TODAY’S DOSE OF HONESTY

Fibroid pain: Is surgery the only answer?

Here’s a “wow-I-didn’t-know-that” statistic: Approximately 80% of women will develop uterine fibroids by age 50. They can be the size of a tennis ball or the size of a pea. Risk factors include a family history of fibroids, obesity, high blood pressure, and just being of reproductive age. Black women are 2 to 3 times more likely to be affected by fibroids. Some women have them and are not bothered by them, and others are debilitated by them. And historically, the most effective treatment has been hysterectomy.

What are fibroids?

First, here’s the mini-med school: Fibroids are non-cancerous (or benign), solid tumors that develop out of the muscular tissue in the uterus. The most common signs of uterine fibroids are abnormal menstrual bleeding and symptoms associated with their size. You may experience heavy menstrual flow at regular intervals, bleeding between periods, or bleeding throughout the month.

There are many variables associated with fibroid pain, including the location, size, and density of the tumor. For some, the size and position of fibroids can exert pressure on nearby body parts such as the spine, bladder, pelvic floor, or abdominal wall. You may also have pain associated with heavy bleeding. As blood collects in the uterus, clots may form that must pass through the cervix to exit the uterus. The resulting cervical dilation may cause pain that some women describe as labor pain. Fibroids can also put pressure on nerves, leading to pain, tingling, or numbness.

Is surgery always necessary?

Actually, treatment is NOT always necessary. By some estimates, only 25% of fibroids are symptomatic. A fibroid that does not cause troubling symptoms may be reassessed periodically with physical exams and ultrasounds.

For fibroids that do cause pain, there are a number of options for managing them; treatment plans factor in age, plans for future pregnancy, past history, and number, size, and location of fibroids. While surgery is a common and very effective option, advances in medication and non-surgical procedures are constantly evolving and may help relieve pain and other symptoms associated with fibroids. Unfortunately, those options often are not fully explained to women. Some of those non-surgical options:

• Hormonal birth control pills may help limit bleeding caused by fibroids. However, contraceptives do not affect the fibroids themselves. 

• Certain intrauterine devices (IUD) also release hormones that can help reduce bleeding caused by fibroids. Once the IUD is removed, however, the symptoms may come back. 

• Magnetic resonance imaging–guided focused ultrasound involves using ultrasound to damage fibroids. It’s noninvasive but can cause heavy periods and irritate the sciatic nerve.

• Tranexamic acid is a prescription nonhormonal medication that may be used to decrease heavy bleeding.

•  Leuprolide (Lupron Depot) is a well-studied medication that works by decreasing the production of hormones that feed fibroids.

• Uterine artery embolization (UAE) or uterine fibroid embolization (UFE) are procedures where the blood supply to the uterus or fibroid is blocked by small particles or gel-like material. Ideally, this leads to less menstrual bleeding and shrinkage of fibroids.

• Newer interventions such as the Acessa procedure (Hologic) and Sonata procedure (Gynesonics) work by delivering energy directly into the fibroids to shrink them. The Acessa procedure is performed laparoscopically, using small incisions on the belly; the Sonata procedure is performed with small instruments inserted into the uterus through the vagina.

What are the surgical options?

When less invasive measures fail to improve your symptoms, however, or are unlikely to alleviate current or future symptoms, it’s time to consider surgery. There are three choices for surgical intervention: myomectomy, fibroid ablation, or hysterectomy. A myomectomy is the surgical removal of fibroids without removing the uterus, and an ablation delivers heat energy into a fibroid to destroy it. In many cases, either of these can be a minimally invasive procedure; some myomectomies can be done vaginally as same-day surgery. Hysterectomy is surgical removal of the uterus; while it’s still the definitive surgical intervention for fibroids, myomectomy does improve quality of life, and fibroid ablation is a newer procedure with promising data so far.

All surgical and nonsurgical procedures carry a risk of complications. More-invasive surgeries that require an abdominal incision have higher risks, such as infection. Make sure that your OB-GYN discusses ALL of your options with you so you can make informed decisions about your course of treatment.

What about alternative remedies?

You’ll find a variety of supplements online that claim to shrink and/or relieve the pain of fibroids. So far, though, there is little science that affirms the effectiveness of these alternative therapies; most existing studies involve small sample sizes. However, some research suggests a few, such as acupuncture, may help some people cope with chronic pain. Some women do find relief from heavy bleeding and cramping with acupuncture, but there’s no evidence that acupuncture can shrink fibroids.

Can fibroids be prevented?

In general, you can’t prevent fibroids. But you CAN reduce your risk by maintaining a healthy body weight and getting regular pelvic exams. And use your girl-power Spidey sense: If you have pelvic pain of any type that is persistent and doesn’t respond to over-the-counter pain relievers, it’s time to see your doctor.

SYMPTOM SOLUTIONS

The “sneaky” sugar that’s most harmful—and how to hunt it down.

One of the most important lines on a Nutrition Facts label is “added sugar.” I like to call it “hidden sugar.” Diets high in added sugar—different from the naturally occurring sugar in fruits, some vegetables, and dairy products—can increase risk of diabetes, obesity, certain cancers, skin problems, gum disease, heart problems, and some mood disorders. For women going through menopause, when the risks of all the above are heightened anyway, added sugar can dial up problems even more.

The recommended daily added-sugar intake for women is 25 g per day; for men, it’s 37-38 g. And you can hit that limit frighteningly fast: Besides (of course) the cakes, cookies, ice cream, etc., added sugars hide in nut butters, breads and cereals, condiments, dressings, pasta sauces, coffee and tea beverages, and seemingly good-for-you foods like fruit juice, granola, and yogurt. They even sneak their way into items labeled “sugar-free.” They’re especially prevalent in highly processed foods of all types.

So, it makes sense, at any age but especially during perimenopause and the years beyond, to cut down on added sugar. Here’s how:

• Plan what you eat—and especially what you snack on—ahead of time. Don’t be caught without good dietary options. Fill your fridge with fresh fruit, have nuts on hand, and turn to fiber-rich complex carbs like whole wheat crackers and plain popcorn for midday breaks.

• Avoid buying sugar-filled foods that will tempt you. If I have Oreo Thins in my freezer, I’ll be heading there multiple times a day!

• Don’t drink your sugar. There are too many good foods to eat! Get fruit fixes from actual fruit rather than sugar-filled drinks; even some “healthful” canned and bottled juices carry a surprising load of added sugars. And watch out for cocktail mixers—most are sugar bombs.

• Know its aliases. Look for agave, corn sweetener, dextrose, juice concentrate, glucose, maltodextrin, maltose, sucrose, and anything with the words sugar or syrup. Unfortunately, it’s all added sugar.

• Read labels. Be religious about this! Added sugar as an ingredient is now separated out from total sugars on every Nutrition Facts label, so it’s easy to find.

• Keep track. It helps to write down added sugar grams as you consume them—and its sources as you identify them. Keeping a record helps you know where you in in relation to that daily 25 g goal.

• Switch to stevia. A 2016 study found that dried stevia leaf powder significantly lowered blood sugar, triglyceride and cholesterol levels in people with diabetes. Stevia is now available at most grocery stores, in powder, liquid, and “in the raw” form. Costs more than sugar, but it’s sweeter, so you use much less.

• Snack naturally. Really craving something sweet? Try a ripe plum, a few sweet cherries, or a slice of refreshing melon. They’re all in season, at their best, and filled with crave-stopping sweetness.

COMMUNITY

“My hot flashes and night sweats are ruining my sleep—help!”

Let’s face it: Perimenopause and menopause wreak havoc on our bodies, but those sweaty awakenings in the middle of the night are just the worst. I asked our Core Expert, sleep specialist Dr. Thanuja Hamilton, to recommend a few ways to help you sleep through (or quickly fall back to sleep after) those obnoxious disruptions.

During perimenopause, levels of estrogen decrease, which can affect normal sleep patterns and lead to shorter periods of deep sleep. Estrogen also plays a role in thermoregulation—how your body heats up and cools down—so a drop in this hormone can increase hot flashes and night sweats, a major reason for awakenings in perimenopausal and menopausal women. It’s even thought to protect against sleep apnea: Prior to menopause, men are twice as likely as women to have sleep apnea; after menopause, women’s risk doubles. When the airway is blocked as it is with sleep apnea, adrenaline surges, tensing airway muscles and waking you up. Progesterone levels decrease as well. This is a calming hormone that can help with relaxation and be mildly sedating, so sleep is understandably disrupted when levels drop.

With age, our sleep cycle tends to start earlier, but the amount of sleep needed remains the same. Sleep in peri- and menopausal women has its challenges, but with the right sleep practices, behaviors, and outlook, you can decrease the impact these changes have on your sleep. If hot flashes are disrupting your sleep: Besides practicing good sleep hygiene (making your bedroom conducive to sleep, watching what and how much you eat and drink before going to bed, limiting screen time prior to bedtime), here a few tips for getting a better night’s rest. (For my personal sleep hygiene routine, click here.)

• Get daytime activity. The more energy you expend, the more your body will want to rest and recover. Just avoid exercising too close to bedtime.

• Take a warm bath. Believe it or not, it can help cool you off: When you step out of the warm water into the cooler air, your body pulls its core heat to the surface to warm you up, lowering your core body temperature in the process. (Dr. Jen says: Talk to your GYN about treatment for hot flashes; there are hormonal and non-hormonal options. If you can’t get a good night’s sleep because of hot flashes, you deserve treatment.)

• Use breathable, moisture-wicking bedding and sleepwear like cotton, linen, or bamboo. Sleep with layers so you can pull them off or on depending on how you feel.

• Cool your surroundings. Lower your thermostat (66 degrees F. is the optimal temp for health benefits). Try bed-cooling systems or cooling gel pads. A fan can not only keep you cool but act as white noise, which can help you sleep.

• Avoid alcohol and heavy meals before bed; they can heat you up at night. Instead, drink plenty of water during the day, and keep a cool drink at your bedside for sipping.

• Have a discussion with your doctor about all prescription treatment options, including HRT, to see which may be right for you.

OUR CORE EXPERT

Thanuja Hamilton, M.D., is a double board-certified sleep medicine specialist. She is corporate medical director of Persante Health Care, a national provider for sleep center management services, and serves as medical director of Jefferson University Health Systems and Virtua Health Sleep Labs. @drthanujahamilton

GOT A QUESTION FOR DR. JEN? Click here to send it.

ABOUT DR. JEN

In her roles as chief medical correspondent for ABC News and on-air cohost of “GMA3: What You Need to Know,” Dr. Jennifer Ashton—”Dr. Jen”—has shared the latest health news and information with millions of viewers nationwide. As an OB-GYN, nutritionist, and board-certified obesity medicine specialist, she is passionate about promoting optimal health for “the whole woman.” She has written several books, including the best-selling The Self-Care Solution: A Year of Becoming Happier, Healthier & Fitter—One Month at a Time. And she has gone through menopause…

Refer a friend and get a free gift!

Do you know someone who might enjoy this newsletter? It’s easy to refer them! Just click the link in the box below and supply their email address. They’ll receive a message asking them to confirm their email address—make sure they do this! Once they’ve done that, they’ll start receiving the weekly newsletter—which, as you know, is absolutely FREE—and you’ll receive Dr. Jen’s Exclusive Hair Resuscitation Plan as my “thank you” for your referral!

Forwarded this email? Click here to subscribe.

Missed last week’s issue? Read it here!

Want a copy of Dr. Jen’s latest magazine? Get it here!