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Fibroids? Tumors?

[00:00:00] Hello, it's Women's Health Wednesday and I am actually doing this video in solidarity with my friend Elsa Emel, who you guys might follow. Happy Go Curly. She's phenomenal. She is a nurse midwife. I wish she would come join me in my practice cuz we would love her to be with us. Alas, she's happy where she is. 

So we decided we were gonna collaborate and I'm gonna talk about fibroids. Let's see what she's gonna talk about later. Fibroids, otherwise known as myoma. Myo means muscle. Oma means growth fibroid Latin. I don't know. Um, so the word fibroid makes people anxious. And I say all the time to women, Hey, I'm calling about your ultrasound. 

Just wanna let you know like 70% of all women, in fact, 80% of black women, you in fact may have a fibroid in your uterus. Very common. I'm not alarmed. So I start with that because I think people. Really stressed out when they hear [00:01:00] anything about like you have, right? Like you hear, you have and you're like, Ugh. 

So a don't freak out and I'm gonna try to keep this video short for me. So let's talk in zip. Zip, fashion, uterine fibroids. Benign fibroids do not transform. Really, there are rare circumstances where your doctor might think it's a fibroid, and in fact, it's, God forbid, a malignant, um, counterpart called thele myo sarcoma, which is incredibly rare, first of all, and the hallmark of that would typically be a rapidly enlarging fibroid. 

So if you have a onset fibroid, That seems to be growing quickly, either because of your symptoms or because your doctor has sent you for a short interval ultrasound six weeks or 12 weeks later, and it seems to have grown quickly. Then she might very well say, okay, you should get that taken care of. 

Short of that, fibroids are benign. I'm gonna repeat it 10,000 times. Fibroids are benign because they're common and they're benign. Now that doesn't mean they don't always cause issues. Many women will. Pain, pressure, bloating, pressure on their bladder, pressure on their rectum, pain during intercourse, [00:02:00] heavy bleeding, irregular bleeding. 

Those are the most common findings, right? They might feel a mass when they touch below their uter below their belly button. They might not feel anything until they have an ultrasound. They might be asymptomatic, which I would venture is the vast majority of women. And they show up for an ultrasound for some other reason, like they're having a little bit of pressure on one side, and it turns out they have a cyst and fibroids, or they have a little bit of bleeding, and in fact, it's turned out to be a polyp in the lining of their uterus, which is a soft tissue as opposed to a firm. 

Muscular growth, and in fact, the fibroids are just an incidental finding. So do not be alarmed if you find out you have fibroids. We're gonna look at my little uterus, so I can tell you this is ignore the I U D if you have fibroids. There are three places mostly that they could be. One would be intramural, which means right in the middle of the muscle. 

One would be submucosal, which means underneath the lining of the uterus right here. And one would. Subserosal, which is the outside of the uterus, so it could be hanging off or just growing on the outside. These ones, as you can imagine, can be bulky and cause pressure and pain as can. The ones in [00:03:00] here, the ones that are in here, are the ones that typically cause the most heavy bleeding, heavy or irregular, and sometimes it's cloudy. 

Now, do you have to get them taken care of? If you are not having symptoms that bother you, you don't have to have them taken care of. If you're having symptoms that bother you, even then, do you have to have them? . It depends. Meaning rarely would we say you have to, unless you're incredibly anemic or having significant discomfort. 

The one time I think all of us, as doctors would agree, you have to have them removed or at least significantly addressed, is if they're so large that they're compressing some organs. For example, your ureters, which are the tubes that lead from your kidneys to your bladder, but that's rare. Again, the majority of time. 

Fibroids are found either incidentally or because you're having bloating, pain, pressure, bleeding. They're found on an ultrasound. Most likely. They are benign. They are incredibly common. 70% of all women, 80% of black women and treatments would include either birth control pills, which may control your bleeding, and that is simple enough. 

and hormone IUD, the intrauterine device that goes into your lining and thins out the [00:04:00] lining that can control it. Sometimes just taking progesterone hormone supplements can do it. And then there are procedures you could do the most simple of which that's direct, but more aggressive would be having your uterus removed, which is a hysterectomy, or just the fibroid removed, which is a myomectomy. 

And that can be done either through those small incisions robotically or laparoscopically, or if it's inside the lining of. Hysteroscopically through the cervix where it gets shaved off and now there are a bunch of newer procedures, for example, ones that will burn the uterine lining. Right, so the uterine lining gets burned. 

So if there's a fibroid there, the surface area no longer bleeds. That's really only for women who don't wanna have children anymore. There is also a uterine artery embolization where the radiology doctor goes through the groin blood vessels that lead to the uterus and block those blood vessels to essentially stop the blood supply to the muscle so that it starts to degrade over time. 

And there are newer ablation procedures that are thermal or freezing procedures. So there's actually a lot of. , but you [00:05:00] don't have to do anything, so don't despair. Okay? Go watch. Happy go Curly too.