Uterine fibroids can cause serious symptoms like back and pelvic pain, heavy periods, anemia and more.
At Regional One Health, women have care options including lifestyle counseling, medication and various types of surgery.
By making world-class expertise and resources available to patients, our Women’s Services team is expanding access to proper care for this common, treatable condition.
Uterine fibroids can be asymptomatic and harmless – or they can cause severe back and pelvic pain, heavy periods, anemia and more. For that reason, proper treatment requires listening carefully to a patient’s concerns and helping her navigate her options.
“The best treatment depends on where the fibroids are located and the symptoms you’re having,” said John Schorge, MD. “If a woman is sitting in front of me with scans that show she has fibroids but she says they don’t bother her, then we don’t have to do anything. If she’s saying, ‘I can’t live like this,’ we have a number of options we can explore.”
Dr. Schorge, a renowned gynecologic oncologist and complex gynecologic surgeon and chief of Regional One Health’s OB/GYN service, hosted a “Lunch & Learn” to help women understand the risk factors, symptoms, and treatment options associated with uterine fibroids.
“It is particularly relevant to our patient population, because fibroids are more common in Black women,” he said. “They usually become symptomatic when a woman is in her 40s or early 50s.”
According to the National Institutes of Health, by age 50, up to 80% of Black women will have fibroids.
Along with ethnicity and age, there are several other risk factors.
If your mom or sister had fibroids, you are at higher risk. Also, because hormones cause fibroids to grow, pregnancy and other conditions that cause hormones to fluctuate can contribute to risk.
Dr. Schorge urges women to see their doctor about symptoms like heavy menstrual bleeding and long periods, spotting between periods, pelvic or back pain, abdominal pressure, constipation, frequent urination or difficulty emptying the bladder, and anemia.
Dr. John Schorge is a renowned specialist in complex gynecologic surgery. He said it’s important to listen to a patient’s concerns when selecting the best treatment for fibroids: “The best treatment depends on where the fibroids are located and the symptoms you’re having,” he said.
If a woman is diagnosed with fibroids, she has a variety of options for care.
Dr. Schorge said the least aggressive approach involves making lifestyle changes.
Eating a healthy diet with limited red meat and sugar, a lot of legumes and oily fish, and plenty of brightly colored fruits and vegetables can help, as can avoiding smoking and alcohol. Other recommended changes include getting regular exercise and managing or reducing stress.
He added some women try alternative treatments like acupuncture and herbal remedies. While no benefits are scientifically proven, studies have shown no negative side effects.
Prescription medications are also available to treat fibroids. William Kutteh, MD, a reproductive endocrinologist, recently joined Regional One Health’s Women’s Services team and offers expertise in medical management of fibroids.
Mifepristone can shrink fibroids to reduce pain and heavy bleeding. Elagolix, a new medication, is approved for heavy menstrual bleeding.
Dr. Schorge said some patients are treated with gonadotropin-releasing hormone agonists, an injected medication. This is typically used only for a brief time to shrink fibroids before surgery, as it increases risk of osteoporosis and causes menopause symptoms like hot flashes.
Surgery is a highly effective treatment for fibroids, and patients have several options.
Hysteroscopic removal, for fibroids inside the uterine cavity, involves inserting a scope through the vagina and cervix to remove tissue.
Surgery is an effective treatment option for uterine fibroids. At Regional One Health, the Women’s Services team specializes in offering minimally invasive options that are highly effective and lead to an easier recovery.
“It’s a common outpatient procedure performed by our OB/GYNs,” Dr. Schorge said. “There’s no incision, and they basically shave down the fibroid until it’s gone.”
For patients with a single dominant fibroid, uterine fibroid embolization (UFE) is an option. Performed by interventional radiologists at Regional One Health, it involves making a needle stick in the groin, inserting a catheter through the femoral artery and closing off the blood vessels that feed the fibroid.
Dr. Schorge stressed the procedure does impact fertility. If a woman becomes pregnant after a UFE, the placenta typically cannot attach to the uterus and fetal growth is restricted, leading to a higher risk of miscarriage or premature birth. There can also be side effects including significant pain for a week or two after the procedure.
Myomectomy, or surgery to remove the fibroid, is an option that preserves fertility. Dr. Schorge said the procedure can be done laparoscopically if the fibroid is no bigger than 6 centimeters. In these cases, patients have three small incisions and typically go home the same day. Larger fibroids require an abdominal incision about the size of a cesarean scar.
The other surgical option, a hysterectomy, removes the uterus, so it is best for patients who don’t plan to have children in the future.
At Regional One Health, Dr. Schorge is focused on making minimally invasive hysterectomies more accessible. Minimally invasive surgeries involve smaller incisions, which means an easier recovery, less pain, and lower risk of complications. Patients usually go home the same day.
Nationally, about 75 percent of White women have minimally invasive hysterectomies compared to 50 percent of Black women. Under Dr. Schorge’s leadership, Regional One Health now performs minimally invasive procedures on 90 percent of all patients.
There are medications that can shrink fibroids and help reduce symptoms. Patients can also try lifestyle changes like eating a healthy diet, getting regular exercise, and quitting smoking.
That includes transvaginal hysterectomy, led by Linda Moses, MD, FACOG, which involves no incision; as well as minimally invasive surgeries for patients with challenging circumstances such as obesity or very large uteri.
With all the treatment options available at Regional One Health, women don’t have to suffer from fibroid pain. “Patients can get that care here at Regional One Health,” Dr. Schorge said. “We can help these patients – it’s a privilege to take care of them and make their lives better.”