Vim & Vigor - Fall 2019 - UVA - 17

thicken and shed with each menstrual
cycle. But the cells that lead to fibroids
seem to be extra-responsive to hormones, and it's this overgrowth of muscle cells that causes the benign tumor
to form. "They could be caused by an
overreaction to scarring, but we aren't
100 percent sure," Zelmanovich says.
3 Fibroids aren't cancerous.
Leiomyomas are always benign. But in
some cases, a leiomyosarcoma, or cancerous tumor, may develop in the uterus.
According to the Sarcoma Foundation,
leiomyosarcoma is extremely rare, affecting only 6 in 1 million women each year.
Simply having fibroids does not increase
your risk for it-nor are you more likely
to get other gynecological cancers.
3 Symptoms may vary-or not
exist at all. Women with fibroids may
experience heavy bleeding with menstruation or bleeding between periods.
Excessive bleeding can lead to anemia,
which may be one reason for treating fibroids. Other symptoms include
constipation or frequent urination (if
the fibroid is pressing on the rectum or
bladder), painful sex and difficulty getting pregnant. "Symptoms will depend
on the size and location of the fibroid,"
Zelmanovich says.
3 African-American women are
affected more severely. The Journal
of Women's Health reports that black
women are three times more likely
than white women to develop fibroids.
They're also more likely to get them
at a younger age; the reasons why are
largely unknown.
3If you choose treatment, there are
many options. Doctors treat fibroids
if they affect a woman's quality of life.
Most of the time, the recommendation
will be watchful waiting; your doctor can
monitor the size of the fibroid at your
annual exams, typically with a transvaginal ultrasound. If you do opt for
treatment, the method you choose will
depend on a variety of factors, like your
age, whether you want to have children
and the nature of your symptoms.

Treatment options include:
Oral contraceptives. Birth control
pills don't shrink fibroids, but they can
improve the symptoms. "Birth control
pills thin the endometrial lining, which
will lessen bleeding," Zelmanovich says.
Hormonal intrauterine devices (IUDs)
can serve the same purpose.
Drugs to suppress hormones. Also
known by brand names like Lupron and
Synarel, gonadotropin-releasing hormone
agonists can shrink fibroids by stopping
the production of certain hormones. But
it's considered unsafe to take GnRH agonists for longer than nine months, and
the fibroids will return once the drug is
stopped. For this reason, women typically use these drugs to either shrink
tumors before having surgery or solve
the issue temporarily if they are close
to menopause.
Myomectomy. This type of surgery
removes only the fibroids but leaves
the uterus and other organs, making it
a good option for women who want to
get pregnant someday. It can be done
through a large incision in the abdomen (sometimes called "open surgery"),
laparoscopically using tiny incisions, or
through the vagina, using a thin, flexible
tube called a hysteroscope.
Embolization. This minimally invasive procedure involves injecting small
gel particles to cut off the fibroids'
blood supply. Because embolization also

WEBSITE

Is Focused
Ultrasound for Me?
Gloria Twesigye found relief
from pain and heavy periods
with a focused ultrasound treatment at the UVA Uterine Fibroid
Clinic. Learn more about the
treatment at uvahealth.com/
ultrasound-fibroids.

might affect the uterus, it is not recommended for women who wish to have a
future pregnancy.
Hysterectomy. This surgery refers
to the removal of the uterus and makes
future pregnancies impossible; it can
also lead to early menopause in younger
women. "It's usually only performed
when it's the last solution available,"
Zelmanovich says. ■

Noninvasive
Treatment
for Fibroids
When Gloria Twesigye experienced pelvic pain and bleeding every day for more
than a month, she sought help at UVA
Health System. An ultrasound revealed
she had uterine fibroids. "I knew it was
common for women to have them. But
I also knew that my symptoms were
not common. When I was researching
treatment options, I was looking for one
that did not involve invasive treatment,"
Twesigye says.
She met with Alan Matsumoto, MD,
an interventional radiologist and chair
of the UVA Department of Radiology, to
discuss treatment options that included
focused ultrasound. This outpatient procedure doesn't require surgery. Instead,
experts focus more than 200 individual
sound waves through a large lens to then
heat and destroy fibroid tissue. During
the procedure, a patient is inside an MRI
machine, which is used as a guide to target the exact area.
"Dr. Matsumoto and I discussed
what treatment would be best for me
based on my age and if I wanted to
have kids," Twesigye says. "He was very
thorough and made sure I knew all the
details of what to expect during the
treatment itself, as well as what I could
expect afterward."

FALL 2019

http://www.uvahealth.com/ultrasound-fibroids http://www.uvahealth.com/ultrasound-fibroids

Vim & Vigor - Fall 2019 - UVA

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