Cece Clark's fibroids had gotten so bad that she often had to lie down in the middle of the day. When she got up, it was usually for another trip to the bathroom. "My periods were astoundingly heavy, and pressure on my bladder made me feel like I had to go all the time," she recalls. But after she tried an uncommon ultrasound treatment, everything changed. "The pressure lessened right away," she says. "It was such a physical and emotional relief."
Clark, 50, of Boston is among the roughly 30 to 70 percent of American women between 35 and 50 who have fibroids, or benign uterine tumors (the rate is even higher for African-Americans). Half of these women experience symptoms like Clark's: heavy or prolonged periods, pressure in the lower abdomen, and a frequent need to pee. For some, sex is painful.
Although hysterectomy is a very effective treatment, many women are choosing less-invasive remedies these days, and with great results. So what's right for you? Here are the latest options, and when to consider them.
Just a few fibroids? Look into ultrasound
It appears to be the most practical remedy for premenopausal women who have five or fewer fibroids (one or two is typical for most women) and no plans for future pregnancies, says gynecologist Elizabeth A. Stewart, MD, clinical director for Boston's Brigham and Women's Hospital's Center for Uterine Fibroids. Unlike the ultrasound you may have had during pregnancy, this one is done on a magnetic resonance imaging table. Clark says it feels like periodic zaps of heat that last about 15 seconds. It takes up to 4 hours, and most women go home the same day. Ultrasound is still a new treatment, with limited availability and insurance coverage. And its long-term effects aren't known, although Clark's fibroids have not returned in the 2 years since her procedure. To get more information or to find the nearest treatment center, call 866-392-2528 or visit http://www.insightec.com.
Done with baby-making? Consider UAE
Like ultrasound, uterine artery embolization (UAE) may be the right call if you have no plans to get pregnant but don't want a hysterectomy. The difference is that UAE, an older procedure, has more evidence to support its use. Small plastic or gelatin particles, the size of grains of sand, are inserted into uterine arteries through a tiny incision in your thigh.
The particles block blood from getting to the fibroids. UAE usually requires an overnight hospital stay, but some doctors will send you home that day. It generally shrinks fibroids by about a third. "Women find relief within the first few menstrual cycles," says James Spies, MD, of Georgetown University Medical Center. The latest evidence suggests UAE is significantly less risky than traditional surgery; Spies reports that fewer than 3 percent of patients needed a hysterectomy within a year after the procedure. But be aware that UAE may induce early menopause, making it risky for women who want to have children.
Want to get pregnant? Myomectomy may be best
This more-traditional surgery removes fibroids while leaving your uterus intact, so it's a safe bet if you're still planning on kids, says obstetrician and gynecologist Alison Jacoby, MD, associate clinical professor of obstetrics, gynecology, and reproductive sciences at the University of California, San Francisco (UCSF).
Depending on their location, the tumors are removed either through your vagina, navel, or abdomen, and the procedure usually requires a hospital stay of 2 days. Recovery takes 4 to 6 weeks, and it's not uncommon for the fibroids to return within 5 to 10 years.
And then there's the all-natural approach
Your diet is a good place to start. Eat less red meat and more fresh fruits and vegetables, beans, nuts, seeds, and whole grains to up your fiber intake and reduce the effects of too much estrogen in your body, advises nutrition counselor Sarah O'Brien, MS, RD, of UCSF's Cancer Resource Center. Also, some women find relief by rubbing over-the-counter natural progesterone cream on their abdomens. Although progesterone and estrogen appear to feed the growth of fibroids, the cream may curb the influence of estrogen enough to shrink the fibroids and ease symptoms.
Why hysterectomy?
Removing your uterus is the only thing guaranteed to eliminate fibroids forever, and a third of the hysterectomies done each year are for that reason. Hysterectomy may be the right choice if nothing else brings relief. But it's major surgery that comes with a risk of infection, bleeding, fatigue, incontinence, depression, and sexual side effects.