Scott Webb (Host): Welcome to UK HealthCast, a podcast from UK HealthCare. I'm Scott Webb. And today, we're going to learn about fibroids, the signs and symptoms, and treatment options from minimally invasive gynecologic surgeon, Dr. George Thomas.

Doctor, it's nice to have your time today. We're going to talk about fibroids and fibroids is one of those things where I feel like I sort of know what they are and I've certainly hosted some other podcasts, but I'm going to rely on you, rely on your expertise. So, let's start there. Tell us about fibroids and who's at maybe at the greatest risk or who they impact the most.  

Dr. George Thomas: Fibroids, essentially,I think about them like big muscle balls within the walls of the uterus. They originate from the cells of the muscle within the uterus. So, any woman is at risk for having fibroids. A lot of the times they're there and you just don't know that they're there unless they either start to have symptoms or they're instantly found if you're having a workup for something else and imaging that shows them.

Host: Yeah. So, let's talk about that. You mentioned like you wouldn't know until you know. So, how do you know what are the signs and symptoms of fibroids?

Dr. George Thomas: Some of the common signs, usually it's broken down into kind of two separate categories. One is a symptom of abnormal bleeding, so this could include heavy period flow or it could also include just abnormal timing of your periods as well. The second category is what we call bulk symptoms, where if fibroids get big enough, they can start to put pressure on other organs around them, like the bladder, so that would lead to urinary frequency or going to the bathroom a lot, or sometimes put pressure on the bowels, causing issues like constipation.

Host: Yeah. And I have heard that fibroids are common, but that said, you know, being common, there's also a lot of treatment options. So, let's talk about, you know, how do you decide the best treatment option, when minimally invasive is preferred or indicated more, maybe over a more complex surgery. Take us through that. What are the options for fibroids?

Dr. George Thomas: When it comes to options for fibroids, the way I like to break it down is into three categories. So, there's expectant management as the first category. And what we mean by that is if fibroids are not causing you any issues and you just happen to find them on a CT scan or ultrasound, but overall you're still going about your day to day life without any issues, then you could choose the expectant management route, which is doing nothing at all. And really, that carries no risk whatsoever because fibroids in and of themselves are a benign disease process.

And then, secondarily, the second category would be medical management. So, if you are one of those patients that is having issues with bleeding, we can use certain medications to alter, to help with hormone suppression, to help to decrease bleeding.

And then, third category is going to be your surgical options. There's lots to choose from. And a lot of the decision is based off of, one, the impact that fibroids and the symptoms are having on your lifestyle, how aggressive you want to be, and then the approach is also based off the location and the number of fibroids that you have.

Host: Yeah. And it does seem, doctor, that minimally invasive, that's such a buzz thing in medicine, it does seem like minimally invasive when possible, when the robot's free, whatever, it does seem like that that seems to be the way things are headed, whether it's the gold standard yet or not. Maybe you could just talk about that a little bit, the minimally invasive versus some more complex sort of, I don't know, open surgery.

Dr. George Thomas: Minimally invasive approach, if we're talking about surgery, usually what falls in that category of minimally invasive is either a robotic-assisted or a laparoscopic traditional approach. And we can do many things with minimally invasive approaches. One of those includes a hysterectomy. So, taking the uterus and the fibroids out altogether. And that's very feasible to be done either robotically or laparoscopically. Another is if you want to keep your uterus, let's say you still have fertility goals, things like that, then going in and identifying those fibroids and taking just the fibroid out, leaving the uterus in place, and that can also be done robotically or minimally invasively.

Host: I'm sure, Doctor, that just the awareness of fibroids, just something like this, doing a podcast about fibroids, has helped improve women's health care. Maybe you can address that a little bit, you know, the awareness of it, the treatment of fibroids, how is it helping women?

Dr. George Thomas: It's one of those things in this day and age and in our culture, you know, we're always trying to improve and advance women's healthcare in general. And so, I think, you know, July was just Fibroid Awareness Month, so having awareness months like that for certain specific disease pathologies for our female patients is super important. I think the importance of annual visits with your primary care physician or a local OB-GYN has also helped to raise awareness as well to bring about learning about this information and the treatment options that are out there.

Host: Yeah. And this may be just, you know, purely anecdotal and I may be imagining this, Doctor. But I feel like, first of all, I think we all suffer from things and we should go see our doctors and we don't because I don't know, it seems like a lot of work maybe. But in general with fibroids, I feel like a lot of women probably suffer from fibroids and they just maybe don't speak with their provider or OB-GYN. And if that's true, you know, how do we encourage them to speak up, to seek care, to not let fibroids sort of affect their daily lives?

Dr. George Thomas: I'm a huge proponent of patient advocacy as far as speaking up for yourself when you're in those visits. So often as females, it's very easy to chalk it up, "Oh, heavy period, that's just par for the course, something normal." But don't feel that that's the case, it's always important to ask those questions like, could there be something else that is causing this and having a low threshold to gently request from your provider if they see fit? Imaging, something as simple as an ultrasound. I mean, those are tests that are not very expensive, but they give us a whole lot of information about what's going on with your GYN structures.

Host: Yeah. just want to finish up today and talk about how UK HealthCare is sort of uniquely positioned to help women with their fibroids.

Dr. George Thomas: We have an amazing team here as far as the collaboration that we're working with and the technology that we have to offer. Obviously, from the expectant and medical management categories that I was talking about, that's pretty standard across the country. But at UK, I think surgery-wise, we offer a lot of different options. And what I mean by that is, depending on what your goals are, and how aggressive and invasive you want us to be, that's what we can offer for you.

And some of the things to highlight there, we talked about the laparoscopic robotic approaches to fibroids. That's one arm of surgical options. There's also new technology called fibroid ablation, which we just started rolling out this past year, which is an incisionless approach to fibroid management. And then, we also work with our colleagues in interventional radiology to do fibroid embolization, which is a procedure that they do. So, there's many different ways to attack fibroids. Here at UK we have all those options to lay out for our patients, discuss with them what are the pros and cons of each one and kind of guide them to the best thing that's going to work for their life.

Host: That's great. Well, I appreciate your time today. As I sort of preface, I'm like, "I think I know what fibroids are," but better to ask an expert and get those answers from an expert. And just awesome to hear about all the options, sort of the gold standards and where maybe treatment of fibroids is headed in the near future, if it isn't already here now. So, thank you so much.

Dr. George Thomas: I appreciate it, Scott. Thanks for having me. Have a great day.

Host: And for more information go to ukhealthcare.edu and search women's health. And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate, and review this podcast and all the other UK HealthCare podcasts. I'm Scott Webb. Stay well.