Joey Wahler (Host): They can cause health complications. So we're discussing Uterine Fibroids. Our guest is Dr. Gamilah Pierre. She's an OBGYN with Silver Cross Hospital. This is Silver Cross Hospital's I Matter Health Podcast, medical experts bringing you the latest information on health topics that matter most to you and your family.

Thanks for joining us. I'm Joey Wahler. Hi there, Dr. Pierre. Welcome.

Gamilah Pierre, MD: Hi. Thank you for having me, Joey. Good morning.

Host: Good morning to you. Great to have you aboard. We appreciate the time. So first, for those unfamiliar, what exactly are uterine fibroids and how common are they?

Gamilah Pierre, MD: That is the best question. Uterine Fibroids are the most common non-cancerous tumor in the uterus. They can grow anywhere in the uterus. They can start off about the size of a blueberry, grow to about the size of an apple, even larger. And I've even taken out fibroids that are as big as eight inches or 15 centimeters, and anybody can get fibroids. About 70 to 80% of women will actually have a fibroid at some time in their life.

Host: So what are some common symptoms here? What are the issues that can arise from this?

Gamilah Pierre, MD: So many things from fibroids. Some of the more common ones are heavy bleeding or bleeding when it's not time to have a period. Pain and pressure, but also symptoms that people don't realize. Constipation, urinary frequency, sexual dysfunction. I've even had patients referred to me with hip pain that had fibroids, back pain.

So fibroids can cause all sorts of pain and problems. Some people are lucky enough to not have any symptoms from the fibroids and they may not need to have anything done, but anything can be related to fibroids. Leg pain.

Host: Leg pain even? Interesting.

Gamilah Pierre, MD: Yes, actually, yes.

Host: Okay. So are certain women more likely to develop fibroids than others?

Gamilah Pierre, MD: So, as I mentioned, fibroids are very common throughout all ethnic groups. African American women are higher risk of having bigger fibroids and having more symptoms. But I see all ethnic groups affected by fibroids. They do have a preponderance for age. So as we get older, genetics, family history, certain estrogen levels, those may make us more at risk for fibroid development.

Host: So if it's suspected that they're present, what kind of testing or exams are typically in play to confirm the presence of fibroids?

Gamilah Pierre, MD: Right. So the first thing I do is get good history, talk to the patient, see what kind of problems they're having. They may not even realize they're having problems until I start asking certain questions. Then we do a physical exam because some fibroids, are very obvious. Patients think that they look like they're pregnant or they think they're just fat or have a big midsection, and really what they have is a fibroid.

To confirm the test, I often will order a pelvic ultrasound. So those are no type of x-ray with the ultrasound. So very easy test to do to look for fibroids. And then every now and then I actually get an MRI to do more confirmation. So those are the most common ways of us diagnosing fibroid tumors.

Host: Gotcha now some women live with mild symptoms of this for years. So how do you know when it's time to get checked or treated? Where's the line there?

Gamilah Pierre, MD: Right. So my point for that is if you're just having regular discussions with your family medicine doctor, internist, or your gynecologist, because some of the symptoms are hard for people to even recognize that it may be a fibroid. But if you have a lot of fatigue, you may be bleeding more than you realize is normal, and your body is not accommodating that. You're becoming anemic, or you may not realize that those urinary symptoms are really related to fibroids.

So my opinion is having regular exams and discussions with your doctor allows you to figure out if something's going on that you may not have even realized there was a problem. But a lot of women are completely asymptomatic, and if they're small and not bothersome, they don't have to be treated.

Host: All right, so what are the current treatment options, speaking of treatment that are available from medication to surgery, and how do professionals like yourself decide what's best in each case?

Gamilah Pierre, MD: So what I decide is when a patient comes to me and we figure out that they have fibroids, my next question is, what are your goals? I need to understand, are they trying to get pregnant? Are they trying to have improvement of their urinary symptoms. So what are their goals? Then, I like to ask them are you interested in keeping your uterus?

Because we have certain things that are uterine sparing. Some patients don't need anything. Then we talk about nutrition, green tea extract, vitamin D, antioxidants. Those can all help to slow the growth of fibroids. Then we talk about medication. Some people will just need a birth control pill, or sometimes even something simple like ibuprofen.

There are also medications on the market that are geared toward fibroids. So based on what their goals are, based on their symptoms and based on their overall presentation, then I guide them. Then we talk about procedures. I call them uterine sparing procedures first. My radiology colleagues have something to offer called uterine fibroid embolization, and they are able to shrink fibroids through an incision in the groin and injecting some particles into the blood vessels. Then we talk about the ways that I as a gynecologist, can shrink the fibroids. I'm really happy to announce that Silver Cross has partnered with me and Hologic to bring something called Acessa and Sonata.

Those are ways of shrinking fibroids through radio frequency ablation. It's some newer technology, so I'm really excited that we have that at Silver. Then we talk about robotic surgery. That's something that I really is near and dear to my heart. Minimally invasive ways of shrinking or removing or cutting out the fibroids.

And some people will elect and some people will need a hysterectomy. And again, we do that through robotic technology. So we're using very small incisions. So we get patients home the same day. Some of these large fibroids, I'm able to send a patient home the same day when we have to do major surgery.

Host: I was going to ask you next about some of the newest or most promising advances in treating this. You mentioned robotic surgery, which seems to be touching just about every branch of medicine these days, right? As well as that radio frequency scenario too. Anything in addition to that or maybe you want to delve more into one of those in particular must be exciting when you get your hands on new technology to help people.

Gamilah Pierre, MD: Yeah. I'm actually really happy that we're able to offer patients so many options, and we really tailor it to them. I have to tailor it to each patient because every patient's different. Their lives are different. What they need from their life, how fast they can, they need to get back to work.

So some of the radio frequency ablation options, the one that I mentioned, Sonata, which is through the vagina, those patients can go back to work the next day. They actually go back to work the next day. Some of the laparoscopic and robotic technologies they may need about a week or so off from work depending on how extensive what we have to do.

But it's really exciting to be able to have somebody come in with all these symptoms and allow them an opportunity to do something that may take an hour and get them back on their feet, where they're not missing a lot of work. Some people need more extensive surgery than that, but even those patients get, with the robotic technology that you mentioned, they're still back to work in a couple of weeks.

That's very different from what we had years ago where you were outta work for two months and in the hospital for a week. I mean, this is a game changer for patients. They don't have to suffer in silence anymore.

Host: Yeah, it's really pretty incredible how many procedures nowadays, get people home the same day or the next day. That years ago, not the case. Right.

Gamilah Pierre, MD: Exactly. And also their infection rate is less. The amount of bleeding. We do some of these large cases and patients may have a teaspoon of blood. I mean, that's crazy when we think about how much blood can happen in these major cases like that. So to be able to offer them minimal infection, minimal bleeding, home same day or next day and back to work in a couple of weeks, it is really impressive to me.

Host: Absolutely. Now, since you are an OBGYN, how about fibroids affecting fertility or pregnancy of course? And what options are available for women who want to preserve that fertility?

Gamilah Pierre, MD: So when a woman is definitive about using the uterus for fertility, really the main option that we have for her is a myomectomy, which is where we actually cut out the fibroid itself. The other techniques are having a lot of promising results that we will be able to use those with people who want to keep their fertility.

Right now we're not sure about the long-term fertility. So if someone's definitive about that, then we have to cut out the fibroid. It can affect how somebody gets pregnant. It can affect things like preterm labor and contractions, but it all depends on the size and the location. With fibroids, location, location, location. Some fibroids for instance, a fibroid that's sitting on top of the uterus here may not be an issue at all. A fibroid that's in the wall here can cause my patient a problem. So it really depends on where they are, how big they are, how they affect fertility going forward.

Host: All right. Couple of other things for you. How about lifestyle habits, diet, exercise, stress management that can help reduce symptoms or risk here?

Gamilah Pierre, MD: Right. Well, as I briefly touched on, nutrition has really got some promising, input with fibroids. And so what I'm saying to my patients is when we have to treat the fibroids, then I'm aggressive about checking their vitamin D levels and putting them on vitamin D supplements so that new fibroids are not coming back, or that fibroids that we had to leave behind are not growing.

We know that antioxidants play a role. We know that antioxidants and stress play a role, so anything you can do to reduce your stress level. Antioxidants, my same blueberry here, a great antioxidant, has a role in treating fibroid. The most exciting thing about fibroids right now is green tea extract.

And I'm actually, was in Korea not too long ago and hoping to travel to Japan to see some of the green tea farms to try to bring that back so that patients can use green tea extract. We don't know exactly how it works. It's probably similar to antioxidants and it's probably not as simple as drinking a cup of green tea, but, we see some great studies out that show that green tea extract is actually keeping the fibroid growth at bay.

Host: All right. And then in summary here, doctor for women joining us who may be struggling with fibroid symptoms, what would you say is the one thing you want them to take away here?

Gamilah Pierre, MD: I want them to not be afraid and know they have options. I think women in the past hear fibroids and they think, oh, I have to have a hysterectomy, or they hear, Oh, it's fine. You know, that's just what women go through. I want them to understand it's not okay. They have options. Hysterectomy is not the only option. It's not a bad option if you need that, but they do have options.

Host: Well, doctor, I can tell you I've interviewed a lot of people over the years. You're the first one ever to use a blueberry during the interview for not one, but two completely different purposes. How about you? Tremendous stuff. Great job in using that seriously to help illustrate what you're trying to get across here, right?

Gamilah Pierre, MD: Perfect. Thank you.

Host: Absolutely. Well, folks, we trust you are now more familiar with Uterine Fibroids. Dr. Pierre, really a pleasure. Keep up all your great work. I hope we can do it again, and thanks so much again.

Gamilah Pierre, MD: Okay. Thank you for having me.

Host: Absolutely, and for more information, please visit silvercross.org/fibroids. If you found this podcast helpful, please do share it on your social media.

I'm Joey Wahler and thanks again for being part of Silver Cross Hospital's I Matter Health podcast.