Understanding Uterine Fibroids

Podcast Transcript

Dr. Erica Newlin:

Welcome to Ob/Gyn Time, a Cleveland Clinic podcast covering all things reproductive health. I'm your host, Dr. Erica Newlin. This podcast is intended to help you better understand your health, leaving you feeling empowered to live your best. On each episode, you'll hear from our experts on topics such as pregnancy, fertility, menopause, and everything in between.

On this episode, I'm joined by Dr. Megan Billow to discuss uterine fibroids, a condition that affects millions of women and can impact everything from periods to fertility and even mental health. We'll cover what fibroids are, why they happen, and what you can do to manage them. Thanks so much for joining me on the podcast, Dr. Billow.

Dr. Megan Billow:

Thank you so much for having me.

Dr. Erica Newlin:

Before we start, can you tell our listeners a little about your role in the Cleveland Clinic and your background?

Dr. Megan Billow:

Yes, so I am a minimally invasive gynecologic surgeon, and what that means is my practice focuses on surgical treatment of complex benign gynecology, particularly fibroids and endometriosis. And my practice really focuses on how we can use minimally invasive approaches to improve patient outcomes and provide safe quality care for patients.

Dr. Erica Newlin:

Great. Before we dive into symptoms and treatment, let's start with the basics. What are fibroids and why do they develop?

Dr. Megan Billow:

So fibroids are really common. The way I like to describe them as essentially muscle balls of the uterus. They're very common and non-cancerous growths, and we don't know one single cause, but we do know that they're influenced by hormones, especially estrogen and oftentimes by genetics as well.

Dr. Erica Newlin:

Are certain women more at risk?

Dr. Megan Billow:

Yes, they are. We do know that African American individuals are more impacted by fibroids, especially at an earlier age.

Dr. Erica Newlin:

Can fibroids cause other issues beyond heavy bleeding?

Dr. Megan Billow:

That's a great question, and yes, they can. So the main symptom that brings women to the office includes heavy bleeding, but because of the size and oftentimes the number of fibroids, women can also have what we refer to as bulk symptoms, which is when they feel pressure or pain symptoms, sometimes bladder or bowel symptoms as well.

Dr. Erica Newlin:

Yeah. Let's talk a little more about that. How would fibroids affect your digestive system?

Dr. Megan Billow:

That's a great question because there's limited space in the pelvis, and I like to describe the pelvis as being like a bowl. And within that bowl, the uterus sits in the middle with the bladder in the front and the bowel in the back. And as that uterus gets larger or fibroids are growing, the fibroids can start to push on the bladder or the bowel and can lead to things such as constipation. Sometimes patients will have more issues with diarrhea and other types of GI symptoms as well.

Dr. Erica Newlin:

For sure. And I had one poor patient, it even caused – she was unable to pee because of the fibroid.

Dr. Megan Billow:

Yeah, exactly. And again, because of that bowl, the bladder sits in front, and that is a very common thing that we see is that patients will feel like they cannot empty their bladder or that they just feel like they have to pee all of the time.

Dr. Erica Newlin:

Why would uterine fibroids maybe cause fatigue?

Dr. Megan Billow:

So the most common reason is because of the heavy bleeding that can be associated and oftentimes is associated with fibroids. And the heavy bleeding can lead to iron deficiency anemia, which is really, really important for patients to be able to identify the symptoms, specifically fatigue, feeling shortness of breath, lightheaded, dizzy, and the heavy bleeding leading to anemia is, it can be very, very severe. And that's why we really want patients to be able to recognize these symptoms so that they can see their providers and get an evaluation.

Dr. Erica Newlin:

In what ways might fibroids relate to sex?

Dr. Megan Billow:

Fibroids do impact the pelvis and because of the size and location, oftentimes if a fibroid is in the back of the uterus, it can cause fullness and pressure, which can lead to pain during sex.

Dr. Erica Newlin:

So with painful sex, fatigue, heavy bleeding, affecting the bladder, the bowel, do you often see that fibroids are impacting mental health as well?

Dr. Megan Billow:

Absolutely. Fibroids are a really big cause of a woman's overall health status and their quality of life. And fibroids can cause women to be bleeding through their clothing, bleeding through their bedsheets. Oftentimes, patients will say they need to pack a bag while they're on their periods because they're afraid that they're going to bleed through their clothing. So it has such an impact on their quality of life, and that leads to also their mental health. It impacts relationships, sometimes financial struggles as well because patients will often say they need to miss work while they're on their periods because of the heaviness of the bleeding or the pain.

Dr. Erica Newlin:

Are there any resources or support groups that you recommend to patients impacted with fibroids?

Dr. Megan Billow:

I will say that that is a great benefit of social media, is that going on social media and seeing other people experiencing the same thing makes oftentimes patients see, feel heard and seen. You know, it's nice to see other people that are having the same experience. And so resources and support groups oftentimes are on social media, but Cleveland Clinic also provides a lot of resources and support through online resources and patient education.

Dr. Erica Newlin:

How do you recommend that patients bring up their concerns with their doctors?

Dr. Megan Billow:

I think the biggest thing to know is that bleeding or pain that is causing you stress or that is really impacting your day-to-day or is something that you need to change your plans for or not go to work or not go to school, et cetera, that is not normal. And so the first step is recognizing that you don't have to live like this, that this is not normal, and then to really advocate for yourself and to reach out to your provider, whether you are, have an established Ob/Gyn, primary care doctor, and bring these concerns up because we need to evaluate for anemia and make sure that this heaviness of bleeding is not causing a significant decrease in your hemoglobin level.

Dr. Erica Newlin:

Do fibroids always impact fertility, and how do we know whether it will or not?

Dr. Megan Billow:

What we know is that fibroids that are implanted inside of the uterus, those are the fibroids that will have the most impact on fertility. And what that means is that it can impact the implantation of the pregnancy inside of the uterus, and so it's really important that if there is any issues with miscarriage, frequent miscarriage, to really seek out an evaluation, however, fibroids themselves do not equal infertility or do not equal the ability to not get pregnant. So fibroids oftentimes don't have any impact on pregnancy and you can go on to have a nice, healthy baby and delivery even with fibroids.

Dr. Erica Newlin:

Great. Now that we've talked about symptoms, let's move on to talk about treatment options and lifestyle changes that might help. First, are there other treatment options besides a hysterectomy?

Dr. Megan Billow:

Yes, absolutely. And while hysterectomy is a surgery that can provide a lot of relief and cures, essentially, and takes care of the fibroids, it's not the only option out there, and it should not be the default either. There's lots of medications and other minimally invasive procedures that can help not only decrease the size of the fibroids, but also decrease the amount of bleeding.

Dr. Erica Newlin:

For sure. Can you delve a little more into what that pathway might look like?

Dr. Megan Billow:

Yeah. So the first thing that we want to make sure that we are treating is that concern for anemia. And so any amount of heaviness of bleeding, we really want to decrease that as quickly as possible, and that's where medications can be helpful. Medications are really great at decreasing the amount of bleeding, however, they're not going to make the fibroids get smaller or go away. And so first, dealing with the heavy bleeding is the biggest essentially issue that we want to tackle. And then after that, especially if patients are not responding to medications or continue to have issues with pain and pressure symptoms, there are some options that provide relief by removing fibroids or making the fibroids get smaller.

Dr. Erica Newlin:

Yeah. Can you talk first about some of those procedures that might make the fibroids smaller or cut off their blood flow?

Dr. Megan Billow:

Yeah. So there is something that we refer to as a uterine artery embolization, or sometimes it's seen as a uterine fibroid embolization. And what that procedure is, is it's done through radiology or interventional radiology. And what they do is they are able to identify the major blood supply to the uterus and they put a material in there that essentially blocks that blood flow. And it is helpful for decreasing the amount of bleeding, as well as potentially making the fibroids get smaller. It can be associated with some initial pain, but it can provide relief for patients that may not be seeking or able to undergo surgery at that time or are not responding to medications.

There's other procedures as well that use essentially energy to decrease the size of fibroids. We do provide one of those procedures here at Cleveland Clinic. It is something though that it's very specific for patients that may have one large fibroid. It's not a great procedure for patients that have multiple lots of fibroids. So it is, all of these procedures are very dependent on the uterus, the size, number, and location of fibroids.

We also offer a myomectomy procedure, which is the removal of fibroids, and that procedure can be done minimally invasive using smaller incisions such as laparoscopic or robotic surgery, but again, it's based on the number, the size, and the location of the fibroids. And it's a great conversation to have with your Ob/Gyn provider about if you're a candidate for any of those procedures.

Dr. Erica Newlin:

Great. Yeah, a lot of different treatment options and really varies depending on what someone's symptoms are and where those fibroids are. Can certain foods or dietary changes reduce uterine fibroids?

Dr. Megan Billow:

That is a question that does come up a lot, and I know there, there is some research that has been done looking at the impact of food and diets and supplements, and overall, there's not any diet specifically that has been proven to shrink the fibroids dramatically, but diet can influence inflammation and sometimes hormones. What we recommend is really a diet that consists of lean proteins, fruits and vegetables, avoiding processed foods, just to really support overall health and really focus on making yourself healthier as opposed to looking for that outcome of decreasing the fibroids.

Dr. Erica Newlin:

On a similar vein, what about, you know, exercise, weight management? Does that make any difference to fibroid growth?

Dr. Megan Billow:

So regular exercise, maintaining a healthy weight, managing stress, addressing anemia can just overall improve symptoms and make you feel better. It's not going to make the fibroids go away or get smaller. And I think the biggest message is that there's nothing that you did or did not do that caused these fibroids. It happens because of genetics, because of cells, and it's not something that we can control through, you know, individual lifestyle choices. And it's really important to, to be mindful of that because addressing these symptoms on your own can oftentimes lead to the, the fibroids getting larger and there are options and we can help you to make sure that the fibroids don't get larger and that you have better quality of life essentially.

Dr. Erica Newlin:

Are there any supplements or other products that have been associated with fibroid growth or fibroid shrinkage?

Dr. Megan Billow:

On the markets, there may be some supplements that advertise that they do that. However, when it comes to research and data, there's nothing that's been proven that these supplements and extra diet changes or things like that will improve symptoms or decrease the size of the fibroids.

Dr. Erica Newlin:

Women's health is one of those things right now where there are a lot of supplements on the market promising to do a lot of different things.

Dr. Megan Billow:

There are lots and lots of supplements, and I've had patients bring them in, and it's literally is called a fibroid shrinkage medication. And, you know, what I always say to patients is, if it makes you feel better or it's helping you, that's great, but we can only go based on, like, what our data and our research shows and just be very careful with over-the-counter supplements and choosing what is best for you.

Dr. Erica Newlin:

So we've covered treatment and lifestyle changes, but what happens as women approach menopause?

Dr. Megan Billow:

So as women approach menopause, what is happening is a change in our hormones. And I think it's great that there is more awareness and more research that is being placed on perimenopause and the menopause timeframe of a woman's life. And what we know that fibroids can be impacted or are impacted by hormones. And as these hormone levels are changing or decreasing, we can also see some changes in bleeding patterns as well as potentially some decrease in size of fibroids.

In menopause, the hormone levels are lower and the fibroids essentially are not being stimulated further and they can get smaller. However, if you've got a really large fibroid that decrease in size is not going to be substantial. It's not going to essentially make any symptoms improve. So we are cautioning and don't like to say, "Wait till menopause, everything will be great,” because there are options, there are interventions that we can provide sooner.

Dr. Erica Newlin:

I think a lot of the time when we find fibroids, regardless of how symptomatic someone is, they're worried about these masses on their uterus and worried about their growth. And what do you usually recommend for patients as far as monitoring and surveillance?

Dr. Megan Billow:

That's the benefit of having your routine yearly annual visits with your Ob/Gyn provider because they can evaluate and do exams to see and monitor the potential impact of fibroids from both a symptom standpoint as well as a growth standpoint. While most and the majority of fibroids are non-cancerous, there are a small percentage of fibroids that are cancerous, but oftentimes are seen in older patients or fibroids that develop after menopause or that cause heavier symptoms in older patients. And so while fibroids are often referred to as tumors or growths or things like that, which can be scary words, the takeaway message is that they're really, the majority of them are non-cancerous, and if they are not causing any symptoms, they really, you don't have to do anything about them. However, it is important to have that established care and be presenting and having your yearly evaluations to ensure that nothing is changing and that we can help with any symptoms that you might be having.

Dr. Erica Newlin:

Great. Well, fantastic. We've covered a lot. We've covered what fibroids are, how they affect women and what can be done. Let's wrap up with some advice for anyone listening who's dealing with fibroids. What's your takeaway message for them?

Dr. Megan Billow:

The takeaway message is really that heavy bleeding and pain symptoms, anything that is impacting your day-to-day, it's not normal. You don't have to live like this, these symptoms, you're not making these symptoms up. And we do have a lot of options to really improve how you're feeling, improve the heaviness of the bleeding, improve any pain or pressure symptoms that you're having. It's okay to speak up for yourself. It's okay to say, "I'm having these symptoms. I think something's wrong." And seek out care and there are options and we can help you and you can have a better quality of life.

Dr. Erica Newlin:

Great. Well, Dr. Billow, thank you so much for joining me on the podcast today.

Dr. Megan Billow:

Thank you so much for having me.

Dr. Erica Newlin:

For more resources on uterine fibroids, visit clevelandclinic.org/fibroids. If you found this episode helpful, subscribe and share it with a friend. Remember, your health matters and understanding your body signals is the first step to living your best.

Thank you for listening to this episode of Ob/Gyn Time. We hope you enjoyed the podcast. To make sure you never miss an episode, subscribe wherever you get your podcast or visit clevelandclinic.org/obgyntime.