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Maggie McKay: Fibroids are nothing to ignore. Today, Dr. Holly Miller will tell us all about new technology for fibroids in Tackle the Fibroid, Protect the Uterus. Welcome to Top Docs. I'm Maggie McKay.

Dr. Miller, thank you so much for being here today. I have a lot of questions. But first, can you please introduce yourself?

Holly Miller, MD: Hi, Maggie. Thank you for having me today. I am Dr. Holly Miller, a board-certified obstetrician-gynecologist, and I practice in the beautiful town of Naples, Florida.

Maggie McKay: Oh, beautiful. That's where my brother lives. It is beautiful.

Holly Miller, MD: It is.

Maggie McKay: To begin, what are fibroids?

Holly Miller, MD: Fibroids are benign tumors of the uterus. They are extremely common, affecting 50% to 60% of women, but a little bit more common in women of African American descent. They can be discovered at any age. But the older we get, the more common they are.

Maggie McKay: And what are some of the symptoms of uterine fibroids?

Holly Miller, MD: Fibroids can be small and relatively asymptomatic. Depending on where they're located, even the small ones can cause symptoms such as heavy menstrual bleeding or pelvic pain, increased pain associated with menstrual periods. They can affect the bladder causing urinary frequency or affect the bowel causing constipation. If they're large enough, they may be felt during sexual intercourse or may cause problems with infertility. So, there is a wide range of symptoms that can affect women of all ages.

Maggie McKay: And Dr. Miller, is there a way to protect the uterus and still treat fibroids?

Holly Miller, MD: Absolutely. There are so many treatment options available and new ones have come online very recently and that's what I'm excited to share today.

Maggie McKay: Can you tell us about the Acessa procedure to start with?

Holly Miller, MD: Absolutely. This is one of the ones that I am most excited about. Acessa is a laparoscopic radiofrequency ablation of uterine fibroids. Now, that's a lot of big words. Acessa has been available for more than 10 years, but not widely available. It's really only been in the past two years that we've been able to match the technology with insurance coverage. And so, I've been able to offer this procedure here in southwest Florida for over a year. It is much different than our prior surgical options in that I go in laparoscopically, so just two small incisions in the abdomen. I place an ultrasound into the abdomen through one of those incisions. With that ultrasound active, I actively find all of the fibroids that are in that woman's uterus. Each fibroid is then targeted with a thin needle and heated to over a hundred degrees Celsius. And so, that's the radiofrequency part of it.

Acessa works by shrinking the fibroids, so each fibroid is treated individually. Over the course of a few months to follow the surgery, the fibroids shrink by about 50 to 60%, significantly improving my patient's symptoms.

Maggie McKay: That is amazing, when you look back just a few years ago. What about the MyoSure myomectomy?

Holly Miller, MD: Right. So, fibroids come in a variety of different locations, and so we use these different technologies and different modalities based on where the fibroids are located. So for fibroids that are mainly on the inside of the uterus, really affecting that part of the uterus that we need for pregnancy and the fibroids that are going to cause the most heavy menstrual bleeding, we can target those with an outpatient hysteroscopic approach. Hysteroscopy means placing a very small telescope directly into the uterus. This is a surgical procedure that I do in the comfort of my office, so my patients are awake and the surgery takes 10 to 15 minutes.

So, I place a small camera into the uterus. I can visualize the fibroids that are there within the cavity of the uterus and then shave out that fibroid through a directed visualization and using a device, specifically the Myosure device, so that's the name of the technology that I use. And it is a full tissue removal device, so it shaves the tissue, completely capturing all of that pathology, so that we know that everything that I take out goes directly to the pathologist to be evaluated.

Maggie McKay: And what are some of the other treatment options? Because there are a few.

Holly Miller, MD: There are. So, we talked very briefly here about Myosure, which is a hysteroscopic myectomy. In our more traditional approaches for fibroids, which have been available for many years, most women would be presented with options of an abdominal or laparoscopic myomectomy. A myomectomy is a much more involved surgery than what I described with Acessa.

To do a myomectomy, the uterus has to have an incision made on it. The fibroid is then shelled out, sort of opening the uterus, making a small incision on that uterus, removing as many of the fibroids as are present and then closing the uterus with multiple layers of suture. While myomectomy has been available for many years, the recovery is much longer than with our new Acessa procedure.

Of course, there are medications available that can temporarily shrink fibroids. For some women, this is an appropriate choice prior to surgery or if they're not a surgical candidate. And there are other women that would consider a full uterine artery embolization where they would treat the entire uterus. But in my practice, I prefer to target the problem directly by targeting the fibroids themselves with a directed myomectomy or Acessa technology.

Maggie McKay: And not to overshare, Dr. Miller, but I will say, years ago, I had a five-pound fibroid, which is pretty big, I think. And I didn't even know it until I went in for my annual checkup. So, I'm only telling you this because I'm thinking today's treatments and recovery have to be easier than it was then, because my doctor said, you know, it's going to be a harder recovery than a C-section. It's going to take about six months. And it did, and I was young. So, how is recovery now? And how does someone even know if they have fibroids and whether or not they need treatment?

Holly Miller, MD: Well, Maggie, thank you for sharing that. That takes a lot of bravery to share that in this very public setting. But what a reminder that we sometimes don't even know what is happening inside of our body. Five pounds is quite large and I bet there was a concern that it was a cancer, and I'm thrilled that you had such great outcomes.

With our newer surgical treatments, we are able to get our patients back to work, back to life, back to all their normal activities fairly quickly. My patients that are choosing Acessa technology are choosing it because I let them return to almost all of their activities within five days of surgery. That is amazing. Most women that I take care of say things like, "Dr. Miller, I have children and a significant other and an important job, and I don't have time for an involved surgery." And so, Acessa is a great option to improve their symptoms, but still get them back to their normal lives as quickly as possible.

Maggie McKay: And are there any risks to surgery?

Holly Miller, MD: Well, there's always risks to surgery and we never undergo surgery lightly. I like to tell all of my patients that risks can be anything from bleeding to developing an infection. If we're doing it laparoscopically, the intestines in the bladder sit right around the uterus, so there's always risk of damaging those. And risks are small with surgery, but they're never zero. And so we have to choose appropriate patients and use appropriate caution, and encouraging women to choose a skilled surgeon is all important to maximize that recovery.

Maggie McKay: What are the chances that fibroids will return after treatment? I know they used to say 50%, which I thought was pretty high. Is that still the case?

Holly Miller, MD: I think 50% is pretty high. We have to consider what surgical treatment that we're doing. In the case of a myomectomy, the goal is for the surgeon to physically remove all of the fibroids that are present. With Acessa, I am doing live action ultrasound in the operating rooms, so I should be treating every fibroid that is already present in that uterus. But for a woman that is predisposed to growing fibroids, she can always grow them again in the future. So, I probably would quote that number a little bit lower, maybe at 20%, but percentages are relative. It depends on a woman's age, and it, you know, depends on so many different factors.

Maggie McKay: Is there any way to prevent getting them?

Holly Miller, MD: That we know of, there is no way to prevent uterine fibroids. There is a slight genetic predisposition to getting them, so they may be seen if your mother had them, then you might be at an increased chance of getting them. But overall, we don't really understand why some women develop these and other women don't. But remember, I've already said 50% of women are going to have fibroids at some point in their lives. So, it's important to be aware that most of us are at risk and we need to let our gynecologist or our doctor know of any symptoms, so that an ultrasound can be done and appropriate treatment discussed while they're still small. We sure don't want to wait until they're five pounds.

Maggie McKay: Yeah, you're not kidding. And go for those yearly checkups because like I had no idea. And if I hadn't done that, it could have gone south fast. Dr. Miller, will fibroids affect childbearing and pregnancy?

Holly Miller, MD: Yes, infertility is a huge risk factor with fibroids. That really depends on the location of the fibroids. If the fibroid is within the cavity or within the inside of the uterus, it can affect the ability to get pregnant, increasing the chance of infertility completely or an early miscarriage. Larger fibroids that are in the wall or the body of the uterus can grow significantly during pregnancy and may cause things such as preterm labor or preterm delivery. Sometimes they're large, but very low in the uterus. And in that case, they might block the safe passage of the baby for a vaginal delivery, increasing the chance of a C-section. So, I've seen numerous complications from the presence of fibroids in my patients.

Maggie McKay: Is it common to find endometriosis in the uterus while you're doing surgery for fibroids?

Holly Miller, MD: There isn't a specific known link between fibroids and endometriosis. However, whenever we're doing a laparoscopy or any type of a gynecological surgery, I'm always looking for evidence of endometriosis. Endo is a disease that also causes similar symptoms such as pelvic pain. Many women have no idea that they have it. And when I'm doing a laparoscopic surgery, I can safely remove all evidence of that endometriosis at the same time. So, we started the surgery for fibroids and ended up treating two different things, contributing to my patient's pelvic pain and other symptoms and, hopefully, improving her overall health and life for many years.

Maggie McKay: Well, this has been so fascinating and informative and hopeful, especially comparing it to a number of years ago and how far treatment options have come. This is so great to hear. Is there any takeaway you'd like listeners to know before we wrap it up?

Holly Miller, MD: I think it's important for women to know that there are new and different surgical techniques. And if they have fibroids, they need to be specifically asking their doctor what treatment option they will perform. Myomectomy is not the same for each of us as surgeons. And again, Acessa is new. There is still a limited number of gynecologists across the country offering it. It is exciting, it is transformative. And I am so excited to have been able to bring it here to Southwest Florida in the past year.

For anyone listening that's outside of the southwest Florida area, there are Acessa surgeons across the country and I know that my colleagues would be happy to speak with women about how we can help them.

Maggie McKay: Dr. Miller, it's been a pleasure talking with you and learning all about fibroids. Thank you for joining us today and sharing your knowledge and your expertise. If someone would like to make an appointment with you or just find out more, where would they go?

Holly Miller, MD: Absolutely. It's been great to be here today. My website is AWP Naples, that stands for A Woman's Place, wpnaples.com. On the website, you can find all of my contact information and also videos about Acessa and Myosure.

Maggie McKay: Thank you so much. If you found this podcast helpful, please share it on your social channels and check our entire library of podcasts for topics of interest to you. This is Top Docs Podcast. I'm Maggie McKay. Thank you so much for joining us and be well.