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

242 Pages·2007·4.66 MB·English
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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

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You've called in sick today. Your back and legs hurt. Your abdomen is bloated and more than a little uncomfortable. You are having your period, and the bleeding is so heavy you can't even think about leaving the house. You have uterine fibroids.One in every four women see their lives affected by ute
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