Leiomyoma

A routine checkup revealed a pea-sized fibroid atop Teresa Mack's pelvis. The benign tumor caused mild pain during her menstrual cycle, but her doctor advised against immediate treatment because she was pregnant.

After Mack successfully delivered her first child, the small lump grew to the size of a naval orange. The attorney and entrepreneur wanted to have more children but feared the fibroid would compete for the baby's blood supply. Gail N. Jackson M.D., Mack's obstetrician-gynecologist at Cedars-Sinai Medical Center in Los Angeles, determined that the fibroid, based on its location, was not yet a threat, so Mack became pregnant with a second child and later a third. All three were healthy babies.

"We didn't want to risk infertility with surgeries to remove the fibroids," Mack says. "The goal was to get through the pregnancies."

The fibroid, now the size of a large cantaloupe, triggered heavy and prolonged menstrual periods. Anemic and exhausted, Mack refused to have surgery and sought alternative treatments for another eight years. She became a vegetarian and took herbal remedies. The pain subsided at times, but the fibroid didn't shrink.

At 41, Mack was experiencing severe anemia. Her choice was to have a hysterectomy. "I looked at all of the options," she says. "Although I had heard about all of the negative symptoms following a hysterectomy, it was the right decision for me. I also had a doctor I trusted and respected to get me through it."

Today, less than eight months after her surgery, Mack has no regrets. "My energy level is great," she says.

Each year more than 600,000 women get a hysterectomy--the surgical removal of all or part of the uterus. The procedure is the most common treatment for uterine fibroids. African-American women are three to five times more likely to have the non-cancerous tumors than White, Latino or Asian women. Black women also develop fibroids at an earlier age.

"The incidents of fibroids in African-American women is very high," says Robert Vogelzang M.D., chief of interventional radiology at Northwestern Memorial Hospital. "It's almost uncommon to find an African-American woman who does not have them."

Many women live with the benign tumors without any trouble while others develop severe symptoms ranging from heavy bleeding, anemia to chronic pain. The causes are still a medical mystery, but medical experts suspect that an increase in the hormone estrogen stimulates fibroid growth, which increases during pregnancy and decreases after menopause.

The good news is that women today have newer, less-invasive choices to treat fibroids. In some cases, the new treatments not only allow a woman to maintain her fertility without incision, but they also shorten recovery time.

One of the newest technologies to date combines Magnetic Resonance Imaging with focused ultrasound that targets, heats and destroys the uterine fibroids without surgery. Approved last year by the Food and Drug Administration, it is an outpatient procedure that works best on patients with small- to medium-sized fibroids. Most patients return to normal activities within three days.

The ultrasound technology is currently available at nine major medical centers throughout the country. Six sites nationally are seeking eligible African-American women for free clinical trials to determine the impact of the new technology on this population. (For more information on availability and sites conducting fibroid clinical trials, go to www. ebony.com)

When U.S. Secretary of State Condoleezza Rice underwent a relatively new Uterine Fibroid Embolization (UFE) procedure last year, thousands of women heard for the first time about an FDA-approved option that some doctors have been overlooking for decades, medical experts say. Most women are candidates for UFE, which is performed by an interventional radiologist.

"It's the best thing I ever did," says Maria Peel, 39, a Chicago sales trainer. "I have referred my sister and one of my school classmates who also suffered with fibroids."

Previously, doctors had recommended a hysterectomy and "never discussed alternatives," Peel says. After researching her options on the Internet, Peel learned about UFE. Since she had the procedure three years ago, her softball-sized fibroids have shrunken 90 percent.

"I found out I didn't need a hysterectomy," she says. "I would have been another statistic having an unnecessary surgery."

For UFE, the physician makes a tiny nick in the groin and inserts a catheter into the femoral artery. Using real-time imaging, the physician guides the catheter through the artery and then releases tiny particles, the size of grains of sand, into the uterine arteries that supply blood to the fibroids. The procedure cuts off the blood supply to the fibroids and causes most, if not all, of them to shrink and die. It requires an overnight hospital stay and pain-killing medication. A woman can typically resume light activities in a few days and return to normal activities within 10 days. Gradual relief from symptoms occurs almost immediately and increases over time, doctors say.

"This is now an accepted way to treat fibroids," says Dr. Vogelzang, one of the UFE pioneers. "Women, however, are not as aware of this uterine-sparing procedure and other less-invasive methods as they should be."

Dr. Vogelzang says his patients, many of whom are African-Americans between ages 40 to 45, find their way to his office by word of mouth and the Internet after other treatments have failed, or when they are faced with a hysterectomy.

Medical experts reason that some physicians may not want to refer a woman to a radiologist for UFE, when they themselves can perform a hysterectomy and other methods for a substantially higher fee than the cost of the UFE procedure. Some gynecologists consider UFE experimental despite the fact that UFE has a 73 percent success rate over five years and offers many benefits over conventional surgery, reports show. Clinical research, however, has not yet concluded that UFE is appropriate for women who want to become pregnant.

For other women wanting to preserve fertility, surgical options include a myomectomy, a more aggressive procedure that leaves the uterus intact. During a myomectomy, a surgeon removes medium- to large-sized tumors through a bikini-line incision just above the pubic bone. With the uterus free of fibroids, a woman may be able to conceive. The drawback is that fibroids are likely to reoccur over time.

"The perfect candidate for a myomectomy is a woman with a fibroid the size of a grapefruit," says Dr. Jackson. "A woman who has a uterus with numerous fibroids looking like a bag of cherries may not be a good candidate."

Another fibroid treatment called laparoscopic surgery uses lasers inserted into the vagina to remove small tumors without an incision.

Among other options are medications that suppress the body's supply of estrogen, thus causing temporary menopause. As the blood flow to the uterus decreases, the tumors shrink. The treatment works only while the patient is taking the medications. Side effects may include hot flashes, vaginal dryness and bone loss. Physicians usually don't prescribe the treatment for more than six months.

Birth control pills, herbs and other hormone-based drugs may help control fibroid bleeding, but their medical benefits are unclear. Consult with a physician first.

Dr. Jackson in Los Angeles says choosing the best fibroid treatment is not clear-cut and depends on the woman's age, location and number of fibroids, size of the uterus and the patient's comfort level. "I really like to listen to the patient and what her desires are," Dr. Jackson says. "I don't limit treatments to age. I look at the women's quality of life."

COPYRIGHT 2005 Johnson Publishing Co.
COPYRIGHT 2005 Gale Group