How large can they grow?

Some of them can grow really large. I’ve seen one that filled up the whole belly. It’s uncommon for them to get that big, but they can. They vary widely in size from as small as a coin to the size of a large melon. A very large one can cause the uterus to expand to the size of a 6 or 7-month pregnancy.

Is a hysterectomy necessary?

In my opinion, no. You don’t need a hysterectomy. I speak to a lot of women in communities and even to men and couples. If a man had a benign tumor in his testicle and he was told he would have his testicle cut off, he would absolutely not want it. Women are told that all the time that for a benign condition to take the uterus out. I think it’s absolutely unnecessary.

Does size and number matter?

For the procedure, it doesn’t, but for a patient, it might. If you have two very small ones, you may not have many symptoms. If you happen to have an ultrasound and you find it but it’s not bothering you, then you don’t treat it. But, if you have many of these benign tumors or very large ones and they cause you problems, then you might want to treat them, but all of these can be treated with embolization.

How you would coordinate care with my OB/GYN?

So assuming you’ve already seen an OB-GYN — or if you don’t already have one, I’ll help you find one. I work with many. We’ll get all the information from the OB-GYN. We’ll see how the diagnosis was made, confirm that this is a fibroid and that your symptoms are coming from it. We’ll make sure they’ve done a pap smear and endometrial biopsy and there’s nothing else going on. Once we’ve taken care of it, we’ll make sure they get the information and get you back so you have continuity of care.

Is it always necessary to treat?

So if the patient is symptomatic, and you’ve got pain, bleeding, and other problems associated with the tumor, then you should probably treat it. You don’t fix something that isn’t broken.

Are there medications or natural remedies used to treat symptoms?

As you can tell, I’m from the East. I’m from India, and I believe in Ayurveda as well in a holistic approach. So I try to take a holistic approach to this — the spirit, the mind, the body, everything comes from nature. There are some natural remedies, but they’re not really remedies because they don’t cure you. Some of these may help you feel better, but I’ve never seen one of this things completely take care of the problem.

How can they affect sexual intercourse?

Sexual intercourse can become very painful, which is called dyspareunia. Once you receive treatment, then that pain goes away. Also, if a woman is bleeding for three weeks out of a month, then it’s very hard to have sexual intercourse. It affects the husband or partner, the kids — everyone is unhappy.

Can they grow during pregnancy?

Yes, during pregnancy there a lot of hormones that are being produced by the body for the baby to grow, and at that time they can get larger because they’re just getting more jolt if you would.

Will they still be a problem after menopause?

Not necessarily. They won’t be a problem after menopause, but if you are taking hormonal supplements, then there is the estrogen that could cause them to grow. So it’s the hormones that make them grow. So if you are not on any replacement, then it’s unusual. In fact, a lot of the gynecologists would say if you’re very close to menopause, do not do anything.

What is a myomectomy? What are the challenges with a myomectomy?

It’s an open procedure; you will need anesthesia. There are many complications associated with that. These days they also have a robotic option, which is very expensive. I’ve had patients tell me [the cost] can go up to $100,000 because the machine is very expensive. Embolization is a very inexpensive option to it. It’s simple, and you’re home the same day. So myomectomy sometimes is necessary, but not always.

Can you help me determine if I am a candidate for the procedure?

Absolutely. We will look at your MRI, your ultrasound, your findings, and we can schedule you ASAP. Like I said, I do the procedure through the wrist, so it becomes much more easier for you, and it’s faster. A lot of times we do this as an outpatient.

How will I feel throughout the procedure?

During the procedure, we’ll give you sedation, which is basically through a small IV. It makes you feel very comfortable. You may not remember anything from that. We also give you enough pain medicine before, so during the procedure, you probably won’t remember anything. I do it now through the wrist, so it’s very minimally invasive, it’s like getting an IV. You won’t realize any of this.

Please describe the particles used to block the arteries

The particles that we use for the embolization are what I like to describe as little, small gelatin balls. They go there and block the artery.

How long should I expect to be off work?

It varies by the person, and it varies on how you tolerate pain. Most of my patients are back at work by a week. You compare that to open surgery or myomectomy or one of those things, you spend a lot of time off work and in a lot of pain.

How long should I expect to stay in the facility after having UFE?

We give you some pain medications, then if you can tolerate it, you can go home the same day. That’s why I also do it from the wrist so when you’re up, when you’re done with the procedure. After two hours, you can do what you want with your hands, and there’s nothing in the areas over your hips.

What kind of follow-up care is typical?

So immediately after your procedure, we want you to come back to the office within a few days to make sure everything is okay. After that, we will follow-up with you periodically to make sure that everything is going well.

Will they come back after having UFE?

It is very, very unusual for them to come back. Occasionally, the uterus may get blood supply from an ovarian artery or some other artery. I rarely see that, and it’s very easy to do the embolization again if it ever does.

Will I still menstruate after having UFE?

Yes, you’ll have your period after the procedure.

Can I still get pregnant after the procedure?

It’s not designed to make you pregnant, but if the fibroid was the cause of your not being pregnant and then that cause goes away, there is a chance you will be able to get pregnant. So we’ve had patients who get pregnant, but I can’t guarantee that because there’s no literature suggesting that this will make you pregnant.

How successful is the procedure?

A very high percentage of UFE’s are successful in treating patients. Over 95% of procedures are successful. The goal of treatment is to make you feel better, stop the bleeding or the pain, and bring it as close to normal.

Are your patients happy with the procedure?

My patients are usually very happy with the procedure. I get hugs from them, their families. It’s a lot of positive energy and it really changes their lives.

What are the typical complications?

The most common complication is pain, but we’ve learned how to manage the pain, so we work with you as a patient and help you go through it. It’s rare, but if somebody doesn’t take the antibiotics, they can get a mild infection or even a severe infection. But we make sure we cover them with antibiotics, so in my experience these are all less than 1%.

Will my insurance cover UFE?

I know just about every insurance covers the procedure. My office will do all the pre-authorization for you. We call the insurance companies. I’ve never had one procedure declined.

Uterine Fibroids

Overview

Uterine fibroids are non-cancerous tumors that grow on or within the muscle tissue of the uterus.
Up to 80% of women develop fibroids at some point in their lives.
They are typically benign growths that can cause a variety of symptoms including heavy menstrual bleeding, pelvic pain and pressure, urinary urgency and painful intercourse.

You are at a higher risk of developing fibroids if you are Black and have fibroids run in your family.
Uterine fibroid embolization is a common treatment option for uterine fibroids which cuts off the blood supply to the tumor, leading it to shrink over time.

What are uterine fibroids?

Uterine fibroids are non-cancerous tumors that grow on or within the muscle tissue of the uterus.

Uterine fibroid symptoms

Uterine fibroids can cause a variety of symptoms, but the most common symptom is heavy menstrual bleeding and pelvic pain.

On occasion, uterine fibroids may also lead to infertility or pregnancy complications, such as miscarriages or premature labor. Other symptoms include the following:

Pain during intercourse
Anemia due to heavy bleeding
Lower abdominal pain/swelling, which can be mistaken as weight gain or pregnancy
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
Sometimes there aren't any symptoms at all!

If you are experiencing any of these symptoms, it’s best to reach out to your doctor for further examination and advice.

What are the different types of fibroids?

Subserosal

Subserosal fibroids grow on the outer wall of the uterus and can grow quite large.
Submucosal

Submucosal fibroids form under the lining of uterine cavity.
Pedunculated

Pedunculated fibroids actually appear as a peduncle, which is an attaching stalk of sorts.
Intramural

Intramural fibroids which grow within the wall of the uterus.
Exophytic

Exophytic fibroids, which jut outwards from the uterus into the cavity, are often referred to as ‘proud’ fibroids.

Causes of uterine fibroids

Doctors don’t yet know the cause of fibroids. However, the following could increase your risk of developing fibroids:

Genetics

Genetics could help increase the chances.

Hormones, specifically estrogen

Estrogen is the chemical that makes your uterine lining thicken at each period. Therefore, prolonged use could increase your likelihood of developing fibroids.

Risk factors for developing fibroids

Women 35-years-old and older have the highest risk, but remember that fibroids can develop before then.
Fibroids can and do occur in women under the age of 35, even as young as the early 20s.
Women who are Black are also at-risk.
Some statistics indicate that up to 80% of African-American women will develop uterine fibroids.
Those who have fibroids run in their family are at an increased risk, too.

Uterine fibroid diagnosis

Ultrasound is an important tool used in diagnosing fibroids.

Fibroids develop in the uterus, so ultrasound imaging is a reliable way to visualize any potential members growing inside a woman’s body.

This type of ultrasound is also useful for determining and understanding the size, shape, and location of the fibroid so that treatment options can be more fully explored.

Ultrasound has become a go-to option for initial diagnosis of fibroids because it is painless and cost effective, making it accessible for anyone who might have concerns about any possible abnormalities in the uterus.

What treatment do you offer for uterine fibroids at MIMIT Health?

Uterine fibroid embolization, or UFE for short, is an increasingly popular procedure for treating uterine fibroids. The advantage of this non-surgical approach over more traditional treatments is that it can be done on a outpatient basis with no hospitalization required.

LISA'S EXPERIENCE

Dr. Chopra Answers Questions About Fibroids

How large can they grow?

“Some of them can grow really large. I’ve seen one that filled up the whole belly. It’s uncommon for them to get that big, but they can.” They vary widely in size from as small as a coin to the size of a large melon. A very large one can cause the uterus to expand to the size of a 6 or 7-month pregnancy.
Does size and number matter?

“For the procedure, it doesn’t, but for a patient, it might. If you have two very small ones, you may not have many symptoms. If you happen to have an ultrasound and you find it but it’s not bothering you, then you don’t treat it. But, if you have many of these benign tumors or very large ones and they cause you problems, then you might want to treat them, but all of these can be treated with embolization.”
Is it always necessary to treat?

“So if the patient is symptomatic, and you’ve got pain, bleeding, and other problems associated with the tumor, then you should probably treat it. You don’t fix something that isn’t broken.”
How can they affect sexual intercourse?

“Sexual intercourse can become very painful, which is called dyspareunia. Once you receive treatment, then that pain goes away. Also, if a woman is bleeding for three weeks out of a month, then it’s very hard to have sexual intercourse. It affects the husband or partner, the kids — everyone is unhappy.”
Is a hysterectomy necessary?

“In my opinion, no. You don’t need a hysterectomy. I speak to a lot of women in communities and even to men and couples. If a man had a benign tumor in his testicle and he was told he would have his testicle cut off, he would absolutely not want it. Women are told that all the time that for a benign condition to take the uterus out. I think it’s absolutely unnecessary.”

“The Risks of a Hysterectomy for Fibroid Treatment”
How you would coordinate care with my OB/GYN?

“So assuming you’ve already seen an OB-GYN — or if you don’t already have one, I’ll help you find one. I work with many. We’ll get all the information from the OB-GYN. We’ll see how the diagnosis was made, confirm that this is a fibroid and that your symptoms are coming from it. We’ll make sure they’ve done a pap smear and endometrial biopsy and there’s nothing else going on. Once we’ve taken care of it, we’ll make sure they get the information and get you back so you have continuity of care.”
Can they grow during pregnancy?

“Yes, during pregnancy there a lot of hormones that are being produced by the body for the baby to grow, and at that time they can get larger because they’re just getting more jolt if you would.”
Are there medications or natural remedies used to treat symptoms?

“As you can tell, I’m from the East. I’m from India, and I believe in Ayurveda as well in a holistic approach. So I try to take a holistic approach to this — the spirit, the mind, the body, everything comes from nature. There are some natural remedies, but they’re not really remedies because they don’t cure you. Some of these may help you feel better, but I’ve never seen one of this things completely take care of the problem.”
Can you help me determine if I am a candidate for the procedure?

“Absolutely. We will look at your MRI, your ultrasound, your findings, and we can schedule you ASAP. Like I said, I do the procedure through the wrist, so it becomes much more easier for you, and it’s faster. A lot of times we do this as an outpatient.”
What is a myomectomy? What are the challenges with a myomectomy?

“It’s an open procedure; you will need anesthesia. There are many complications associated with that. These days they also have a robotic option, which is very expensive. I’ve had patients tell me [the cost] can go up to $100,000 because the machine is very expensive. Uterine fibroid embolization is a very inexpensive option to it. It’s simple, and you’re home the same day. So myomectomy sometimes is necessary, but not always.