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Fibroid tumors: What PCPs need to know
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Up to 68% of women, most of them younger than 50 years, may have fibroid tumors, which impact the physical, social and professional lives of many of these women, researchers wrote in the Journal of Women’s Health.
Despite the frequency of the condition, its etiology is not fully understood, making treatment options unclear, according to a paper published in Seminars in Reproductive Medicine.
Healio Primary Care asked Jonathan Schaffir, MD, of the obstetrics and gynecology department at The Ohio State University Wexner Medical Center and Richard Scott Guido, MD, a gynecologist at Magee Women's Hospital within the University of Pittsburgh Medical Center, to discuss which women are at risk for developing uterine fibroids, symptoms of the condition, what treatment options are available and other important information about uterine fibroids. – by Janel Miller
Healio: What women are most at risk for developing fibroid tumors?
Schaffir : Fibroids are stimulated by the same hormones that trigger menstrual cycles, so the major risk factor is being a woman of reproductive age. Other risk factors include being African American, nulliparous and/or obese.
Healio: What are some symptoms associated with fibroid tumors?
Guido: A woman with heavier or prolonged periods may have uterine fibroids. She may also have pelvic pain, an urgency to urinate or frequently urinate due to the tumor pressing on other organs. Women with fibroid tumors may also experience constipation and pain during sex.
Admittedly, some of these symptoms overlap with endometriosis, abnormal uterine bleeding and adenomyosis. Therefore, primary care physicians should not rush to assume a woman with heavy or long periods has a fibroid tumor. These clinicians should perform other appropriate exams, have the patient undergo an ultrasound and perform other tests such as CTs and MRIs if needed in order to make a more definitive diagnosis.
Healio: What are the risks associated with not treating a fibroid tumor?
Schaffir: When fibroids cause heavy menstrual bleeding, untreated fibroids may lead to severe anemia, resulting in fatigue and dizziness due to the significant loss of menstrual blood. There may also be a connection between fibroids, infertility, and miscarriage. However, PCPs should reassure their patients that fibroids are benign lesions that very rarely are associated with cancer.
Healio: What treatment options exist for fibroid tumors?
Guido: There are no FDA-approved pharmacological options in the U.S. exclusively for reducing the bleeding associated with fibroid tumors or completely removing them. However, off-label uses of gonadotropin-releasing hormone (Gn-RH) agonists like Elagolix, Lupron and Synarel have shown effectiveness in stopping the menstrual bleeding and shrinking the fibroid in some patients.
Some additional treatment options include progestin-releasing intrauterine devices, birth control pills, tranexamic acid, high intensity focused ultrasound, uterine artery embolization and radiofrequency ablation. But it’s important to note that these options will only lessen the menstrual flow. Fibroids can also be completely removed surgically via laparoscopy, myomectomy, open incision or hysterectomy.
Healio: How can a PCP decide which of those treatments are best for a patient?
Schaffir: Treatment should be individualized based on a conversation between the woman and her health care provider depending on what her particular symptoms, her age and her reproductive plans are.
For example, a single, large fibroid in a woman who is interested in having children would respond well to a myomectomy because the tumor has little chance of returning. Conversely, a woman with multiple fibroids that are causing heavy bleeding and who has no intentions to have any more children may want to consider either a hysterectomy to remove the fibroids completely, or uterine artery embolization, which may reduce their size and bleeding.
References:
Al-Hendy A, et al. Semin Reprod Med. 2017;doi:10.1055/s-0037-1607264.
Kahn AT, et al. Int J Womens Health. 2014;doi:10.2147/IJWH.S51083.
Marsh EE, et al. J Womens Health (Larchmt). 2018;doi:10.1089/jwh.2018.7076.
Mayo Clinic. “Symptoms and causes.” https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288. Accessed July 23, 2019.
Sohn GS, et al. Obstet Gynecol Sci. 2018;doi:10.5468/ogs.2018.61.2.192.
Disclosures: Schaffir does not report any relevant financial disclosures. Healio Primary Care was unable to determine Guido’s relevant financial disclosures prior to publication.