Jamie Lewis (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future.

Today, I'm sitting down with Novant Health obstetrician and gynecologist, Dr. Jaleema Speaks, to talk about uterine fibroids. Before we get started, Dr. Speaks, I'd love to know how OB-GYN care became a passion of yours. What made you decide to become a physician?

Jaleema Speaks, MD: Ever since I was little, I had interest in caring for people and wanting to make people feel better. My grandmother, growing up, used to be an instructor of yoga as well as Lamaze. And so, I was around pregnant women often at a young age and learned so much from how she guided and cared for them. And even though she's passed away, sadly, her legacy lives on through the care she was able to give generations of women through their pregnancies.

Host: That's quite a legacy. Well, we're here to talk about uterine fibroids. What are they exactly?

Jaleema Speaks, MD: So, uterine fibroids are benign or non-cancerous growths that occur in different locations in the uterus. They can occur near the lining, in the lining, in the muscle, or in the outer layer of the uterus called the serosa.

Host: You said already, first thing, they're benign, but I do want to know, are they something that a woman should worry about at all? Do women have symptoms when they have uterine fibroids?

Jaleema Speaks, MD: That's a great question, Jamie. So, the symptoms that a woman may experience can range from no symptoms at all, and occasionally they can be detected incidentally when we're doing imaging, looking for other things. But depending on their size and/or location, they can have a range of symptoms from pelvic pain, pelvic pressure, heavy periods. Sometimes, depending on how big they are, because sometimes they can grow to the size of grapefruits, that can put pressure on other neighboring organs, such as the bladder or the bowel. And so, sometimes women may experience changes in bathrooming habits or pain with intercourse even, because of the size and location of uterine fibroids.

Host: What should a woman do if she suspects that she has one?

Jaleema Speaks, MD: Hopefully, and I would like to encourage all women to continue to engage in their health care, and to include an obstetrician and gynecologist as part of their health maintenance and wellness. And because uterine fibroids can sometimes be detected with regular pelvic exams, but anytime there's a change in what we experience in terms of pelvic pain or abnormal bleeding, those are certainly symptoms that we would want to investigate further to ensure that we're ruling out cause of those symptoms as being uterine fibroids. So, absolutely, if there are any concerns, to reach out to your OB-GYN. But also, hopefully, continue to receive that annual health maintenance and preventative care.

Host: Right. What's the traditional treatment option for fibroids?

Jaleema Speaks, MD: Traditionally, hysterectomy was first line, and referring to hysterectomy as removal of the uterus surgically, which is quite a challenge for women who want to maintain reproduction or fertility. Historically, there has also been a surgery called myomectomy, or a surgical removal of the fibroids with the goal of keeping the uterus in place and repairing it after removal of the uterine fibroids such that pregnancy is still an option and fertility can be spared.

Host: Well, I understand there's a new treatment option. Can you explain what radiofrequency ablation is?

Jaleema Speaks, MD: Yes. Excellent. Radiofrequency ablation is not necessarily new in its technology. It's used in other health specialties such as cardiology, and we've used it in gynecology to help address heavy bleeding. But a newer modality or use for this modality, I should say, is either through transcervical treatment of uterine fibroids using radiofrequency ablation or laparoscopic, using small incisions through the abdomen to administer radiofrequency to fibroids with the goal that, after these treatments, the uterine fibroids decrease in volume and they also can change in their texture.

So, sometimes uterine fibroids can feel very rubbery and dense and hard and firm. And over time, after treatment with radiofrequency ablation may feel more soft like a marshmallow, more compressible. And that's why it can help with both the bleeding and the pain or what we call bulk symptoms from larger fibroids.

Host: Do all women qualify for this kind of treatment?

Jaleema Speaks, MD: I think it's a great option to review with your gynecologist. And to determine who would be a good candidate would require reviewing some imaging, so making sure we have good ultrasound. These treatment techniques are for premenopausal women, so women who are still having their menstrual cycle. And that's mainly because fibroids after menopause, or after we stop having regular period, roughly in our early 50s, because of those hormone changes, uterine fibroids typically start to get smaller and become less symptomatic after menopause. But certainly, this is a great option for uterine preservation for women who are interested in preserving their uterus or getting back to their day to day life and activities, with a recovery that's a little bit different than a hysterectomy.

Host: What's the most common question you receive about this kind of treatment?

Jaleema Speaks, MD: I think, in general, what to expect during the recovery course. And often, the women who express the greatest interest in these treatments are women who are very active and very on the go. And some of the recovery time that may be associated with more traditional kind of historically what we've used measures. They're interested in getting back to their day to day activities much sooner than typically we would advise for something like a hysterectomy or an abdominal myomectomy.

Host: You already touched a little bit about on the benefits of RFA, but can you detail that a little bit further? What are those kinds of benefits of this treatment?

Jaleema Speaks, MD: Certainly. So, unlike a hysterectomy where immediate changes are noticed because an entire organ is removed, the spectrum of during healing of what women may experience may take time, but we usually offset that with ongoing medical management. But because of the changes that happen over time, pain is usually very minimal. People don't need strong pain medications for long durations of time. Their activity restrictions are not quite as long. So, we have many women getting back to the office, for example and back to work. workouts and whatever physical activity for enjoyment in a shorter period of time than abdominal procedures and hysterectomy.

Host: Excellent. Well, what are the risks of RFA?

Jaleema Speaks, MD: For most surgical procedures, we think of risks in a couple broad categories. And one is bleeding. And just because the uterus and typically fibroids have large blood vessels that supply them. And whenever we're operating or introducing small instruments near those blood vessels, there's a risk of bleeding more than anticipated. But I would say that it's very rare for this procedure and typical blood loss is minimal. We always are mindful about infection, especially when we have an approach in a part of the body such as the abdomen or within the uterus, where there's normally not bacteria, wanting to reduce the risk of introducing bacteria to those areas. So, they're very specific precautions and safety measures to reduce the risk of infection. And then, we always want to be mindful of surrounding structures to the target organ. So in the pelvis, we have our bladder, we have blood vessels, nerves, as well as our digestive system, intestines.

So, the good thing about, Both types of radiofrequency ablation is that they use ultrasound guidance as well as visualization. And so, that's an added safety measure to make sure that we're not near any of those other structures that we want to avoid.

Jamie Lewis (Host): Well, I know it's still a relatively new treatment option, but are you seeing good outcomes so far?

Jaleema Speaks, MD: Yes, I must admit when one of my earliest patients who had an ablation done, when I saw her maybe two weeks post operatively and doing an exam, I was surprised quite honestly at the texture of what the fibroids felt like on exam. Fibroids again can feel very dense and hard almost like a softball. But postprocedure, her uterine fibroids felt much more compressible. And so, there's almost a lightening in the pelvis-- lightening, like feeling less burdened, less pressure-- that women may experience, as well as a reduction in the bleeding. We typically see peak results come at three months in terms of reduced bleeding, but there can be ongoing improvement through that first year after these procedures.

Host: Well, thank you, Dr. Speaks, for joining us today.

Jaleema Speaks, MD: Thank you so much for having me, Jamie.

Host: Once again, that was Dr. Jaleema Speaks. To find a physician, visit novanthealth.Org. For more health and wellness information from our experts, visit healthyheadlines.org. And thank you for listening.