Uterine Fibroids: Diagnoses and Treatment Options

How are Uterine Fibroids Diagnosed?

Fibroids, also called myomas or leiomyomas, is a condition with which women can develop round masses in their uterus. Fibroids primarily affect women in their 30s-40s, and inexplicably affect African American women more than any other race. Fibroids also tend to be hereditary. Some fibroids grow in size as women grow older while others stay the same size, but they should stop growing after a woman reaches menopause. Typically, there are no symptoms for fibroids and they do not require treatment, but it is still important to go to a doctor in case symptoms arise. As of now, the leading cause of fibroids appears to be female hormones, which is why they tend to increase in size when hormone levels are high and cease to grow after menopause begins.

There are a few ways to diagnose fibroids. At any gynecologic visit, the doctor will conduct a pelvic exam. That is when a doctor can initially feel for any fibroids. If they suspect that the patient has fibroids, then other tests can be conducted. The most common test is an ultrasound. Ultrasounds are used to diagnose a variety of conditions, but are most commonly used when a woman is pregnant. They provide a way to look into the uterus without using radius and are a safe method of diagnosis. There are two parts when using an ultrasound for diagnosis. The first part is moving the transducer around the abdomen after applying conducting gel on the abdomen first. The second part is inserting an ultrasound probe into the vagina and taking pictures of the ovaries, endometrium, and the vagina.?

Alternatively, an MRI can be done. Though MRIs and ultrasounds can sound like the same thing, an MRI actually provides more detailed images about the location and size of the fibroids.

What Treatment Options are Available for Uterine Fibroids?

There are various non-surgical and surgical techniques available for the treatment of uterine fibroids. First, for the non-surgical techniques, there are two options: medications and non-invasive procedures. The medications will not eliminate fibroids but will help to regulate a woman’s menstrual cycle and treat symptoms such as heavy bleeding during menstruation and pelvic pressure. The non-invasive procedures help to target the fibroid tissue and burn the affected tissue off.

For medications, there is a wide variety available to treat symptoms related to uterine fibroids. The first option is gonadotropin releasing hormone (GnRH) agonists. These agonists can treat uterine fibroids by blocking the production of estrogen and progesterone, which puts the patient in a menopause-like state. However, this treatment option is only recommended for a short period of time as long-term use of the medication can lead to bone loss. Physicians will typically prescribe this as a precursor for surgery so the size of the fibroids shrink. Another option is the use of progestin-releasing intrauterine devices (IUDs). These devices help to control heavy bleeding caused by uterine fibroids but do not work to shrink the fibroids themselves. The third possible medication is tranexamic acids such as Lysteda and Cyklokapron. This medication is used as symptom relief only and does not help to shrink the size of fibroids. Other forms include oral contraceptives to decrease menstrual bleeding and nonsteroidal anti-inflammatory drugs that help to control pain caused by uterine fibroids.

There is currently one type of non-invasive treatment option being used to treat uterine fibroids: MRI-guided focused ultrasound surgery (FUS). This procedure is performed while the patient is within an MRI scanner that has a high-energy ultrasound transducer. The MRI will give the doctor the precise location of the fibroids and the transducer then uses sound waves to heat and destroy small areas of the fibroids tissue.

There are a number of different surgical procedures available for treating uterine fibroids. The first option is uterine artery embolization where embolic agents are injected into arteries that supply the uterus and cut-off the blood supply to the fibroids, causing them to die. Another treatment option is the use of radiofrequency ablations. In this procedure, radiofrequency energy targets and destroys uterine fibroids by shrinking the blood vessels that supply blood to them. This can be done during a laparoscopy or transcervical procedure. A third option is a laparoscopic or robotic myomectomy where the surgeon simply removes the fibroids while leaving the uterus intact. A fourth treatment option is typically only used for symptom relief and is an endometrial ablation procedure. This is completed by inserting a slender instrument into the uterus and uses heat waves, hot water, or electric current to destroy the uterine lining to end menstruation or reduce bleeding. However, the only permanent treatment option for uterine fibroids is a hysterectomy where the surgeon removes the uterus altogether, which will unfortunately lead to the complete infertility of the patient.?

Is There Research Being Done on Uterine Fibroids?

Although there is not a lot of information on uterine fibroids circulating in everyday conversations, a few researchers have made it their goal to find better treatment options for women suffering from uterine fibroids. One such researcher is Dr. Hugh S. Taylor at Yale University.

Dr. Taylor is spearheading a clinic trial to test the efficacy of a new oral medication called Linzagolix. This medication works to limit hormone production and unlike other medications, it directly blocks the receptors instead of overstimulating the receptors. The interesting thing about this medication is that it is titratable, meaning the physician prescribing the medication can change the amount of estrogen receptors that are blocked to best treat the patient. Another unique aspect of this medication is that it treats both fibroid symptoms and fibroids themselves. Linzagolix is a great option for women suffering with uterine fibroids as it is less aggressive than other medications and does not completely halt estrogen production and immediately put women into a menopausal state. This drug has already been approved in Europe but it has not yet been approved for use in the United States but Dr. Taylor is hopeful that this medication will be approved for use in the United States and help to reduce the use of hysterectomies to treat uterine fibroids.

Two professors at Duke University and North Carolina Central University, Friederike Jayes and Darlene Taylor respectfully, have been experimenting with enzymes that digest collagen. Since uterine fibroids consist of benign collagen tumors, developing a treatment that targets these fibroids collagen tumors can be a game-changer for treating fibroids. Before working together, Dr. Taylor had developed a drug called LiquoGelTM which helps to deliver drugs to specific regions in the body that are affected. Then, once Dr. Taylor and Dr. Jayes combined their efforts to merge LiquoGelTM and a collagenase drug inside a syringe to deliver the drug directly to the tumor. Since this drug is directly injected into the affected area, it will stay there without migrating to other areas of the body and overtime, the gel will degrade so the body will be able to get rid of it.

Although there has been more attention on women’s health issues, it is still not enough. “uterine fibroids, because they are almost never fatal and only affect women, have not received the scientific attention they deserve” said Dr. Jayes and Taylor. It is imperative that women’s health issues are taken seriously, even if they are not fatal. These diseases and illnesses are debilitating for women suffering from them, so developing better treatment for these diseases is essential.

References

Backman, I. (2022, September 22). Promising trial for a drug to ease uterine fibroids. Yale School of Medicine. https://medicine.yale.edu/news-article/promising-trial-for-a-drug-to-ease-uterine-fibroids/

Miller, B. (2023, January 29). Engineering smart therapeutics: Innovative uterine fibroid treatment. Duke Department of Obstetrics and Gynecology. https://obgyn.duke.edu/blog/engineering-smart-therapeutics-innovative-uterine-fibroid-treatment