The Fibroid Foundation recently spoke with Dr. Linda Bradley, Director of The Fibroid and Menstrual Disorders Center and Director of Hysteroscopic Services at the Cleveland Clinic. Dr. Bradley is an internationally recognized gynecologic surgeon. I had the pleasure of meeting Dr. Bradley at last year’s Fibroid Summit at Howard University. Dr. Bradley has vast knowledge and experience. Her desire to educate and to help women with fibroids is evident. We discussed many topics that are frequently asked of the Fibroid Foundation. Dr. Bradley shared her insights:
Q: When a woman is diagnosed with fibroids, where should she start?
A: The question is, are they bothering you? Monitor them with an annual exam. Someone who has no symptoms should never have surgery or intervention. 70-80% of women with fibroids are African American. Ask, are they present and a passenger or are they a problem? What stage are they? Are your symptoms minimal, mild, moderate or severe? Definitely (treat them) if it’s effecting quality of life? If you’re missing two or three days of work a month, that’s severe. Fibroids can cause separate things or multiple things together. Have you been embarrassed by symptoms? Are you not going out because you just can’t change pads fast enough? A normal period should not make you miss anything (activities). Are you cancelling events due to your period? Do you have pain? Are you running to the emergency room, or using narcotics for pain? What do you want to have fixed the most? Depending on those symptoms, we can offer treatments.
Q: Can you talk a little about Lysteda, and it’s benefits.
A: I do think that Lysteda is an underutilized drug in this country. It’s been out since 2009. For heavy bleeding, definitely ask about Lysteda. The new generic name is tranexamic acid. It’s not a hormone. It’s take as directed. As soon as your period starts you take two pills, and repeat it every 8 hours. This is for someone who is hemorrhaging a lot or is going to be traveling. If their doctor doesn’t know about it, then perhaps they should find another physician. It’s been used in other countries for 30 years. Some women with smaller uteruses and heavy bleeding may benefit from Mirena, if they’re not looking to get pregnant for a couple of years. People have to be good detectives to find the doctor that meets their needs for alternatives or evaluation. There are many women whose uteruses aren’t that big, but they just bleed a lot. Match the offerings for the treatment with the patient’s chief complaint. Each patient has to be individualized. This is not going to work for that massive uteri.
Q: I’m often asked for physician recommendations. Do you have any recommendations on how women may go about finding a good fibroid physician?
A: The AAGL, American Assoc of GYN Laparoscopists. These are people with special interests in minimally invasive surgery, which could include robot, hysteroscopy or laparoscopy. The Cleveland Clinic has My Consult. Via My Consult, the patient sends office notes, the information is reviewed…and then we set up a formal discussion.
Q: Should women with fibroids seek a fibroid surgeon specifically?
A: Be with a practice that has multi-specialty expertise.
Q: What questions should women ask when meeting with their fibroid physician?
A: Collaborate with your physician. The starting point would be an ultrasound. Know how big your uterus is – the size of a lemon is normal. Or is it the size of a cantaloupe, grapefruit or watermelon? These are different things. Journal your symptoms for a couple of months. Be definitive. How many pads are you using? How frequently? Are you sleeping through the night? Are they taking iron pills, fatigued, (having) shortness of breath with walking? Have they stopped exercising? Are they eating ice (sign of anemia called Pica), or having unusual cravings like dirt or paper? When you are anemic, unusual cravings occur. Take your medical reports to your new physician. Leave a copy at home as well.
Q: For a woman looking to preserve her fertility, what treatment options are available?
A: A Myomectomy (removal of fibroids). How they are done depends on the size, the number and the location. A lot of the surgeries that I do are done with a hysteroscope. It’s done in an outpatient procedure for smaller fibroids, abdominally for larger fibroids. Emerging procedures like Laparoscopy and Robotic Myomectomy are usually if you have fewer fibroids. Fibroids are unique. They are one of a kind, like a snowflake or a thumbprint. You have to have a surgeon or a facility that offers the various options and knows the criteria for procedures. Be with a practice that has multi-specialty expertise, so that easy referrals to known colleagues can be made.
Q: How can women address post surgery scar tissue?
A: Scar tissue is not typical. At the time of surgery, patients can have fibroids as well as endometriosis. Confirm at a 6-week check up (post-surgery) to see if there are other symptoms. If someone had surgery years ago, it may be something else that could have occurred. It’s kind of hard to say. If you ask if something could “ever” happen, the answer will always be yes.
Q: Sometimes women learn that they have fibroids when they conceive. Should women who are pregnant be concerned about fibroids?
A: Most of the time it creates no problem. If you look at how many births there are in the world each year. The doctors will monitor the patient. Fibroids may grow a little bit. They may cause pain, but it’s not an always type of thing. People should be monitored for symptoms. It’s called Expectant Management.
Q: Tell us about Celebrate Sisterhood, the program that you developed at Cleveland Clinic.
A: It’s a day of empowerment, enrichment and education. We’ve coined the term Edutainment – Education and Information! Last year we did a cooking class, exercise, break out speakers and health screenings – blood pressure, cholesterol, HIV, etc. There is lunch, giveaways…music. We honor women – last year we honored Judge Jean Murrell Capers who just turned 100. Another honoree empowers women helps with domestic violence. A whole day of different kinds of things. Each year we try to grow and do something a little bit different. (The Fibroid Initiative will provide information on the upcoming Celebrate Sisterhood 2013 events)
The Fibroid Foundation thanks Dr. Linda Bradley for sharing much needed insights with us!
“Dedication involves making the space to let young ideas take hold; every tree was once a seed and every company was once an idea.”
~ Zephyr Bloch-Jorgensen
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