Fibroid Treatment Options

In this episode I am going to discuss ALL the current treatment options for fibroids - including diet, acupuncture, medications, and major surgery. 🚺📚🏥 

You need to be armed with the facts to discuss with your doctor the right option for you!

Transcript

SPEAKER_00: 0:00

Hey guys, Dr. Celestine here, and welcome to another episode of the For Vaginas Only podcast. In this episode, we are going to talk about fibroid treatment options. So I've talked about fibroids before. I have an episode called All About Fibroids, where I kind of gloss over a few things in terms of treatments and make it really generalizable. But we're just going to get down to the nitty gritty. You have fibroids. What the hell can you do about it? Let's find out here. But first, let's cue the music. Hello and welcome to For Vaginas Only, the podcast about everything female. I'm your host, Dr. Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. Okay, so really quick, I'm going to say just because you have a fibroid doesn't mean you actually have to treat it. If you want to find out more about that, listen to my All About Fibroids podcast episode, because this episode is solely about the treatment options. Things are going on, you need it to be treated, you're talking to your doctor about it, you want to understand what the options are, welcome to this podcast episode. So first and foremost, I'm going to I did a TikTok actually, believe it or not, and it was about Cherie from the Housewives had fibroids and she talks about doing acupuncture. So acupuncture, you know, I practice Western medicine. That's people that have studied in the United States, but acupuncture is more of a Chinese medicine. And it's been shown, I found actually a really good study of that shows that it can shrink small to medium fibroids over time. It's not instantaneous, obviously, but it has shown to shrink them... you know, and has actually been clinically studied and have clinical significance. So I think that, yeah, that's a treatment option for somebody that your symptoms aren't severe. You're not like dying from your fibroids. Not that fibroids kill you. Fibroids are benign. But some of the symptoms can be just like, I mean, torture. So if you don't have really, really bad symptoms, just small to medium fibroids, you could try acupuncture. That might be a good option for you. Just make sure you go to a reputable place to do it that actually functions as a treatment for fibroids and advertise it that way and have the certifications to back it up. All right, so next I'm going to just briefly touch on hormonal medication. Now, if you guys have listened to any of my birth control podcasts before, you know I kind of like to refer to it as hormonal medication because just like you take blood pressure medication, diabetic medication, these are just hormones in a pill, and they're used to treat many different things. Now, I will say... Birth control, for example, one of the hormone medications I'm going to talk about here, is not a treatment for fibroids. It is a treatment for the symptoms of fibroids. It can help decrease how much bleeding you might have. Sometimes it improves some of the pain with your periods that might be due to fibroids. but it doesn't actually treat the fibroids. The other medication that's kind of like that, but not hormonal, I'm kind of going off on a tangent a little bit, but the other medications that treat symptoms of fibroids are a medication called tranexamic acid or Listeria. That simply decreases the amount of bleeding you have from your periods. And the third is ibuprofen, which helps with the pain, which can be related to fibroids. So the hormonal one, a birth control, doesn't actually treat fibroids, treats the symptoms. And two, Two of the medications that just treat the symptoms are listida and ibuprofen. But if that's the only symptom you're having, a little heavier bleeding, you don't want surgery, you don't want a procedure, you don't want any of the next hormonal medications I'm going to talk about, then birth control, listida, and ibuprofen are great options. So the next two hormonal medications I'm going to talk about are actually hormone... kind of manipulators, and they are shown to shrink fibroids. One category is called GNRH agonists, and the other is called GNRH antagonists. So it actually... alters your hormone, your hormone cycle, including this hormone called GNRH, and it down-regulates your estrogen in your system. And estrogen, we know, is one of the main hormones that feeds fibroids, feeds their growth. And we know that, like, simplistically to describe why we know that to you is because in menopause, usually fibroids start to shrink, and that's when you have your lowest estrogen. Some other hormones change in menopause too, but we think Estrogen is kind of the main culprit. So GNRH agonist, one medication that is in this class is called Lupron. So Lupron can be used usually for six months, sometimes up to 12 months. If you also have pills, hormone pills that you're taking on top of it, we call it add back therapy. Because when you are decreasing your estrogen, it actually starts to affect your bones. It can increase your risk of osteoporosis. So this is not a medication you could be on long-term. Even with the add-back therapy of taking estrogen or taking progesterone, you still really should only be on it for about a year. So, you know, like... I know my young girls listening to this are like, how the hell is this going to help me? I can only be on it for a year. And you're kind of right. So this medication is given a lot of the time pre-surgery. So if you have a really big fibroid where you might be looking into almost having an open surgery where they have to open your abdomen like a C-section, and perhaps you want minimally invasive surgery, like a laparoscopic procedure or robotic procedure, we can use this medication to shrink your fibroids in order to make that kind of surgery possible. The other way we use it is if you're close to menopause and you're having fibroid symptoms, you know, you're a year or so from menopause about, we can use this medication for possibly up to a year to help shrink your fibroids until your body naturally will do it on its own. So that's Lupron or a GnRH agonist medication. It's injected, by the way. The next medications are GnRH antagonists. And there's two kind of more popular ones that fall into this category. One is called Orion. That's the brand name. O-R-I-A-H-N-N. And the other one is called MyFemBree. M-Y, my, fem, F-E-M, brie, B-R-E-E. But these medications, unlike the GnRH agonists, they don't actually shrink your fibroids. They, or GnRH, yes, so these GnRH GNRH antagonists, I mean, God, even I'm confusing myself. So these antagonist medications actually treat the bleeding only. And sometimes you need to add back therapy too by taking a little bit extra estrogen or progesterone. So this treats the bleeding of fibroids, myofembry and oreon, whereas Lupron can shrink fibroids. But again, you can't be on these forever and ever and ever. It alters your hormones. It sort of makes your hormones in the menopausal range, affects your bones. So not really long, long-term treatments, but these, especially the myofembry, newer option that has helped a lot of people. And now we get to the procedures. So I am, okay, I will not rush to do surgery on anybody, but I do love doing surgery just in general. Fixing something with my hands is part of the reason why I got into medicine. I can go in there, use my hands, and make you feel better. It's rewarding in general for me. I definitely do not rush my patients into fibroid surgery, especially if they don't need it. But talking about the procedure options are just a little fun for me. So these are the procedures or surgical options for fibroids. So the very first one, actually, I don't even know where they do this procedure. I have heard of it. I can't tell you where it's done. I know that it's relatively new. And as far as I'm aware, not really studied that well yet, but it's actually MRI guided ultrasound. So you're in an MRI machine. They locate the fibroid and they put like ultrasound waves, through each fibroid, which will shrink them over time after the procedure is done. And apparently some promising results in studies so far, but like I said, I don't even know anybody that does this and I've never seen it done. So it's not that common if it's being done at all. If you guys know anybody that's had this or if you know where they're doing it, then feel free to let me know because I'm interested in seeing. how it works. The second procedure is in the class of minimally invasive surgery. So it's not a big surgery, but it's still a procedure. It's called a uterine artery embolization. And actually a radiologist does this and they insert into your blood vessels that are feeding your uterus, these particles that close off the blood vessels. that are directly feeding the uterus, preferably by where your fibroids are located. And over time, the fibroids shrink. Now, from what I've seen and heard, this can be really uncomfortable as your fibroids start to shrink from cutting off the blood supply. And you have to also be aware of, you know, it's not recommended that you have children or try to get pregnant after this because you know, the blood supply to your uterus is sort of cut off and that's where a baby grows. So irregular things can happen once we start messing with that blood supply if you actually try to have a child. Now overall, if we're taking the pregnancy out of the equation, this is a pretty lower risk procedure that works fairly well to shrink your fibroids over time after getting it done. So that's uterine artery embolization. The next minimally invasive procedure is is something called Excessa. And it's actually laparoscopic. We go in with small incisions into your belly button with a camera. We have another incision that you actually have a probe and you look to see where the fibroid is. You stick the probe into the fibroid and you use radiofrequency to sort of melt the fibroid again over time. It starts to liquefy at first and over the next few months or so, you know, it really starts to degenerate the fibroid and start to shrink the fibroid. And it's minimally invasive. It's a same day procedure. I have done it in training. I've never done it in my actual practice, but I know a lot of physicians that do this and I've seen some success stories with it. So minimally invasive procedures are those two. Now, another one I'll kind of talk about is an ablation. And that's where we go in and we burn the lining of your uterus. We do it through the vagina, also a same-day procedure. But this doesn't actually treat or shrink fibroids. Again, this kind of goes into the category with the medications that treat the symptoms. because it just decreases how much bleeding that you have or stops your bleeding altogether. So if that's your main symptom, then this might be a procedure for you. At the same time, we can go in, we can look with a camera. That's called a hysteroscopy. And if there's any fibroids inside the uterus, we can actually remove it or shave them down. And that can severely, you know, greatly rather help the amount of bleeding or discomfort you have with periods due to your fibroids, especially if you only have fibroids that are inside the uterus cavity. So that's a type of myomectomy actually, which is our next procedure. A myomectomy in general can be done minimally invasive or can be done as an open procedure where we do an incision in your lower abdomen like a C-section. A myomectomy is actually going in and plucking out each individual fibroid. So we can do it robotically, we can do it with the small 5 to 10 millimeter incisions in your abdomen, or it can be done with a big cut in the lower abdomen And that all depends on your other medical problems, your prior surgeries, how big your fibroids are. So there's a lot of factors that go into also your surgeon's abilities. Some people just can't do robotic surgery, etc. So a lot of factors that go into which one you will end up having. So you go in, you pluck each fibroid out or you cut each fibroid out of the uterus muscle. We sew the uterus back together and then that's it. That's the myomectomy. Also uncomfortable, there's a lot of bleeding associated with it, a lot of cramping and discomfort as your uterus heals because we've now sewn it back together, sometimes in multiple different locations because we've had to go all over to get your fibroids out. But people do really well with this. The one thing I will say... is, you know, if your uterus is still there, obviously new fibroids can grow back. And I wouldn't say it's the fibroids that they took out, but sometimes there's really, really tiny ones that we don't see, or there could just be new ones that come up later on in life. So it's not always a long, it's a good solution, don't get me wrong, but it might not last forever. And then the final one, the only thing on this entire list that really lasts forever in terms of getting your fibroids gone is a hysterectomy. And that is a surgery where we take out your entire uterus. And that means no more fibroids can grow back because fibroids only grow within the uterus. So we can still leave your ovaries in place. So if you're not menopausal yet, you still have your hormones because the ovaries are what produce the hormones, but the uterus coming out removes all the fibroids and and they'll never, never to see them again. So it's a more permanent procedure. And that can actually be done sometimes minimally invasively. Even if you have a larger fibroid, your doctor can consider doing Lupron, the medication I talked about earlier that you inject that shrinks them, to shrink your fibroids to possibly try to do it minimally invasively, whether it's robotic or laparoscopy, or a hysterectomy can be done as well with an incision in the lower abdomen. like a C-section incision. Okay, so I will say here, there is some good evidence for diet changes as well, specifically like an anti-inflammation diet and specifically, specifically cutting out red meat from your diet. I've seen some promising research that shows that it helps to shrink fibroids. Now, if you have a large, gigantuan fibroid, do not expect this to turn your life around. It's really for not the huge ones, maybe like... a five centimeter or less, where you can start to see some difference in the fibroid size per se. And what's more so been studied are the actual fibroid symptoms start to improve with this anti-inflammation diet and or cutting out red meat. So definitely something there for my people that want to try the nutrition aspect of treatment. So those are all of the treatment options that we have right now. for fibroids. So it depends. Like I said, you can have a really small fibroid that can be seen on ultrasound and really we don't have to do a single thing about it. But if you have a lot of pressure, a lot of pain, heavy periods, painful periods, bloating, you know, your fibroid makes you look like you're pregnant, it's pressing on your bladder, it's causing you bowel problems, we got to intervene. So we have to go through these options, pick one that's actually the safest route or best route for you and also one that you feel comfortable with. So here you are, you're armed with everything. You have an idea of what options are out there and I hope you can bring this to your doctor to discuss it. And that's it. That's fibroid treatment options. So good luck to everybody out there. I know that a lot of times, especially black women, we have a higher propensity to get fibroids and we also have a higher propensity of feeling as though doctors aren't really listening to us or connecting with us. But I feel that one, find one that you're comfortable with, obviously. And two, when you are armed with the information, no one can turn you away. No one can dismiss you. So I think knowledge is power in that way. And I hope that this podcast episode has helped you with that. And I'll see you guys on the next one. Bye.