off blood supply to the fibroid and causing it to wither.

In endometrial ablation, electrodes, lasers, microwaves or balloons filled with water are used to remove the lining of the uterus, destroying fibroids.

New Treatment Uses Sound Waves

Focused ultrasound surgery–the treatment recently approved by the FDA–uses an MRI scanner to locate the fibroids along with a device, called ExAblate 2000 System, that destroys them by means of high-frequency sound waves.

Fibroid remedies can have adverse effects. Of the various surgeries, only myomectomy is recommended for women who hope to have children. Endometrial ablation, another form of surgery, ends the menstrual cycle in roughly half of cases. Some fibroid drugs can trigger early menopause. And hysterectomy–the only way to remove all uterine tissue and thus the only way to remove all fibroids–can numb sexual sensation.

"As we seek to improve fibroid treatments, we need to find ways to minimize any impact on a woman’s fertility or sexual functioning," says Lisa Martinez, director of the Cincinnati-based Women’s Sexual Health Foundation.

While health advocates wait for better treatments–and while they wait for a vote on the Uterine Fibroid Research and Education Act that could come this legislative session–they encourage women with two or more fibroid symptoms to seek medical care. At the very least, they advocate for "watchful waiting" or checking the growth’s size annually.

"Though less than 1 percent of fibroids become cancerous, you need follow-up care to rule out this possibility," says McLucas.

Four years after having her hysterectomy, Karlene King agrees. "Had I listened to my body and sought help more quickly, I may not have needed invasive treatment," she says. "But since fibroids never go away on their own, you can never sit back and assume that they will simply get better with time."

Molly M. Ginty is a freelance writer based in New York City.