Scott Webb (Host): Fibroids are common for women and there are a lot of treatment options, both surgical and non-surgical. And joining me today to tell us more is Dr. Megan Cesta. She's a Pelvic Health and Gynecologic Surgeon at Summa Health.

 This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb.

Dr. Cesta, thanks so much for your time today. We're going to talk about fibroids. All things fibroids today. So let's start there. What are fibroids and where do they develop?

Megan Cesta, MD: Fibroids are a collection of smooth muscle. They grow in the uterus and they can grow in the cervix and sometimes in the immediately surrounding tissues. They're a very common finding. They occur in 40 to 80 percent of women during their reproductive years. They're overwhelmingly benign or non-cancerous findings.

Host: All right, so they are common. That's good to know. And do you know what causes fibroids?

Megan Cesta, MD: That's a good question. I wish we knew exactly what causes fibroids. As far as we know currently, it's kind of a complex genetic situation that's involved in the development of fibroids. We do think there are some hormonal influences as well, but for the most part, we still really don't know exactly what can cause someone to develop fibroids.

Host: Yeah, because I was going to ask when you think about, you know, which females are at higher risk of developing them. Well, is it family history, genetics, hormones? Is it all the above?

Megan Cesta, MD: You are absolutely correct. It's all the above. We know that there are some things that can put patients at higher risk of developing fibroids. Some of those things would be like a higher BMI or clinical obesity, something we call nulliparity, meaning not having children before, or even a family history of fibroids can put you at higher risk.

We know that they also disproportionately affect Black women, and they're more likely to develop fibroids and undergo treatment for them. There are some things that put women at lower risk, though, and those are things like long term use of contraceptives and an increased number of pregnancies throughout their lifetime.

Host: All right. So it is possible to lower the risk a little bit. And are there some, let's say common myths about fibroids that are just sort of out there and you want to dispel them?

Megan Cesta, MD: Oh yeah, there are so many myths about fibroids and they're kind of pretty prevalent in society today. One of the most common myths is that all fibroids are symptomatic or need treatment. We know, in fact, we've already discussed how common they are, and not all fibroids cause symptoms or problems, and not all fibroids need treatment.

Another really common thing that we'll see is patients feel that hysterectomy is the only treatment option. Since fibroids are so common, we're constantly developing new techniques and ways to treat them that would allow patients to keep their reproductive organs. And so hysterectomy is not the only treatment. Additional myths would be that we can predict how fibroids grow or how fast they grow. We used to think that fibroids grow kind of regularly or in a fashion called linearly, where we can predict how fast they grow. And further research has kind of shown that fibroids actually grow in spurts, and it's really hard to predict from year to year how quickly these fibroids will grow.

Host: Yeah. And you mentioned there that one of the myths anyway, is that they always have symptoms. So they are common, but they may not always have symptoms, but what are some of the symptoms when there are symptoms, if that makes sense?

Megan Cesta, MD: Yeah, that makes perfect sense. A lot of the symptoms of fibroids depend on how big they are and where exactly they're growing. There's multiple different layers in the uterus and fibroids can grow in any one or any multiple layers, and based on that, they can cause different symptoms. Most symptoms appear during a woman's reproductive years, and the most common would be heavy bleeding, for example.

If a fibroid kind of grows near that inside lining of the uterus, it can cause significant alterations in your bleeding pattern. Patients can even exhibit low blood counts or have something called anemia. If the fibroids grow kind of deeper in those layers in the muscle of the uterus, fibroids can cause cramping with your periods, or they can even cause pelvic pain.

The larger they can grow, because they can grow anywhere from, you know, the size of a bean all the way up to larger than a grapefruit or something. The larger they are, they can cause something we commonly refer to as bulk symptoms. These are symptoms just like associated with a heaviness in the pelvis, or maybe even alterations of your bowel or bladder habits, because it's almost like something you know, it was very heavy is sitting on your pelvic organs. And then additionally, they can cause difficulties during reproductive years, becoming pregnant, or sometimes maintaining a pregnancy.

Host: And is it just a patient history and physical exam in terms of diagnosis, or is there more that you do?

Megan Cesta, MD: There's a lot more that we can do. Initially, patients may present with symptoms that would initiate a workup, so symptoms like we talked about with either difficulties with pregnancies, or heavy bleeding, or even that pelvic pain. And based on our exam, oftentimes we can examine how big the uterus is, and that will allow us to have a suspicion to work up any diagnostic imaging for fibroids, and we most commonly use initially is an internal pelvic ultrasound to diagnose fibroids within the uterus or cervix.

Host: All right, and you, we were dispelling some of the myths earlier, and you said that, you know, some folks out there believe that, well, if you've got fibroids, we go right to hysterectomy. And you dispelled that, of course, and that is not necessarily the case. So what are some of the ways in which women, females can manage the symptoms of fibroids?

Megan Cesta, MD: Yeah, a lot of it depends on the severity of the symptoms and what type of symptoms you're having. So for heavy menstrual bleeding, we can do very conservative measures, certain things like lifestyle or diet changes, can help decrease the level of menstrual bleeding, and sometimes that's enough. That's enough symptom relief for a patient, and they're okay with that. If patients have anemia or low blood counts, we can supplement that with iron supplementation, but that doesn't always resolve the problems caused by the fibroids. There are many different types of medications, most of which are geared towards altering our hormones, and that can help with the bleeding patterns and sometimes shrink those fibroids.

What we know is the medications and surgical treatments don't always make the fibroids go away. So we do need to kind of continue monitoring for those fibroids throughout a patient's lifetime.

Host: Yeah, so it does sound like a bit of monitoring and maintenance and maybe some will get to the surgical end of things. So let's talk about that. What are some of the latest advancements in the surgical treatment for fibroids?

Megan Cesta, MD: There are multiple different options for treatments for fibroids. As we spoke earlier, not every woman needs to have a hysterectomy for fibroids. That certainly is the most definitive option. Once patients have a hysterectomy, that does remove the uterus, most commonly the cervix and the fibroids. And it's an extremely low likelihood of ever having fibroids coming back after that. So we tend to call that definitive management. There's more conservative surgical options. If patients are still planning on having children in the future, the most common and approved method for treating that is called myomectomy. There are a couple different ways to perform myomectomy, but that means that your surgeon will either go in through the uterus from down below or through the belly through most commonly a laparoscopy to remove those fibroids, again called a myomectomy.

And then there are some organ sparing procedures. This is called radiofrequency fibroid ablation. This is a procedure that can be done transcervically or through the cervix, or it can be done laparoscopically through the abdomen. Basically, we have instruments and we're ultrasounding the fibroids as we're doing surgery. We advance our instrument into the uterus and we're able to essentially heat it up from the inside out. This allows your body to recognize the fibroids and over a course of time, it kind of resorbs that fibroid and it can allow them to soften and shrink, which can really help reduce symptoms.

Host: Yeah, so medications, some surgical options, hysterectomy, maybe in the worst case scenario. Just want to finish up here, just final thoughts, takeaways from you

for women who may be suffering and may be suffering in silence or not so silent, but either way, if they're suffering, if they think they've got fibroids, how do we get them in the office?

Megan Cesta, MD: That's a great question. That's the aim of our treatment teams. You know, as providers, we want to be able to meet with patients and discuss kind of what their life goals, what their symptoms are, what's affecting their life. So I would encourage patients, you know, that every patient and every fibroid is unique. It's not one size fits all, and to really have that open dialogue with your provider about what possible options may fit your lifestyle and your symptoms the best, because oftentimes we can align those goals and really help patients have successful outcomes while we're treating their fibroids.

Host: Yeah, I love that. We're just all so different and one size is rarely going to fit all of us. So great to you know, understand what you do and how you do it and how you can help folks today. Thank you so much.

Megan Cesta, MD: Thank you for having me.

Host: And for more information about Summa's Pelvic Health Care, visit summahealth.org/pelvic. And if you enjoyed this episode of Healthy Vitals, we'd love it if you'd leave us a review. Your review helps others find our educational content. I'm Scott Webb. Thanks for listening, and we'll talk again next time.