TOP 5 MYTHS ABOUT UTERINE FIBROIDS
1.MYTH: Having fibroids means I have to have my uterus removed, right?
FACT: In almost all cases, this is absolutely not true. These days, an advanced videolaparoscopic surgeon like Dr. Nezhat can safely remove all fibroids without having to resort to hysterectomy (i.e., the removal of a womans uterus).
2.MYTH: Huge fibroids myths – Im not a candidate for minimally invasive surgery or I must undergo an abdominal hysterectomy because my fibroids are too large.
FACT: In the hands of experienced surgeons, this is absolutely not true. Advanced surgeons like Dr. Nezhat are able to remove even the largest fibroids minimally invasively.
3.MYTH: Removing fibroids surgically will cause problems during pregnancy.
FACT: Decades ago there were indeed a few reports of uterine rupture during labor, which can cause fetal distress. It is because of lingering fears about this theoretical risk that some patients are told that a cesarean delivery is necessary if they have had a myomectomy. However, no randomized trials have been performed on this subject, making it difficult to determine whether other confounding factors may have been at play.
The good news, however, is that with the surgical advances of today, the incidence of such adverse outcomes is exceedingly rare, and essentially unheard of with advanced surgeons like Dr. Nezhat. For example, in Dr. Nezhats experience, none of his patients have experienced uterine rupture as a result of myomectomy surgery.
All the same, every patient presents with a unique health history and therefore must be evaluated on a case-by-case basis to determine risks versus benefits. In the medical literature the benefits have been well-established; pregnancy rates, for example, have been reported as high as 60% after myomectomy, regardless of which type of myomectomy is performed.
4.MYTH: I read that there are medications that will cure uterine fibroids.
FACT: There is no medicine on the market that can dissolve, remove, or otherwise cure fibroids. However, some symptoms may be managed with the following medications:
- Combined oral contraceptive pills – Combined contraceptive pills, also called birth control pills, contain both estrogen and progesterone hormones, which can help decrease bleeding symptoms. Some studies show that they can slow the growth of fibroids, but cannot decrease the size of the fibroid
- Progestin-Releasing IUD(intrauterine device) – This device is inserted into the uterus and contains a small amount of progesterone hormone. This can decrease bleeding symptoms. However, as mentioned earlier, progesterone does not shrink fibroids, and may even increase their growth.
- Progestin pillsThese pills contain synthetic progesterone hormone, which will decrease bleeding side effects. Progestin pills have no effect on the fibroid itself.
- Selective Progesterone Receptor Modulators (SPRMs) – Recent randomized controlled studies have shown some promising results with SPRMs, specifically one called ulipristal acetate (UPA).
- Gonadotropin Releasing Hormone (GnRH) agonists- These medications (Lupron, Zoladex, Synarel, etc.) suppress the release of natural estrogen and progesterone production, which then causes shrinkage of fibroids and decrease in bleeding symptoms. Typically, your doctor will prescribe this medication to correct anemia from heavy bleeding and shrink the size of the fibroid prior to surgical management. This short term use right before surgery is not associated with the serious side effects that can develop with long term use. In long term use, these medications cause a temporary menopausal state and are often associated with, not only hot flashes, but other potentially serious side effects, especially if taken for longer than 6 months. As such, GnRH agonists are not a long-term management option. As well, certain types of fibroids have been known to return within a year of stopping these medications.
- NSAIDs(nonsteroidal anti-inflammatory drugs) – These are non-narcotic pain medications that may help with the painful symptoms of fibroids, but will not affect the fibroid or any bleeding symptoms.
- Aromatase Inhibitors– These are medications that inhibit the formation of aromatase, which is an enzyme thought to facilitate not only the growth of fibroids, but its over-production is also implicated in other conditions, such as endometriosis and breast cancer. Brand names of aromatase inhibitors prescribed for fibroids include anastrozole, exemestane, and letrozole.
- Cytochrome P450– This is an emerging treatment option that is showing some promise in early studies. It targets the production of an enzyme that helps metabolize certain drugs.
- Progesterone Antagonists– Progesterone antagonists like mifepristone (RU 486) are also emerging treatment options now being studied for fibroids. A progesterone antagonists is a substance that reduces the levels of progesterone available in the body, which has been shown to decrease the size of fibroids, as well as reduce the bleeding.
- Pirfenidone – This antifibrotic drug is also a new medication that is currently being studied to help shrink fibroids. It has also proven effective for some forms of idiopathic pulmonary fibrosis, which involves the overgrowth of scar tissue (fibrosis) of the lungs.
5.MYTH: Fibroids do not interfere with fertility.
FACT: To the contrary, fibroids can indeed reduce one’s chances of conceiving. Here are the details:
Fibroids can distort the uterus so a pregnancy cannot grow properly secondary to the mass of the fibroid. Also, the blood supply of the pregnancy can be diverted to a growing fibroid. In these cases, pregnancies can miscarry.
Fibroids can grow near the fallopian tubes and cervix thereby blocking proper motility of sperm and egg through the uterus and tubes. Fibroids can also line the cavity of the uterus making it impossible for a pregnancy to properly implant in the uterus.
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Drs. Nezhat have pioneered many of these techniques and instrumentations and are among the most, if not the most, experienced surgeons in treating fibroids.