Carla
Dionne |
Welcome
everyone.
The
information provided during this chat is to be used for informational
purposes only. In no event shall the host moderator or chat guests
be liable to you or anyone else for any decision made or action
taken by you because of this information nor does your use of
this information constitute the offering of medical advice by
the chat guests. Please seek the advice and supervision of a health
care provider when considering the medical information provided
here tonight.
That
said I would like to welcome Dr. Michael Broder, gynecologist,
and Dr. Scott Goodwin, Interventional Radiologist to the uterinefibroids
chat room and open the floor to questions. Please feel free to
ask away! |
barb450 |
I
had a UAE on March 29th of 1999. My 5 month checkup
showed that my largest fibroid went from 9.7 cm to 7.8 cm. Would
you call that a significant reduction so far? |
uffdakab |
I've
been told a myomectomy is not an option in my case because of
location of fibroid – 4-month, both inside and outside the uterus,
49 yrs old. Have appt. with my gyn tomorrow to consult. Appreciate
suggestions for questions to ask. |
Carla
Dionne |
Dr.
Goodwin, perhaps you could address barb450's question first. |
barb450 |
Since
it's measured by volume what would the percentage of reduction
be? |
Dr.
Goodwin |
The
amount of shrinkage for barb450 is not that much so far, but sometimes
fibroids will continue to shrink for up to 1 year after embolization. |
barb450 |
Well
I do feel less bulk and no pressure. Do you think I might be able
to avoid hyst? I'm 46. |
Dr.
Goodwin |
Also,
sometimes the character of the fibroid changes after embolization
so that it is much softer. |
barb450 |
Thank
you Dr. Goodwin. |
Carla
Dionne |
Thank
you Dr. Goodwin. Dr. Broder, could you please address the issue
of when a myomectomy is not possible in the case of uterine fibroids? |
Dr.
Broder |
Sure.
First I'd like to tell barb450 that she should base her decisions
more on her symptoms than on measurements or other "objective"
criteria. Those are fine for studies, but if you feel better,
you are better. |
barb450 |
Thank
you. |
Dr.
Broder |
As
far as myomectomy not being possible, there really isn't a particular
location or number of fibroids that makes myomectomy "impossible."
It depends on the comfort level of the surgeon. Some gynecologists
say "it's too risky" to do myomectomies if there are more than
X number, or if they're in a particular location. It's true that
blood loss and operating time is longer with more fibroids, but
if that's what you want, you should be able to find someone qualified
to do it. |
uffdakab |
My
gyn had indicated that it would rip up my uterus, that's why she
said it was not a good choice. Does that make sense? |
kim.ransdell |
Hi
Everyone. At the risk of sounding redundant, I had UAE on 9-25-98
with Dr. Goodwin. Unfortunately, my dominant fibroid is still
causing "bulk" symptoms. I'm scheduled for a myomectomy and curious
about the location of the fibroid issue…what would preclude a
gyn from doing a myo? My Dr. sounds like he's undaunted by ANY
fibroids. Mine is large, pedunculated subserosal fibroid. |
Dr.
Broder |
Well,
myomectomy IS "ripping up the uterus," you just have to put it
back together at the end. And taking many fibroids out means lots
more "rips," that's why she thinks it's not worth doing. Studies
comparing myomectomy and hysterectomy don't support the idea that
hysterectomy is safer—but as I said, it can be easier, especially
if there are many of them. |
uffdakab |
I
have the one main large one. Not sure of the "type," just know
it is partly in and partly outside. |
kim.ransdell |
AGGGHH!
I've never heard myo portrayed in this light. If I hadn't already
survived one, I may be having 2nd thoughts. :) |
Dr.
Broder |
Fibroids
are named by whether they are inside the cavity of the uterus,
inside the wall of the uterus, or on the outside of the uterus.
The ones inside the uterus can be hardest to remove, but that's
not a hard and fast rule. |
uffdakab |
What
about progesterone as an alternative treatment to try? |
Carla
Dionne |
Dr.
Broder – with a case like uffdakab describes, would you present
the option of UFE? |
chattcat |
What
sort of fibroids are not candidates for embolization? I had a
myomectomy 5 yrs ago for a large fibroid…grapefruit size or larger
is how it was described to me…a pedunculated sort…I now suspect
it is back…all the same old symptoms…is UAE a possibility for
me? |
Dr.
Broder |
Yes,
I would present UFE as an option, though one with a shorter track
record than myomectomy. |
Dr.
Goodwin |
Pedunculated
fibroids on a narrow stalk can frequently be removed fairly easily
with a myomectomy. |
rumarr |
Do
fibroids always shrink at menopause. I'm 51 just starting with
menopause symptoms. I've already had a myo 16 years ago. |
Dr.
Broder |
I'd
also say that almost no one should have an invasive procedure
for fibroids (UFE or surgery) unless they had significant symptoms
and didn't get relief from (or didn't want to take) some hormonal
treatment. |
Dr.
Goodwin |
Subserosal
pedunculated fibroids can fall off inside the abdomen after embolization
and cause problems for several months. |
uffdakab |
When
planning on a hyst for a large fibroid (4-month), how necessary
is it to use Lupron for a couple of months to try to shrink it
prior to surgery? Lupron scares me! |
kim.ransdell |
Gulp…can
ANY subserosal fibroids "fall off" or just the type on thin stalks? |
Dr.
Broder |
Rumarr,
most symptoms of fibroids decrease with menopause, though it doesn't
happen overnight. The closer you are to menopause, the more "watchful
waiting", or perhaps treatment with progesterone or Lupron, is
a good idea. |
uffdakab |
Can
you please speak more about the progesterone and Lupron? |
Carla
Dionne |
Dr.
Goodwin - when subserosal pedunculated fibroids fall off after
UFE, what kind of problems are presented and how are they usually
resolved? |
Dr.
Goodwin |
Usually
pedunculated fibroids, i.e. those on a stalk, are those that can
fall off. |
Dr.
Broder |
Lupron
is best suited for treating someone if their fibroids make it
necessary to do an abdominal rather than vaginal hysterectomy.
It is also useful if you're anemic from bleeding, and want to
increase your blood count before surgery. |
Dr.
Goodwin |
When
subserosal fibroids fall off patients can have abdominal pain,
which can last several months. |
rumarr |
Is
Lupron safe? I've heard negative things about it. |
Carla
Dionne |
Dr.
Goodwin – has this occurred with any patients that you are aware
of? |
chattcat |
And
what happens to relieve the symptoms, Dr. Goodwin? Or do they
eventually just go away on their own? |
uffdakab |
Ditto
on the Lupron safety question. I've heard horrible things about
it. |
Dr.
Goodwin |
The
number of patients who have experienced sloughing of subserosal
pedunculated fibroids is very small measuring less than 1% as
far as I know. |
chattcat |
I
took Lupron for several months prior to both surgeries, horrible
experience and in both cases did not shrink fibroids. |
hanapa1 |
I
had a myomectomy 16 months ago and a c-section 5 months ago. Should
I wait more time before having UFE for another tumor? |
Dr.
Goodwin |
Patients
are managed with pain medications. Symptoms will eventually resolve
on their own. |
barb450 |
When
you have a chance, I think a key question would be how long is
an embo effective for? Do you have any data on that? |
Dr.
Broder |
Dr.
Goodwin, is there any danger besides pain with a myoma that falls
off after embolization? |
kim.ransdell |
Would
it be intermittent or constant pain? I've had a lot of pain post-UAE,
but no one checked into whether the "giant" had fallen off. |
Dr.
Goodwin |
UFE
is not contraindicated in a patient with your surgical history. |
Dr.
Broder |
To
respond to the Lupron question: Lupron does have significant side
effects, but there really isn't any indication that those last
more than several months, and not everyone experiences them. So
using it is a question of what the expected benefit is versus
the possible risks. |
Dr.
Goodwin |
Most
UFE failures have occurred at the outset. Delayed failures have
been unusual. Post procedural MRI on Kim showed no sign of sloughing
of the fibroids. |
Dr.
Broder |
I'd
like to know why hannapa1 is having UFE – it sound like she's
still having children, and UFE is generally not advised for those
women. |
Dr.
Goodwin |
USA
data on UFE is only 3 years old. |
barb450 |
I
see. Thank you. |
uffdakab |
Is
there much data available on use of progesterone as an alternative
to any of the procedures discussed? |
Dr.
Goodwin |
I
agree that UFE is indicated in patients desiring fertility only
under special circumstances. |
Dr.
Broder |
Responding
to barb450, about 10-15% of women who have myomectomies end up
back for more surgery for fibroids by the time they reach menopause.
As Dr. Goodwin pointed out, UFE data is really too new to make
a good comparison, but in the short run, recurrences don't seem
to be any more of a problem than with a myomectomy. |
Carla
Dionne |
Dr.
Broder – I think hannapa1 was merely asking if UFE was a viable
choice for her at this time. |
barb450 |
Have
you ever heard of that polyvinyl substance moving? Sorry, didn't
mean to interrupt. |
Dr.
Goodwin |
PVA
cannot migrate after embolization. |
barb450 |
whewwwwww |
kim.ransdell |
Thanks,
I'm a nervous patient, as you know. It was still "hangin' on"
in December, so probably still is. I have had no studies done
since then, besides an ultrasound in March. I'm just paranoid.
:) |
hanapa1 |
After
6 months bedrest during my last pregnancy due to fibroid and preterm
labor, I am not going to have any more children. |
Carla
Dionne |
Dr.
Goodwin – what's the difference between polyvinyl alcohol particles
and silicone particles? |
Dr.
Broder |
Progesterone
can be used to treat bleeding from fibroids when it's given cyclically
(typically 5-10 days per month). It can also sometimes help symptoms
of pain, but it works much less well for "bulk" related symptoms,
like pressure. |
Dr.
Goodwin |
PVA
is a completely different plastic material than silicone. |
barb450 |
Doesn't
progesterone cause tumor growth? |
uffdakab |
Dr.
Broder, does that mean it doesn't help much for shrinking, but
can maybe help get a woman to menopause, when it will hopefully
shrink? Just saw barb450's question – never heard that one. Please
address. |
Carla
Dionne |
Thought
so. :) Saw some "scare" stuff on a "medical" site (put out by
a doctor) that indicated IRs were really using silicone for UFE
and that women undergoing UFE would end up just like women with
silicone breast implants – with all sorts of random immune disorders. |
barb450 |
I
thought hormones did. Sorry if I'm wrong. |
uffdakab |
Thought
estrogen was the culprit in the growth. |
barb450 |
But
my mom who had a total hysterectomy 20 years ago was put on some
sort of hormone and had to stop because she was growing tumors. |
Dr.
Broder |
There
is no evidence that progesterone (taken orally) causes fibroids
to grow, although progesterone in the body may be one of the things
that causes them to grow. That may not make sense, but there are
many differences between "physiologic hormones" (ones the body
make) and pharmacologic hormones (ones you buy in the drugstore).
Estrogen has also been implicated as a cause of fibroid growth,
but again, taking estrogen doesn't cause them to grow. |
uffdakab |
Dr.
Broder, so do you agree that natural progesterone is the way to
go if taking progesterone? Can you address oral vs. cream? |
Dr.
Broder |
All
menstruating women have high levels of both progesterone and estrogen,
yet many don't get fibroids. You can't tell who will have them,
or how big they'll be by measuring hormone levels either. There
may be individual cases where hormones seem to cause fibroids
to grow, but millions of women have taken birth control pills
for decades, and their rate of having fibroids isn't any higher
than women who never took the pill. |
uffdakab |
I've
heard of estrogen dominance being a major problem, and natural
progesterone can help counteract that. Is that viable? |
barb450 |
But
we already have fibroids so in that case would it make a difference? |
Dr.
Broder |
"Natural"
progesterone has theoretical advantages, but in practice you just
need to do what works. It's true that as women approach menopause,
they ovulate less regularly, and ovulation provides the natural
level of progesterone. So, no ovulation, no progesterone. As a
result, many women in their forties have symptoms that can be
resolved with progesterone treatment. |
uffdakab |
Thank
you Dr. Broder. Can that be measured somehow – to determine ovulation
and progesterone levels? (hope I'm not hogging the floor here) |
Dr.
Broder |
As
I mentioned, if your symptoms are bleeding or pain, then a trial
of hormones (progesterone) may be worth it. After all, we're talking
about taking medication maybe 2 weeks per month for 3-6 months.
There is no really useful way to choose who to treat based on
hormone levels. You may have normal progesterone values one month,
but not another. And what's normal for you might not be normal
for others. |
uffdakab |
…and
do you recommend oral or cream? Is natural available as an oral? |
Dr.
Broder |
It's
easier to judge the dose with oral progesterone. I haven't used
progesterone cream much, but I do have several patients who find
it useful. "Natural" progesterone is available in oral form. |
uffdakab |
Thank
you very much, Dr. Broder. This info will help with my consultation
tomorrow. |
Carla
Dionne |
To
both doctors – I get asked a lot about the difference between
a vaginal doppler ultrasound and a MRI when checking on fibroids
pre-procedure. Both are used – which is better and why? |
Dr.
Goodwin |
UTZ
provides better flow information. MRI provides better anatomical
information. |
Dr.
Broder |
I
would say that both have their uses – mainly in studying the response
of fibroids to the procedure. I don't think it makes any difference
to the patient, though. If the procedure works, she will feel
better. |
barb450 |
Thank
you also to both Doctors. |
Dr.
Goodwin |
MRI
is better at diagnosing comorbid diseases such as adenomyosis. |
uffdakab |
What
is adenomyosis? (or is it too late to ask that question?) |
Carla
Dionne |
Can
you explain what the significance of finding adenomyosis would
be when considering UFE? |
Dr.
Goodwin |
Adenomyosis
is deposits of endometrial tissue in the uterine wall which can
cause bleeding and can be difficult to diagnose. |
Dr.
Broder |
Adenomyosis
is when tissue normally found only in the lining of the uterus
is found within the wall of the uterus. Significant adenomyosis
reduces the chances that a myomectomy will work. I don't know
if it affects UFE. |
Dr.
Goodwin |
UFE
is probably not generally effective for the treatment of adenomyosis. |
Carla
Dionne |
So,
if one has adenomyosis then perhaps UFE is not the best course
of treatment for their fibroids? But if myomectomy also is unable
to resolve this issue, what choices does a woman have left? |
Dr.
Goodwin |
UFE
has worked in some women with both fibroids and adenomyosis, but
there is reason to believe that their symptoms were principally
due to the fibroids. |
Dr.
Broder |
Adenomyosis
is a tough thing to be sure about – often it's not clear that
it's the cause of symptoms until after a myomectomy doesn't work.
I didn't say myomectomy never works if there is adenomyosis, only
if the adenomyosis is really the cause of the symptoms, not the
myomas. |
Carla
Dionne |
So
adenomyosis can be silent and not cause any symptoms? |
Dr.
Broder |
Yes,
often it causes no symptoms at all. Like fibroids, adenomyosis
is common and so are problems like bleeding and pain. So it's
hard to know if adenomyosis is the cause or an innocent bystander. |
barb450 |
alert |
Dr.
Broder |
I'm
afraid I have to sign off, I have a patient in labor… |
Carla
Dionne |
Well,
it's 7 p.m. and time for the chat to come to an end. I want to
thank both Dr. Broder and Dr. Goodwin for joining us tonight.
Transcripts will be made available and placed in the archives. |
uffdakab |
Thank
you so much doctors – and all you wonderful ladies. |
Carla
Dionne |
Dr.
Broder – go deliver that baby! |
Dr.
Goodwin |
Thank
you for the opportunity to communicate with all of you. I will
be signing off now. |
Carla
Dionne |
If
anyone wants to hang around and chat awhile, you're welcome to
do so. Goodnight. |