MUST READ..... Women between 28 and 40 suffer most from uterine fibroids (II) –US-based expert

Women between ages 28 and 40 suffer the most from uterine fibroids which disrupt their lifestyles. There are no known ways to prevent complications.  Signs and symptoms include abnormal menstrual cycle, abnormally heavy periods that occur more frequently than normal cycles: less than 28-30 days, painful menstrual periods and pains during or after sexual intercourse, pressure  on the bladder which can cause frequent
urination.Fibroids are benign muscle growths that develop and grow in the uterus. They are disproportionately common in black females affecting up to 80-90 per cent even of black women. We do not know what the causes are or why they are particularly prevalent in black women. However, they are structural abnormalities. They cannot be cured with herbs or a change in diet once they are identified. Ignoring them does not work as they grow and can reach incredible sizes, says Dr. Lanalee Araba Sam, Director of Robotic Gynaecologic Surgery – West Boca Medical Centre, Fort Lauderdale, Florida. Dr. Sam is a pioneer in Gynaecologic Robotic Surgery. She is also the Founder and Medical Director of Elite Obstetrics & Gynaecology. DocStar, as she is affectionately called, is an award winning solo practitioner and business visionary, adept in providing a solution-based approach to OB/GYN: In this two-part presentation to JEBOSE BOULEVARD, the Florida-based doctor, daughter of Ghanaian/Canadian immigrants, discusses Uterine Fibroids, treatments and procedures  as it affects black women with emphasis on African women:
What are the risks of removing fibroids through surgical operations
The final risk that a surgical myomectomy imposes is the possibility that going in and removing all those fibroids, we may not be able to put that uterus back together again. In one patient, I removed 66 fibroids, but I was able to put the uterus back together again and stopped the bleeding. In some patients, again, it’s possible that the patient can end up, over the course of a myomectomy, with a hysterectomy. If it’s impossible to stop the bleeding or put the uterus back together again, the patient needs to be aware of that potential for a hysterectomy with any attempted myomectomy. In the many years that I’ve been doing these surgeries … and that is 14 years of private practice at this point … I’ve been fortunate enough to say that has happened only once in my career, where I did have to remove a uterus, because it was so full of fibroids, there was no way that I could put it back together again.So we’ve dealt with the 28-year-old with a three-centimetre fibroid; we’ve talked about the 34-year-old with multiple fibroids and the 34-year-old with the single, large fibroid. So let’s talk about the 48-year-old woman who comes in with, symptomatic fibroids, who is not planning on having any more children and is really quite uncomfortable with these fibroids that are causing heavy bleeding, back pain and pain with intercourse .But what would be her options?When we are no longer thinking about fertility, future fertility, as an option, this is the talk that I give to patients. I say, “first, we can do nothing. We can do our ultrasound, identify the fibroids.” If she’s having heavy bleeding, in a patient that’s over the age of 40, for sure, we would probably do something called a endometrial sampling, where we take a sample of the menstrual blood to make sure that there’s no evidence of abnormal precancerous cells inside the uterus that are causing the bleeding and that we’re not mistaking the fibroids as the cause of bleeding.If that biopsy is negative, I say, “All right. Here are our options: Again, we can do nothing. We can just watch this, because we know that most fibroids are not cancerous. Number two, we can attempt hormonal treatment, which means that we can try to treat the symptoms.”We can use birth control pills to try to regulate her cycles, number one. Number two, we can use something called Depo Provera, which are injectable hormones that basically, is a birth control that you take every three months and may be able to stop periods altogether. Number three, we can give a medication called Depot Lupron, which basically puts the person into menopause, so it stops the hormonal supply to the uterus and may cause those fibroids to shrink. Now all of these options have their own possible side effects, and they are bandages to treat the symptoms.We can get a little more aggressive by doing something called a uterine fibroid embolisation, which is where an interventional radiologist cuts off the blood supply to the uterus to, hopefully, make the symptoms decrease and to shrink those fibroids down .Another procedure is called magnetic resonance- guided focused ultrasound, where, again, a radiologist basically uses a laser beam through the skin to, centimeter-by-centimeter, kill off the fibroids and the tissue that’s alive in the uterus; and, hopefully, that will help to stop them from growing.Now, both uterine fibroid embolisation and magnetic resonance-guided focused ultrasound require proof that an endometrial biopsy was negative, that the patient has had a normal Pap smear; and they both require an MRI to have the radiologist assess whether they think that this is an appropriate treatment for this patient. We then just basically have to watch, and wait, and see, in three to six months whether or not it works.And, if it doesn’t work, then we come back to me.What will be the definitive treatment for a 48-year-old woman with multiple fibroidsIt would be to consider a hysterectomy. Women often think that a hysterectomy means they are going into menopause. There are many different types of hysterectomies. There can be a total hysterectomy which means removing the cervix and the uterus; but, a total hysterectomy with bilateral salpingo-oophorectomy means removing the cervix, the uterus, and both fallopian tubes and ovaries.What I counsel to women is that the ovaries are what provide you with hormones. The uterus and the cervix do not provide any hormones. It is your ovaries that are responsible for estrogen, progesterone, and hormones, whether or not you are in menopause. As long as your ovaries or as long as at least one ovary is in your body, you are still getting hormonal support and not in menopause. You do not need hormone replacement therapy.So, definitive surgical treatment of a 48-year-old would be some sort of hysterectomy. And, again, there are many different types and different ways to approach hysterectomy, which we can talk about in another of these conversations. And regards to 48-year-olds with fibroids: In talking to her about her options, I generally point out that some people say, “Oh, well, I’m 48, you know. When I hit menopause, I’m sure these fibroids will shrink.”Well, the average age for menopause, which means your hormones shutting off and no period for one year, is 52. So these patients that we are using as example are 48 year- olds  with a grossly enlarged uterus, multiple fibroids, bleeding heavily, have  pains and symptoms. To say that “I’m gonna just sit that out for another four years,” doesn’t make a lot of sense.One other option that I forgot to mention was the possibility of a progesterone-secreting IUD. So, putting an intrauterine device in the uterus, which thins out the lining of the uterus and, hopefully, helps to decrease the bleeding that the patient is experiencing from these fibroids is an option. Again, much like the hormonal approach of birth control pills, Depo Provera, or the IUD, it’s a Band-Aid on symptoms. It may work for a while. It may get you through for a while. But, depending, again, on the size of these fibroids, it may not work, and every patient is different.Fibroids are benign muscle growths that can be symptomatic, with bleeding, and pain, and painful intercourse; can be asymptomatic and just caught on a physical exam or on a secondary finding on another ultrasound, or CT, or MRI, that a patient has. A treatment very much depends on the age of the patient, their symptoms, their clinical exam, and their desires for future fertility. There are many different treatment options. Every patient needs to be thoroughly evaluated and discussed individually to determine what is the right treatment for that patient. After the age of bearing children, a uterus is not that relevant, to the extent that after childbearing, basically, uteruses are there to grow fibroids, develop endometrial hyperplasia, or uterine cancer, or bleed for no good reason (chuckles). There is not any significant structural or anatomical purpose for the uterus itself, except for having children. Now, again, to reiterate, hormonal support is from the ovaries, and not from the uterus.