Uterine Fibroids: The Complete Guide (A Johns Hopkins Press Health Book)

242 Pages·2007·4.66 MB·English

by  Elizabeth A. Stewart MD

UTERINE
FIBROIDS
A Johns Hopkins Press Health Book
UTERINE
FIBROIDS
The Complete Guide
Elizabeth A. Stewart, M.D.
THE JOHNS HOPKINS UNIVERSITY PRESS
Baltimore
Note to the Reader
This book is not meant to substitute for the medical care of women with fibroid
tumors,and treatment should not be based solely on its contents.Instead,treat-
ment must be developed in a dialogue between the individual and her physician.
This book has been written to help with that dialogue.
Drug dosage:The author and publisher have made reasonable efforts to determine
that the selection and dosage of drugs discussed in this text conform to the prac-
tices of the general medical community.The medications described do not neces-
sarily have specific approval by the U.S.Food and Drug Administration for use in
the diseases and dosages for which they are recommended.In view of ongoing
research,changes in governmental regulations,and the constant flow of informa-
tion relating to drug therapy and drug reactions,the reader is urged to check the
package insert of each drug for any change in indications and dosage and for
warnings and precautions.This is particularly important when the recommended
agent is a new and/or infrequently used drug.
© 2007 Elizabeth A.Stewart
All rights reserved.Published 2007
Printed in the United States of America on acid-free paper
9 8 7 6 5 4 3 2 1
The Johns Hopkins University Press
2715 North Charles Street
Baltimore,Maryland 21218-4363
www.press.jhu.edu
Library of Congress Cataloging-in-Publication Data
Stewart,Elizabeth A.
Uterine fibroids:the complete guide / Elizabeth A.Stewart.
p.cm.
Includes bibliographical references and index.
ISBN-13:978-0-8018-8700-0 (hardcover :alk.paper)
ISBN-13:978-0-8018-8701-7 (pbk.:alk.paper)
ISBN-10:0-8018-8700-3 (hardcover :alk.paper)
ISBN-10:0-8018-8701-1 (pbk.:alk.paper)
1.Uterine Fibroids.1.Title.
RC280.U8S752007
616.99'366—dc22 2006103536
A catalog record for this book is available from the British Library.
Special discounts are available for bulk purchases of this book.For more information,
please contact Special Sales at 410-516-6936 or [email protected].
All illustrations and photographic overlays by Jacqueline Schaffer
To Bill and Paul
Both ahead of their time in their support of women and
the unique issues women face.
This page intentionally left blank
Contents
Introduction ix
Part I. About Fibroids
Chapter 1. Who Gets Fibroids,and What Are
the Symptoms? 3
Chapter 2. What Are Uterine Fibroids? 10
Chapter 3. Why We Are So Far Behind in
Understanding and Treating Fibroids 20
Chapter 4. The Endocrinology of the Uterus 26
Chapter 5. Why Do Fibroids Form? 37
Chapter 6. Diagnosis:How Do I Know That I Have
Fibroids? 42
Chapter 7. When Fibroids Come Back 56
Part II. Surgical Treatment
Chapter 8. Surgery Inside the Uterus:Hysteroscopic
Myomectomy,Endometrial Ablation,and
Vaginal Myomectomy 63
Chapter 9. Laparoscopic Myomectomy and Myolysis 70
Chapter 10. Abdominal Myomectomy 75
Chapter 11. Uterine Artery Embolization 83
Chapter 12. Focused Ultrasound Surgery and Other
Thermoablative Therapies 95
Chapter 13. Hysterectomy 104
vii
viii CONTENTS
Part III. Medical Treatment
Chapter 14. Traditional Hormonal Therapies:
Birth Control Pills and Progestin 117
Chapter 15. GnRH Agonists,Add-Back Therapies,
and GnRH Antagonists 121
Chapter 16. Innovative Medical Strategies for Treating
Uterine Fibroids 126
Part IV. Other Factors, Other Conditions
Chapter 17. The Genetics of Fibroids 133
Chapter 18. Pregnancy,Infertility,and Miscarriage 144
Chapter 19. Adenomyosis and Endometrial Polyps 153
Chapter 20. Uterine Cancers 159
Chapter 21. Fibroid-like Conditions 165
Chapter 22. Alternative and Complementary Therapies 172
Chapter 23. What Can We Do about Fibroids? 175
Appendix:Hints for Surgical Recovery 179
References 191
Index 215
Color illustrations follow page 110
Introduction
Fibroids (or, in medical parlance, leiomyomas, myomas, or leiomy-
omata) are basically knots of smooth muscle in the uterine wall.
As Natalie Angier noted in her wonderful book titled Woman: An
Intimate Geography,“Fibroids are as common as freckles and deserve
their common name.”1 They are found to be present in at least
25 percent of all women,and they would be found in over 80 per-
cent of all women if one looked carefully enough. Fibroids are the
leading reason for a hysterectomy, accounting for more hysterec-
tomies than all kinds of gynecologic cancers put together. Despite
this high prevalence, we know much less about them than we
do about the smooth muscle cells in the lungs that contribute to
asthma or the smooth muscle cells in the heart or blood vessels
involved in coronary artery disease. Fibroids clearly deserve more
scientific investigation.They have been the focus of my work as a
scientist and a practicing gynecologist.
Why write a book about fibroids? For me,there are many person-
al reasons.
First, the field is changing rapidly. Making decisions about treat-
ment options was easy when hysterectomy was the one-size-fits-all
treatment.But as a headline from a news article a few years ago suc-
cinctly stated,“Diagnosing fibroids is simple.Deciding what to do is
hard.”2 Today, in making a decision about treatment, many factors
come into play:how many fibroids are present,their size and loca-
tion, what symptoms I am having, my plans for pregnancy in the
future,to name a few.
Second,women are increasingly sophisticated in their approach to
making decisions for themselves and their loved ones.The Internet
ix