Dearest: My guest tonight, Michael S. Broder, M.D., M.S.H.S., is an assistant professor of obstetrics and gynecology at the UCLA School of Medicine. He has extensive research training and has served as a consultant to the RAND Corporation (a research think tank in Santa Monica, CA) since 1996. Dr. Broder has earned a listing in Who's Who in America, 2001. He is a frequent public speaker on women's health issues. Dr. Broder has also studied the overuse of hysterectomy to treat gynecologic problems. Dr. Broder is on the board of the National Uterine Fibroids Foundation, a group dedicated to helping women with uterine fibroids. Dr. Broder and Dr. Scott Goodwin co-authored the book, What Your Doctor May Not Tell You About Fibroids: New Techniques and Therapies--Including Breakthrough Alternatives to Hysterectomy It's a pleasure to welcome you to Power Surge, Dr. Broder. Michael Broder, M.D.: Thank you, I'm happy to be here. Dearest: Could you please give us a brief description of uterine fibroids and what causes them? Michael Broder, M.D.: I wish that there was a brief description. Uterine fibroids are benign tumors, meaning that they aren't cancer. They usually grow in the uterus but can grow in other places, as well. No one really knows what causes them, but they are very common. By age 40, about half of all women will have a fibroid that can be identified by ultrasound. Dearest: Are certain age and/or ethnic groups more prone to develop fibroids? Michael Broder, M.D.: Yes, fibroids begin to develop in women in the late teens or early 20s, but it's more common to see women in their 40s with problems. They often grow slowly, and don't cause problems for many years. As far as ethnic groups, African American women are more likely to develop fibroids than Asian or Caucasian women. No one knows exactly why that is. Dearest: I read that 77% of women have fibroids. Does one always experience symptoms with fibroids? Michael Broder, M.D.: I think that the 77% figure might be a little high, but certainly they're very common. They most commonly don't cause symptoms, so it's more common to have fibroids and not know it, than to have problems. Dearest: I understand that fibroid tumors are benign, but do they ever have the potential to become malignant? Michael Broder, M.D.: They cannot become malignant. A fibroid is benign by definition and will always remain that way. A leiomyosarcoma is a uterine tumor which is a very rare cancer. At one time it was thought that fibroids could turn in to this kind of tumor. Sometimes this kind of tumor (leiomyosarcoma) can be confused with a fibroid at an examination. CKrafft: Do fibroid tumors go away after menopause? Michael Broder, M.D.: Probably not. But the symptoms that they cause tend to go away after menopause. They do shrink somewhat and it's possible that the smallest of them will go away, but unlikely that most go away completely. Once the cells are there, they don't usually go away, but the overall size decreases. If the symptoms go away, and that's what really matters. The shrinkage is due to the loss of estrogen and progesterone. PatC: I really don't know very much about uterine fibroids. What problems do they cause? Michael Broder, M.D.: The most common problem is irregular or very heavy periods. Sometimes when fibroids get very big, they can cause a protruding belly or pain. They can also cause infertility. The most common problem, though, is changes in the bleeding pattern. Dearest: What questions do you recommend a woman ask a doctor who has told her she needs to have a hysterectomy to relive her fibroid problem? Michael Broder, M.D.: That's an excellent question! I have lots of women who have been told that they need a hysterectomy, but at least 2/3 don't really need that. The most common mistake that I see doctors making is not to try safer, non-invasive things first. For example, if a woman is having bleeding troubles, there are medications to try first. Dearest: Of the 35-45 percent of hysterectomies performed because of fibroids, why wasn't a myomectomy or the newer, UFE (uterine fibroid embolization) performed instead? Michael Broder, M.D.: That's a very hard question to answer since no one has studied what is happening in the doctors offices. Traditional training for gynecologists is that hysterectomy is the "right" treatment for women who don't want more children. Because fibroids can recur after myomectomy, many gynecologists want to avoid more possible surgery. That completely ignores the fact that many women don't want to part with their uterus. As for UAE, it's not performed widely around the country. Dearest: When was UFE developed and how successful has this treatment been? Michael Broder, M.D.: Many women don't have access to someone who can perform the UFE. Most gynecologists don't refer their patients for UFE, even if there are people close by who could perform it. UFE and UAE are 2 names for the same thing. In UAE, the uterine arteries are blocked or "embolized". UAE is probably the more correct term. UFE is more descriptive and has become a more common way of referring to this procedure. The first use of this technique was in the 1990s. It started gradually and has increased over time. There have now been more than 10,000 women who have been treated with UAE for fibroids. In the first few years, it is very successful, particularly in controlling bleeding. As many as 90% of the women see a dramatic reduction in the bleeding. Dearest: I was surprised to read that this procedure is performed by an interventional radiologists, rather than a surgeon? Michael Broder, M.D.: An interventional radiologist has had training in this technique as well as radiology and knows about injecting a dye or particles into the veins as well as observing where they go or seeing how they react with the body. Interventional radiologist often treat aneurysms in the brain. This is a natural outgrowth of what they do. Surgeons, on the other hand, are trained in procedures actually cutting into the body cavities one way or another. Radiologists are more used to working in blood vessels, rather than cutting. Sadie Joy: What happens to the polyvinyl particles in a UAE procedure? Do they remain in the body or are they flushed out? Michael Broder, M.D.: The particles that are used to block the uterine arteries are made of polyvinyl alcohol (PVA). PVA is a non-reactive substance and doesn't cause irritation to the body. PVA stays in the body forever, like surgical staples. Dearest: What tests are done to discover if a woman has fibroids? Michael Broder, M.D.: Often they can be felt on a physical exam, and that's the first clue. Two of the best ways to confirm are ultrasound or MRI scans. MartieMapp: I just had a sonogram and it showed multiple small fibroids with one large, approximately 5cm. I have had breakthrough bleeding and I'm on hormones. The nurse mentioned the UAE but what do I need to ask the doc about this? How many he has done? by Power Surge. All Rights Reserved.