Understanding fibroids and how they affect African American women

Transcript

Deborah Howell (Host): You know, fibroids can wreak havoc with your health, your career and your life, and are seen at disproportionately higher rates in African American women. So, let’s take a deep dive into this subject with an expert in the field and get some excellent advice on how to cope. Here to tell us more, is Dr. Albert Odom, an OB/GYN physician who specializes in fibroid treatment with Prisma Health. This is Flourish, a podcast brought to you by Prisma Health. I’m Deborah Howell. Welcome, Dr. Odom.

Albert Odom, MD (Guest): Thank you for having me, Deborah.

Host: Wonderful to have you today. So, let’s begin at the beginning. What are fibroids?

Dr. Odom: Well fibroids are benign tumors that occur in the uterus. Rarely do they become malignant. Very rarely do they become malignant, but they’re the most common tumor or mass that occurs in the female pelvis.

Host: Do we know what causes fibroids and can you prevent them?

Dr. Odom: Well, not really. We think that the fibroids develop from sort of a mutation in the individual muscle cells of the uterus and sorta like the switch gets turned down for growth and just doesn’t get turned off. And so you start with a little, tiny little nodule in the uterus that just keeps growing and keeps growing into a large mass. One of the things that’s lacking in research in fibroids is how to prevent them. And that’s the focus right now on research in fibroids.

Host: So how do you know if you have fibroids? I mean, what are the symptoms?

Dr. Odom: Well, they can kind of be divided into two broad categories. One, would be related to how it affects the menstrual cycle. And the other one is a sort of a space issue, meaning space in the pelvis. Fibroids are known to cause heavier, frequent periods or menses. And painful menses as well. So, usually that’s the first tip-off that you might have, you might have fibroids. The other issue would be a space issue, just fills up the pelvis and can be associated with things like constipation, frequent urination, pelvic pain, increased girth of the abdomen, and painful intercourse.

Host: Yeah, not pleasant. Are there any groups more likely to get fibroids and do we know why?

Dr. Odom: Well, over the lifetime risk of having uterine fibroids about 70% of white females will get them. And about 80% of African-American females will get fibroids. It is definitely more prevalent in the black population. No doubt about that.

Host: So if African-American women have such a high incidence of fibroids, what specific advice do you have for this community?

Dr. Odom: Well, probably the biggest thing is that there’s multiple options for treatment. Very often I’ll see a black female that comes into the office with fibroids and the only option she’s been given is hysterectomy, and there are multiple options for treating fibroids and it really depends on, what they want, to a large degree.

Obviously, a hysterectomy will fix the problem, but there may be other options to fixing the problem and things like just removing the fibroids themselves, uterine artery embolization to shrink the fibroids, a newer procedure called laparoscopic radiofrequency ablation of the fibroids themselves as well. So I would say, make sure you get regular visits to your gynecologist, but also know that there are options.

Host: Great. And we’ll get into these options a little bit more in just a couple of minutes, but right now I want to ask if there are other risk factors.

Dr. Odom: Well, of course being a female, obviously that that’s a risk factor and being a black female is even a greater risk factor. And there’s some things that we think are associated with it, like increased red meat in your diet might increase your risk of getting fibroids. If you have, a first-degree relative like a mom or a sister who has fibroids, you’re more likely to get it. So, genetics definitely play a role. We’ve already discussed how race plays a role in it. Dairy products apparently are associated with a decreased risk of uterine fibroid formation. So those are sort of what I would call soft things that are associated with fibroid formation. But it really, there’s just not a whole lot you can do to prevent them either way.

Host: Yeah, well, I’m going to go have a milkshake. I know that. Okay. So what are the long-term implications of having fibroids?

Dr. Odom: Well, the long-term implications are because how it affects menses. You can have severe anemia from having severe blood loss during your menses. It can interfere with the ability to conceive, not only to conceive but also to carry a full-term pregnancy. And then all the other things that go beyond that, things like missing work because of bad periods, generally feeling bad, just pelvic pain, and things like that. Those are probably the long-term effects.

Host: Right. And of course the biggest question is do fibroids cause cancer?

Dr. Odom: Rarely. There are tumors that look very similar to uterine fibroids are called leiomyosarcomas. Thank goodness, they’re extremely rare. And so rarely do the fibroids, the benign tumors called fibroids, rarely do they become malignant and leiomyosarcomas are entirely different tumors. They do look like and act like fibroids, but there’s usually no real reason to worry that much about something being malignant, because somebody has told you you had a fibroid.

Host: Well, thank you for busting that myth. I appreciate it.

Dr. Odom: Yeah.

Host: So if you have fibroids, do they cause weight gain?

Dr. Odom: Minimal, if you had very large fibroids, very, very large fibroids, you might, if you had them removed or if you had a hysterectomy, you might lose a pound or two, but you’re not going to lose like 10 or 15 pounds.

Host: Right. Unless exceedingly large. Now how are fibroids diagnosed, Doctor?

Dr. Odom: Well, usually somebody presents with those symptoms, we talked about, heavy periods, frequent periods, increased abdominal girth, constipation, frequent urination, pelvic pain. And the first thing you do, obviously is a pelvic exam and see your gynecologist to get a pelvic exam. And they feel that mass, feel that uterus is enlarged and usually the next step is an ultrasound. And usually, an ultrasound will give you the preliminary reading of whether or not you have fibroids or not.

Host: Okay. And let’s say that comes back positive. You do have them. We touched on some treatment options earlier, nonsurgical and surgical. Would you like to go further into that?

Dr. Odom: Sure. Fibroids are somewhat driven by the female hormones, estrogen and progesterone production. And so if somebody develops a uterine fibroid, premenopausal, and somewhere between age of 20 and 50, then they’re usually going to be growing during those years. And if you can take away the estrogen and progesterone. There’s two medications on the market called Depot Lupron, and a newer one called ORILISSA®, which causes temporary menopause. Now that’s usually a temporizing treatment. You usually don’t want to be menopausal at 30 and stay menopausal for the rest of your life. And also the insurance won’t pay for that to be done anyway, but you can shrink fibroids temporarily if you were looking at a surgical option. The non-surgical options out there also are uterine artery embolization. And uterine artery embolization is something that’s done by an interventional radiologist. And basically what they do with that is just cut off the blood supply to the fibroid and cause it to become ischemic and it’ll shrink because of the lack of blood supply.

Then you also have surgical options, which would include obviously hysterectomy, where we remove the whole uterus. The other option would be myomectomy where you remove the fibroid themselves. And that can be done either with an open incision or laparoscopically, and then a newer procedure, which has been in place for about three years now, it’s called laparoscopic radio frequency ablation of fibroids, in which case, it’s minimally invasive surgery, outpatient, and, basically what you do there is insert a probe into the fibroid and heat the fibroid up. And it alters the protein matrix of the fibroid, softens the fibroid and they’re basically absorbed by the patient.

Host: That is a great advance, let me tell you as a Lupron graduate, yeah. We’re glad for the ablation. A lot of friends of mine call it their drive-by ablation.

Dr. Odom: Ah, yeah.

Host: It’s just so fast and easy. Do you feel as if all the treatments are being best utilized?

Dr. Odom: Probably not. That’s a kind of my bias of looking at it. If you’re somebody that’s suffering from chronically heavy menses, chronic anemia, pain with the menses, hysterectomy is a very good option because all of that is going to end. But some people are just not told that there are other options and really deciding on the treatment that a patient is going to have, should have a lot to do with what they want out of life and what their preferences are and whether or not they want to maintain fertility.

Whether or not they want to keep their uterus. I have a lot of patients that say I came into this world with a uterus and I want to go out of this world with a uterus. And it’s certainly not anybody else’s place to tell them they can’t do that. So maybe myomectomy is underutilized, particularly laparoscopic or robotic assisted laparoscopic myomectomy. Both of those techniques require a little bit of increased surgical skill compared to a hysterectomy. The newer things, the uterine artery embolization and the radio frequency ablation of the fibroids. Those are probably underutilized at this point, and particularly the radio frequency ablation, because it’s such a new technique.

Host: Right. You know, I can just speak to this as a woman who did have the surgical option after endometriosis. And it was really tough decision to say, wow, saying goodbye to my uterus is, surprisingly painful to think about. But afterwards, without the pain, I was so happy I’d made that decision.

Dr. Odom: I have a lot of patients that are in their late forties, that aren’t interested in the hysterectomy. They want to be treated because their fibroids are giving them a fit, but they want to keep the uterus. And, it should be a discussion and a decision made with the patient. Not for the patient, i feel like.

Host: A hundred percent agree. Now what happens if fibroids are not treated, can they go away on their own?

Dr. Odom: Occasionally. There are certain circumstances where they will shrink, like after pregnancy, they tend to grow with pregnancy and then they shrink back down perhaps to a smaller degree after pregnancy. But by and large, most of them will continue to grow through menopause.

Host: Okay, not such good news. I have a final question for you. What is the difference between endometriosis and fibroids?

Dr. Odom: Well, the endometriosis is when the tissue that normally lines the inside of the uterus, where the baby’s implant and where the periods originate, that, that’s called the endometrium. And so what happens is that tissue is implanted outside the uterus, most frequently in the pelvis, and most frequently kind of behind the pelvis and near the ovaries. There is kind of two broad theories on how it got there.

One is you’re born with it and it just takes a number of years of having regular menstrual cycles before it presents with something. The other theory is that it actually has retrograde flow out through the fallopian tubes with the period and the blood that’s in menstrual flow has endometrial cells in it and they implant.

So that’s when the tissue actually implants in the pelvis. Usually, it’s microscopically initially, and then eventually presents in a macroscopic way. Then the fibroid is just a tumor that occurs. It’s a tumor of muscle that actually occurs in the uterus, in the cavity of the uterus or on the outside edge of the uterus.

Host: Well, thank you so much for that explanation. I know a lot of people get them confused because sometimes the symptoms are similar.

Dr. Odom: They are. That’s very right.

Host: Thank you so much for all your great information you’ve given us today. We really appreciate how you’ve shined a light on fibroids today and some of the treatments.

Dr. Odom: Well, thank you for having me. It’s a big deal. It supposedly accounts for about $10 billion in healthcare costs in the United States yearly. It’s a huge contributor to the healthcare costs in the United States.

Host: Unreal. Okay. Well, now we know more about them and hopefully, you know, knowledge is power. Dr. Albert Odom is an OB/GYN physician with Prisma Health who specializes in fibroid treatment. For more information and other podcasts like this one go over to PrismaHealth.org/Flourish. This has been Flourish, a podcast brought to you by Prisma Health. I’m Deborah Howell. Have yourself a great day.