Women’s health:
Coping with fibroids
When it comes to her body, it’s a good thing Sharon Moultrie, 52, has a sense of humor.
For more than 12 years, Moultrie had been troubled by her inability to conceive a child. She knew that she experienced heavy bleeding during her periods. And she also had a sense that she might be infertile.
What she didn’t know was that she had uterine fibroids, the most common growths in the female pelvis. By some estimates, up to 80 percent of women develop fibroids before the age of 50, although only about 25 percent experience symptoms.
For the most part, uterine fibroids are benign. But they can take a heavy toll on a woman’s quality of life.
Fibroids can cause heavy menstrual bleeding, severe cramps, frequency of urination, constipation, lower back pain and anemia. Some women’s abdomens become so enlarged they appear to be four to five months pregnant. Fibroids can even cause miscarriages and infertility.
Moultrie had another way to describe uterine fibroids — thugs.
“They come in, grow, recruit others and take over,” she said. “By the time you realize what’s happening, they own your uterus.
“Sometimes I’d have a regular cycle,” she continued. “Then, without warning — a massive attack.”
Moultrie said she would dutifully mark the day of her expected period on a calendar. “But [the fibroids] kept my calendar,” she said. “I had no control of it.”
Nor did she have a name for the cause of her problems. Despite repeated visits to fertility specialists and gynecologists over the course of 15 years, she suffered in darkness.
“I always had to be prepared,” she said. “It controlled my social activities. What kind of life is that?”
Not much is the short answer.
Because of the emotional and physical toll triggered by fibroids — as well as the economic burden — the National Institutes of Health recognizes the problem as a significant public health issue. It is estimated that the direct costs of uterine fibroids add up to $2.2 billion annually — a number that does not include loss of work days attributed to the recovery time required by hundreds of thousands of women each month.
Many treatments are available. Oral contraceptives and progesterone therapy for bleeding are recommended medical therapies. But they are limited. The progesterone treatment, for instance, doesn’t change the size of the fibroids; it impacts only the bleeding.
Other hormones, such as lupron, can actually stop the menstrual cycle and shrink fibroids, but they come with a price. These hormones often cause osteoporosis and menopause-like symptoms. For that reason, their use is short-term, and the tumors return and continue to grow.
“The question is how long to stay on it,” explained Dr. Nia Robinson, a gynecologist at Brigham and Women’s Hospital. “If a woman is close to menopause, this is a good alternative. Long-term use may not be recommended.”
When medical treatments do not work, surgery is often an option. In the U.S., treatment of fibroids is one of the primary reasons for the removal of the uterus. With over 600,000 cases each year, hysterectomies are the second most common surgery in women, trailing only Caesarean sections, and the second most common reason for hospitalization in women. Only childbirth has higher numbers.
Massachusetts is no exception. In fiscal year 2006, an uncomplicated hysterectomy was one of the top 15 reasons for all hospitalizations. Although the procedure has an average cost of less than $13,000, hysterectomies totaled more than $100 million — more than twice that of kidney transplants.
Hysterectomy is the only procedure to permanently treat fibroids, and may be necessary if the woman’s fibroids are large and other treatments are not possible. But the emotional toll of losing the ability to have children and the long recovery period can be hard to bear, especially for younger women. Even older women whose childbearing years have passed often cannot come to grips with losing their uterus.
Moultrie said she wasn’t taking any chances.
“My tonsils were removed when I was a kid and I’m not donating any more body parts,” she decided.
At first, Moultrie’s doctor prescribed birth control pills to control the bleeding. That worked for about two months. Moultrie was then told that her other option was a hysterectomy.
Moultrie had another option. She had learned of a relatively new procedure called uterine fibroid embolization (UFE). In its most basic terms, the procedure destroys the supply of blood to the fibroids.
Though her doctor was initially less than enthusiastic — in fact, he told her that her fibroids were “too big” for the procedure to work — she went ahead anyway.
That was six years ago, and everything has worked just fine so far. Moultrie said she didn’t expect her recovery to be very quick. She thought she would be out of commission for at least two weeks. But she was back on her feet in three days.
The cause of fibroids is unknown. But it is believed that estrogen and progesterone — the female hormones — promote their growth. They can be single or multiple, small as a pea or big as a cantaloupe.
Their growth is unpredictable.
In a recent study on the growth of fibroids published in the Proceedings of the National Academy of Sciences, researchers determined that fibroids in the same woman grew at different rates and that fibroid size did not predict growth rate.
More important, they found that while growth rates for whites decreased with age, the same was not true for blacks, which may contribute to more serious symptoms in blacks.
Fibroids are most common in women in their 30s and 40s, but women of any age can be afflicted. For reasons not understood, the tumors are two to three times more common in blacks than whites. They occur at a younger age and grow more quickly in blacks, according to the American College of Obstetricians and Gynecologists.
“We don’t know why women of color have earlier onset and more severe symptoms,” said Robinson. “Multiple studies have pointed to a genetic cause in white women. We know there is likely a genetic factor in black women as well, but we’re not sure what differences lead to their oftentimes more severe symptoms.”
Despite their prevalence, fibroids are not well understood, neither by the medical community, nor by the women who suffer from them. Some women think that their symptoms of heavy bleeding, pain and abdomen growth are normal and do not seek treatment.
So significant is the issue that Sen. Barbara Mikulski, D-Md., introduced the Uterine Fibroid Research and Education Act of 2007, cosponsored by Sen. Edward M. Kennedy and then-Sen. Hillary Clinton. The bill was not passed, but it generated national attention.
Amenata Botus-Isaac didn’t need congressional hearings to know something was wrong.
About five years ago, she started experiencing heavy menstrual bleeding, intermittent bleeding between periods and severe cramps. Her abdomen seemed a bit larger as well.
“I thought it was a normal process of aging,” she said.
But then the pains grew worse. “Sometimes while walking, I’d get a pain in my lower abdomen so sharp that I could not move,” she said. “I had to stand where I was. I knew something was wrong.”
Her doctor suspected uterine fibroids, which were eventually confirmed by an ultrasound.
That’s when her husband finally stepped in. He found Dr. Nia Robinson and accompanied her on her first visit.
Robinson offered several options to Botus-Isaac. She could leave it alone — an approach called watchful waiting — on the chance that they could shrink as she approached menopause. She could try UFE. Or she could save her uterus and have only the growths removed in a procedure called myomectomy.
Botus-Isaac opted for myomectomy.
“I wanted [the fibroids] gone,” she said. “I wanted them out.”
She had the surgery last September and was in the hospital for three days. Though her recuperation took about two months, Botus-Isaac does not regret her decision.
“I am happy,” she said. “My periods are back to normal and my stomach is flat again.”
And she and her husband just might have a baby. |
| Amenata Botus-Isaac (right), shown with her husband, Rene, is in training for a 150-mile bike challenge for multiple sclerosis. Botus-Isaac underwent myomectomy, a surgery to remove her fibroids. |
Nia L. Robinson, M.D.
Gynecologist/Obstetrician
Brigham and Women’s Hospital
 Sharon Moultrie (left) chose uterine fibroid embolization rather than a hysterectomy. Moultrie suffered with uterine fibroids for more than 15 years.
|
|
