December 21, 2023 • 47 mins
Have you been diagnosed with a fibroid? Have severe period pain and think it's normal? 1 in 4 women will be diagnosed with a fibroid in their lifetime, it is one of the most common pelvic conditions affecting women around the world and often a misunderstood condition!
Join co-hosts, Dr. Maleeha Mohiuddin, Dr. Dionne Ibekie and guest Obstetrician and Gynecologist, Dr. Kiarra King, as they discuss fibroids, their impact on your health and fertility, and treatment options. This episode is not just an educational deep-dive—it's a a blueprint to having a more informed discussion with your doctor!
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dionne (00:00):
Maleeha.
You may be able to relate tothis, given that you and I are
both first generation Americans.
When I got my period for thefirst time, my mom sat me down
and told me about this milestonein my development from
adolescence to womanhood.
She explained the implicationsand, as a very strict immigrant
(00:20):
mother, it was mainly a warningthat now I'm able to get
pregnant and I had better, notPeriod Pretty straightforward, I
mean.
She also explained how to carefor myself and the products I'd
need and how to use them.
But that was basically all thediscussion surrounding periods
(00:41):
for me.
Maleeha (00:42):
Oh, you know, Dionne, I actually remember a very matter
of fact short version down,very down to business.
I think it left me with waymore questions than answers in
truth.
But you know, like a true goodimmigrant child, I was like not
about to ask my mom any of thosequestions, like I saved them
(01:03):
for my friends.
But thank God we actually had anurse in fifth grade who gave
us our talk, the talk.
I don't know if they do thatanymore, but thank God for her.
Dionne (01:16):
Yeah, that.
Yeah, we have that too, I meanwe have to look out for our
safety because there's certainyou have cousins for that.
But anyways, clearly, as I gotolder, I noticed symptoms of
cramping, heavier men's sees attimes and sometimes pain.
It wasn't until college that Ihad an ultrasound done and they
(01:39):
discovered that I had a fibroid.
I then became one of 26 millionwomen in America who have this
condition.
It's estimated that one in fourwomen will get a fibroid.
It is one of the most commonpelvic conditions affecting
women around the world, and formany it can come with
debilitating symptoms.
Maleeha (01:59):
Absolutely Dionne.
I mean, I think this is areally important topic that
doesn't get discussed enough,even though it affects so many
women.
I think it's just assumedperiods equal pain.
Dionne (02:13):
Right, yeah, right, and we're always hysterical, right?
That's always good.
Kiarra (02:20):
That's a whole other topic.
Dionne (02:25):
But anyways, today we have the pleasure of having Dr P
R King, a board certifiedobstetric and gynecology
physician based in Chicago, toshare her expertise on this
common condition in the realm ofwomen's health.
We are so lucky to have her, asshe is a sought after media
expert in the women's health andwellness space.
(02:45):
She's also a speaker anddigital content creator,
focusing on fashion, wellnessand lifestyle.
She passionately cares forwomen and believes that
education is empowerment, andactively works to ensure her
community is informed.
So join us on this episodewhere we really get into this
topic of fibroids.
Maleeha (03:08):
This is the IV drip, a podcast designed to give you the
dish on health topics you needto know, but didn't know to ask.
Dionne (03:18):
We are your hosts, Dr Malihem Mohidin and Dr Deanna
Becky, both Harvard, trainanesthesiologists and besties.
Join us as we explore hottopics that are rarely discussed
but can have a huge impact onyour life.
Maleeha (03:32):
Dr King, welcome to our podcast.
Kiarra (03:35):
Thank you so much for having me.
I'm really excited to be onwith you all and talk about this
topic.
It's something we see all thetime clinically, but sometimes
the general public won't reallyknow as much about fibroids.
They'll know they're havingsymptoms, but they won't really
know what the symptoms mean.
(03:57):
So I'm really glad that we'llbe able to break some of that
down today.
Maleeha (04:01):
Oh, you are so right.
I mean, I think, reflectingback on just what Dionne said
about her conversation with hermom, it's pretty common to just
get like the bare minimum aboutthe basics of women's health,
and not even that much of it.
And it's really not until weencounter a problem in our own
(04:22):
health that we even begin tolearn about the conditions that
are specific to women's health.
You know, and although now wehave social media and platforms
like ours, wink Wink and yourswe hope that's starting to
change that there's more outletsout there and more access to
information.
Kiarra (04:42):
Absolutely.
I couldn't agree more.
A lot of my time when I wasclinically active, and even now,
is spent educating whetherthat's educating via social
media, as you mentioned.
I have so many friends.
I'm like their personal, likecurbside console, yes, and I get
so many, so many text messageslike hey, my doctor said this,
(05:06):
or my fibroids are this size, orwould you take a really quick
look at my ultrasound report.
But you know, not everyone hasaccess to a friend who's a
gynecologist and so you know Ilove to be able to share
information currently, you know,via social media or my blog
that is relatable and thatpeople can get actual
(05:27):
information from.
I know you all can imaginePeople are.
You know, they go go to GoogleUniversity, youtube University,
and they get a lot ofinformation and listen.
I can fully appreciate thatbecause they're generally is a
paucity of information, orpeople do go to their doctor's
(05:49):
office and they don't feel likethey're heard or that they get
questions answered.
The people are just, they'regenuinely searching for
information, for something tomake what they're going through
make sense, and so I can providesome insight on on that in any
way here via you all's wonderfulpodcast, then I'm always happy
to do so.
Maleeha (06:10):
Well, we appreciate it.
Dionne (06:13):
Absolutely.
Our audience is lucky to haveyou.
They get a glimpse of what youdo in the clinic and what your
friends get to know.
So we are so happy to have you.
Maleeha (06:23):
Let's get into it.
Dionne (06:25):
Shall we.
Maleeha (06:26):
So let's start at the basics, and you're going to have
to break this down into laymanspeak.
You know no medical speak here.
Okay, so what exactly arefibroids?
I mean, we've heard this termthrown around, but what does it
really mean?
Kiarra (06:43):
So fibroids I'm going to use the medical term simply
because sometimes people lookthese up and they see it and
they're like well, what is that?
It's the medical term sounds alot more scary or Leioma.
They are not malignant, whichmeans they are not cancer, and
they're basically benign tumorsof the uterus, of the smooth
(07:05):
muscle of the uterus, andthey're very common and
reproductive age women they'rethe most common pelvic mass in
reproductive age women.
Yep.
Dionne (07:17):
Wow, I actually did not know that and you're right.
When people hear that wordtumor, they get so scared and,
like you said, they go to Googleuniversity to get more
information and sometimesthey're wrong information.
But can they become malignant?
Can fibroids convert?
Maleeha (07:35):
Cancerous yes.
Kiarra (07:37):
So the likelihood of finding cancer in a fibroid is
incredibly small.
When I was in training, wealways just quote it less than
1% just because that was a.
You know that it is less than1%, but it's really less than
like 0.1%, which is really tinythat there would be cancer found
(08:00):
in a fibroid.
Now there are other cancerousgrowths of the uterus but again,
typically fibroids are notcancerous at all.
Dionne (08:12):
That is reassuring.
That is reassuring.
Yeah, it's 0.1%.
Maleeha (08:15):
It's like one in 1,000.
Dionne (08:17):
Yes, exactly Right.
Maleeha (08:19):
Okay, so we mentioned earlier that about one in four
women can develop fibroids,which is a much higher statistic
.
Who are the women that are athigh risk for getting these, and
is this a hereditary issue, oris it a population, like certain
segments of the population aremore prone to fibroids?
(08:42):
Can you elaborate on that?
Kiarra (08:45):
So, as I mentioned a little bit earlier, women of
reproductive age are at thehighest risks.
Fibroids are hormonallydependent and so in someone who
is an adolescent or prepuberantor someone who is postmenopausal
, you're not having thoseeffects of the female
(09:06):
reproductive hormones on theuterus that Sure have the
potential to promote or enhancefibroid growth.
So definitely, age, familyhistory can be one.
Black women, african Americanwomen are at a higher risk, and
(09:27):
obesity can be another factorAgain, because women with higher
BMIs have more fat, which canbasically store more estrogen,
which can again enhance thegrowth of fibroids.
Dionne (09:42):
Hmm, Can I just say you just made me look forward to
menopause.
Well then, you At least there'sone positive thing about it,
right?
Kiarra (09:51):
We'll have to come back so we can talk about menopause.
And then you maybe yes, Paulyou maybe kind of figure out do
I want to switch back?
Do I want to switch back?
Dionne (09:58):
I might take back my words.
Take your answer back.
Yeah Well, you brought up thatAfrican American women in
particular tend to have a higherrisk and we know, with a lot of
medical conditions, africanAmericans tend to be impacted
more significantly.
Why, with fibroids?
(10:19):
Why, in this case, do AfricanAmericans tend to have a higher
risk of developing fibroid?
Kiarra (10:25):
Sure, so it's not fully known.
Some of the things we do knoware that black women tend to
suffer from fibroids more thantheir white counterparts.
There was an article in theGray Journal and for those of
you who are like, what is theGray Journal?
It's a major publication withinthe world of OB-GYN it's the
(10:48):
American Journal of Obstetricsand Gynecology, and one of the
articles I read, they noted that, despite the racial differences
in symptoms and incidents,relatively little data have been
published regarding thebiological basis of fibroids in
African American women, and inthat same article they mentioned
that African American womenwere two to three times more
(11:11):
likely to undergo hysterectomyfor fibroids than other racial
groups.
And another interesting thing isoften they have more severe
symptoms at the time of clinicalpresentation.
There's also some growingevidence that vitamin D
deficiency and its subsequentcorrection may impact fibroid
(11:38):
size, and so when you thinkabout who may be at higher risk
for vitamin D deficiency, youcan look at people that have
more melanin in their skin.
So you have to wonder how deepis that correlation?
And I think certainly there'smore studies that are needed to
(11:59):
really kind of get down to thenitty gritty of how all of that
works.
Because if vitamin D is a majorfactor, then that's something
we can easily target and prevent.
Maleeha (12:12):
Yeah, absolutely, that's very interesting.
Vitamin D.
I mean, that's like super ontrend too.
I feel like everything isvitamin D related to a vitamin D
deficiency, so that's a reallyinteresting point, I mean, okay,
so what are some commonsymptoms of fibroids?
I know Dionne mentioned earliershe had cramping and abnormal
(12:34):
periods.
What are some other commonsigns and symptoms?
Kiarra (12:39):
So for many women fibroids are asymptomatic,
meaning they don't have symptomsat all.
They have no idea that thefibroid is there, the only
reason they know they mayundergo an ultrasound.
Let's say they find out,they're pregnant and they're
having their first ultrasoundand it's noted that there's a
fibroid there, but prior to thatthey had no idea.
(13:01):
So the people that do tend tohave symptoms will have heavy
periods, painful periods.
They may have pain or pressureoutside of their menstrual cycle
.
So many women will have crampingwith their menstrual cycle, but
they may have pain or pressurethat exists all month, or all
(13:25):
year for that matter.
They may have pressure on thebladder so they may have to go
to the bathroom more frequentlybecause the fibroid is pressing
into the bladder, or they mayhave constipation or difficulty
having bowel movements.
For the same reason, I alwaystell people if you can imagine
(13:46):
looking at someone on the side.
The bladder sits towards thefront of the body, the uterus is
sandwiched in between andbasically the rectum is behind,
and so you can imagine if youhave this really big and bulky
uterus, it might press on thebladder in the front or may
press on the rectum behind andit can cause some intestinal
(14:10):
issues there and for some peoplethey can have pain that is
radiating pain.
I know you all asanesthesiologists, know all
about radiation, pain radiating,but some people can have pain
radiating down their back.
I wouldn't say it's exclusiveto fibroids, but certainly one
may be more likely to have moresignificant pain with fibroids
(14:33):
than someone who doesn't.
Wow.
Dionne (14:36):
You know, compared to this list, when I think back to
the symptoms that I mentioned, Ithink I had a pretty mild Thank
God.
I can't imagine dealing withhalf of these things, to be
honest.
Kiarra (14:48):
So a lot of these symptoms can be downright
debilitating for some people,and I actually did mention some
people develop shortness ofbreath or lightheadedness.
Some people actually pass outbecause of the heavy menstrual
bleeding.
It can lead to symptomaticanemia, which can cause all of
(15:08):
those symptoms shortness ofbreath, lightheadedness and
sometimes that is the first timepeople find out that they have
fibroids because they're walkingaround and they're totally
exhausted and fatigued and outof breath for so long.
And they just chalk it up toI've been working really hard at
work, or I'm a mom and I'malways busy and I'm always
(15:29):
exhausted.
And they finally go get checkedout and their doctor's like
we're going to run a few tests.
All your blood counts seven.
What's going on?
Are your periods heavy?
Well, not really.
Or they've been that way all mylife.
So I didn't really think muchof it.
(15:50):
Lo and behold, they go and havean ultrasound and they have
large fibroids that are leadingto heavy bleeding and
symptomatic anemia, and so theycan absolutely be debilitating
for some.
Maleeha (16:04):
I have seen this firsthand.
So much, deanna.
I was just telling you thisstory.
I had a friend who's literallya friend who's a physician and
her sister is a teacher andworks.
you know how teachers work shortof breath, dizzy chalked it up
to overwork, went to get labsand her hemoglobin was six,
(16:27):
which is really low for those ofyou who are out there and you
know, I think this wasinteresting about women's health
and this is why it's soimportant to talk about this
stuff is that these things areso related to our overall health
.
For women, you absolutely haveto ask these questions, and
you're right.
Like how would you know you'remenstruating too much if you're
only looking at your own pads,and you know what I mean?
(16:49):
Like who are you comparing itto?
Exactly, exactly, and these areso important and it is important
that you go to a provider whois paying attention to these
things, who was watching yourblood counts, and have these
conversations.
You know, and fibroids canaffect things that a lot of
women are dealing with now, likefertility, and can you talk a
(17:12):
little bit to us about how yousee fibroids affecting fertility
in women?
Kiarra (17:17):
Absolutely so.
Fibroids can impact fertilityas well as pregnancy for some
women who are dealing withinfertility and fibroids.
If those fibroids are in aplace that are one blocking the
openings of the fallopian tube,that can make it challenging for
sperm to reach the egg or for afertilized egg to get back into
(17:42):
the uterus and implant properly.
Additionally, if the fibroidsaren't really in the areas of
the tubal openings and they are,say, scattered throughout the
uterus, that can make it not aseasy for a fertilized egg to
find a place that's nice toimplant.
And so this sometimes willhappen with patients who have.
(18:07):
They can even have smallfibroids.
So sometimes people think like,oh, I have this one big fibroid
, it's really bad.
Sometimes even smaller fibroids.
If they're multiple and they'rekind of scattered throughout the
uterus, it can make it hard,once an egg has been fertilized,
for that embryo to find a placeto implant, so they may have a
(18:29):
higher risk of pregnancy loss inthat case, when someone does
become pregnant with fibroids inplace, then, like I mentioned a
little bit earlier, typicallyan ultrasound will be done most
of the times in early pregnancyand if fibroids are noted, then
(18:49):
that is someone that we're gonnamonitor throughout pregnancy,
because fibroids for some peoplecan grow during pregnancy, for
some people they can stay thesame size and for some people
they'll shrink or what we'llcall degenerate.
And so the biggest thing we'reconcerned about is the fibroid's
growing because, especially ifyou're already starting off with
(19:11):
a large fibroid, if thatfibroid continues to grow now
you're concerned is that fibroidgrowth going to impact the
growth of the fetus, and so thegrowth ultrasounds will allow us
to look at the fibroid size,look at the size of the baby,
make sure baby seems to still bedoing okay in terms of all of
(19:31):
the growth parameters.
Dionne (19:33):
Yeah, I had someone close to me deal with that exact
scenario where her fibroid wasgrowing during pregnancy and she
had to get on bed rest.
Luckily, baby made it to term,she had a safe delivery, but it
was scary.
It was scary for her.
So you're absolutely right.
(19:54):
I mean these are things againthat we don't learn about, even
when we do our women's healthclasses in fifth grade, right?
So this is super important, I'mjust saying, because there's
just so much related to fibroidsthat you don't learn about.
So I'm glad we're talking aboutit.
Maleeha (20:17):
I mean, which highlights the importance of
pre-dental care right.
I mean that's another episodeentirely, but you definitely
pointed out the importance ofmonitoring things serially and
understanding it's a dynamicprocess and the importance of
kind of having that continuum ofcare is so critical.
Dionne (20:37):
So how are fibroids diagnosed?
I mean, you mentioned it alittle bit, but if you can kind
of be more specific, you know,like the different modalities,
maybe the different ways.
Kiarra (20:48):
So generally, a patient's gonna come in to the
office and they may be comingfor an annual wellness exam.
They may be coming with aconcern for an annual wellness
exam.
If the patient is not aware ofany fibroids and we're doing a
(21:09):
pelvic exam, we may find them.
Incidentally, meaning we happento feel something unusual, we
feel a mass, we feel somethingsolid that doesn't quite feel
like the uterus and the patienthadn't reported any symptoms.
Or the patient may be comingand they may say for the past
six months I've had really heavyperiods, I'm passing clots I
(21:32):
never passed large clots before.
I'm peeing all the time inwhich we say, okay, we're gonna
check things out, we'll do anexam, we'll get some labs and
then we'll do an ultrasound.
So a pelvic exam is absolutelyone way.
If you've ever had a pap smear,part of the pelvic exam is
(21:55):
using a speculum and then theother part is when the physician
or midwife or nurse uses theirhands to palpate inside the
vagina and on top of the abdomenand what we're feeling for is
the uterine position, theuterine size we're feeling.
Do we feel any masses nearwhere the ovaries are?
(22:16):
So that's one way Probably themost typical way that we will
confirm if we suspected it onpelvic exam.
We are gonna confirm with apelvic ultrasound, which is very
sensitive, meaning it can pickup things like fibroids very
(22:37):
easily, and so when someone hasa pelvic ultrasound they will go
to the radiology department andthere will be a probe that's
either placed on the abdomen orsometimes we use a vaginal probe
and basically that creates animage of the pelvic organs and
we can see the uterus.
We can see the ovaries.
(22:57):
Sometimes you can see the tubesa little bit.
You usually don't see those sowell on ultrasound unless
there's fluid or something inthem, but you can see the uterus
and then you can see, oh, thereis a large mass in the uterus
that shouldn't be there.
And, based on differentcriteria, we can know this is a
fibroid or this is assist on theovary and it's just kind of
(23:23):
smashing against the uterus.
So we're able to use tools tohelp us come to a diagnosis.
We can also use things likehistroscopy.
Now, again, that isn'tsomething that we would take
someone straight to, histroscopyand we can talk about what that
is also, but that is one waythat we can diagnose and treat
(23:46):
fibroids.
Maleeha (23:47):
Sure, and you kind of walked us through.
First it's patient history,then followed by a physical exam
pap smear.
The next step would be likeultrasound and potentially,
based on those findings, you godown different pathways.
Exactly, sounds like it.
But you mentioned histroscopy.
(24:07):
Deanna and I are familiar withthat.
We do those procedures all thetime.
Dionne (24:11):
Yeah, I didn't buy that.
Maleeha (24:14):
So, but in terms of explaining it, I'm going to
yield the floor to you.
Kiarra (24:20):
Absolutely so.
It's essentially anytime yousee the word scope in any
medical thing, there's a cameraof some sort involved.
So a histroscopy.
It sounds almost likehysterectomy but that generally
is a procedure when you hearthat hyster prefix is going to
(24:40):
be a procedure describing theuterus.
So a hysterectomy isessentially when we take a
surgical camera and we insert itthrough the cervix and then
into the uterus and it basicallyallows us to get a video
picture of the inside of theuterus so we can see the
(25:03):
openings of where the tubes openinto the uterus and we can see
the inside of the uterine cavity.
Generally in someone withoutfibroids it's just a very smooth
, I don't know.
It kind of looks like Mars,maybe.
I mean, maybe Mars isn't smooth, so maybe I should have said
(25:25):
Mars.
But it is a very the colormatches Very smooth the color
matches.
So it's a very smooth pinksurface and then, depending on
where a woman is in hermenstrual cycle, sometimes it'll
look a little fluffier, if youwill, but when we see fibroids
(25:46):
we'll basically see these almostlike outpouchings into the
uterine cavity, so it no longerlooks like a smooth surface and
so, as I mentioned, sometimesthat can be a way that we
diagnose a fibroid.
We may be taking someone for ahysterectomy for a completely
different reason and we say, oh,they have a small fibroid there
.
If we've gotten that far andnot realized that there was a
(26:07):
fibroid, they probably weren'tsymptomatic, or symptomatic to
the point where they noted it,or we didn't note any laboratory
abnormalities in terms ofanemia.
And so when we're at that point, if someone is coming say they
have known fibroids that areinside the uterus, we can
actually use hystereoscopy totreat as well and we can remove
(26:31):
fibroids, and we can also removethings that are known as polyps
that are inside the uterus aswell with the hystereoscopy.
Maleeha (26:39):
Sure, I mean for all of you guys listening out there.
It's kind of like thecolonoscopy for the uterus Right
and now it's changing.
Dionne (26:46):
You are under anesthesia .
Maleeha (26:48):
Yeah, you're under anesthesia, so don't worry, ok.
But I mean, I think people aremore familiar with colonoscopies
generally, but it's the sameidea we're taking a look and
we're seeing what we see andpotentially treating as well,
which is great.
Kiarra (27:03):
Exactly.
Maleeha (27:04):
You know, like you mentioned, there is a
possibility to treat the issuewhile you're doing the
hystereoscopy.
Is there?
Is hystereoscopy the go-to forsurgical removal of the fibroids
?
Are there other ways to exciseor melt the fibroids or make
them?
Kiarra (27:26):
You know, these days there are lots of options.
Back in the day when I say backin the day, let's say like
56,000 years ago people justthey got hysterectomies and
probably myomectomies to somepoint, but a lot of times people
just got a hysterectomy andthat was it.
You took the uterus out and youwere done.
Nowadays, you know, people havea lot more options, which I
(27:48):
think is great, because noteveryone wants to undergo a
major, definitive surgery.
The types of recommendationsthat we talk about in terms of
treatment depend on severalthings Depends on fibroid size
and location, and so this isthis is how I typically walk a
(28:09):
patient through.
What do we do now that you havefibroids?
So, first of all, again, ifthey're found, incidentally, and
or they're not bothering thepatient in terms of symptoms,
you really don't have to doanything at all.
If someone has a one centimeterfibroid and they're not having
any concerns, no heavy bleeding,we are not going.
(28:32):
Well, first, do no harm, right.
So we're not going like we'regoing to go take out this one
centimeter fibroid and just tosay you don't have a fibroid
there, so we don't always haveto do anything.
That is certainly a patientthat I would say hey, you have a
small fibroid.
It doesn't seem to be botheringyou now Keep an eye out on your
(28:53):
symptoms.
If you notice heavy bleeding,large clots that you have not
experienced before, changes inyour bladder and bowel function,
pain outside of your typicalmenstrual cramps, anything
that's unusual surrounding yourpelvic organs, any symptoms, let
(29:15):
us know.
This is not like, okay, youhave a small fibroid.
We never need to check again,because fibroids can absolutely
grow, and so that would be thetype of person that would be
what I would do for someone whois asymptomatic.
Even you know, if I always tellpatients fibroids or the uterus
is like a balloon, if you thinkof a balloon blown up, where
(29:35):
you blow the balloon into,that's like the cervix and the
rest of the balloon is like thebody of the uterus.
So sometimes people havefibroids that are hanging on the
outside of the balloon or onthe outside of the uterus.
Those don't typically causeproblems in terms of heavy
bleeding because they're notinside the cavity.
If large enough, those canoften cause things like the
(29:58):
pressure, you know, and the masseffect onto other organs, and
so even for someone like that,if they're not really having
symptoms of pressure or pain oryou know, like I said, they
probably aren't going totypically have heavy bleeding.
We don't necessarily have to doanything for those either.
Sure, because, again, this ismajor surgery.
(30:21):
If they're generally feelingwell, they don't have any anemia
, we don't necessarily have todo anything.
Now, for the people that do havesymptomatic fibroids, we can do
a variety of things, sure, andthose things are gonna depend,
like I said, on size, location.
What are their lab values?
(30:41):
Do they have significant anemia?
If someone comes in with ahemoglobin of seven and they are
49, they don't want more kidsand they're like I am done they
may just wanna opt for ahysterectomy, like they may say.
You know what it could beanother few years before I go
through menopause, I don't wannado this anymore, and so we
(31:03):
would optimize them beforesurgery and try and get their
hemoglobin values back up beforea surgical procedure.
But we may start with the mostconservative options.
So that may be something likemaking sure they're getting in
enough iron in their diet,making sure that they're getting
enough rest and diet andexercise, all those types of
(31:24):
basic things.
And then we may start withhormonal options.
So for some people they mayrespond really well to, say, a
hormonal IUD in terms of helpingwith heavy bleeding.
Then we could go on to for somepeople, something like an
endometrial ablation may behelpful, depending on where the
(31:44):
fibroids are.
That won't necessarily treatthe fibroids but for some people
with heavy menstrual bleeding,especially if those fibroids
aren't directly in the cavity,that may help their bleeding
profile.
Then we may go to something likea myomectomy and that is
removal of the fibroid.
(32:05):
That can be donehistroscopically, which we just
talked about.
If the fibroids are in thecavity of the uterus,
myomectomies can be donelaparoscopically, so going
through a small incision in thebelly.
They can be done through anopen surgical incision, so
almost like a C-section incision, where we make incisions, we
(32:28):
get to the uterus and then weexcise the fibroids that way.
And there are a lot of othertechniques.
There are radioactive ablationtechniques where, again via
laparoscopy, you basicallyinsert a probe directly into the
fibroid and the fibroids haveto be of a certain size and
(32:49):
that's why we initiallymentioned you have to know what,
the size, location and all thatso far in terms of making any
recommendations to begin with.
But with that procedure youinsert a probe into the fibroid
and it basically helps thefibroid to degenerate over time.
Yeah, so it doesn't happenright away.
It's not like you leave thehospital from your surgery and
(33:10):
you go the next day to have anultrasound and it's magically
disappeared.
But over time it will shrinkand there are things like
uterine artery embolizationthat's not something a
gynecologist would perform butour interventional radiology
colleagues would perform andthey basically go through the
major arteries in the groin andthey find the arteries that
(33:36):
supply the uterus, which are theuterine arteries, and they
essentially put a material intothe arteries to block them off
because, again, fibroids need ablood supply.
If they're cut off from theirblood supply, then they will
essentially degenerate andshrink over time.
So, with all of those oh andthen, ultimately a hysterectomy
(33:58):
would be the most definitivestep, which is completely
removing the entire uterus.
Depending on age, you don'thave to remove the ovaries
because you wouldn't wanna putsomeone into a surgical
menopause unnecessarily.
But so we would generally walkthrough all of those different
steps and, again, depending onwhere a person's fibroids are
(34:24):
the locations, are theirsymptoms.
We can recommend what wouldwork and then also get their
input.
It's their body.
Certainly, for someone who stilldecides or desires future
childbearing, we wouldn't wannado hysterectomy and generally we
(34:47):
wouldn't wanna do a uterineartery embolization, either for
someone who desires futurechildbearing, or an endometrial
ablation, because you'reliterally impacting things that
are necessary for a healthy termpregnancy.
So if you ablate theendometrium although there are
pregnancies that are documentedafter endometrial ablation but
(35:09):
they often have issues likegrowth restriction because the
placenta that's the interface ofwhen the baby implants into the
endometrium and the placentabegins to grow you can imagine,
if you've ablated theendometrium, that once a
pregnancy is established,implantation and what that looks
like may be potentially altered.
(35:30):
So there's a lot of differenttreatment options, which I think
is amazing because our patientsare not one size fits all.
Everyone leads different lives,everyone has a different
capacity for what they cantolerate with their body, and so
I think it's fantastic that wehave so many options.
Dionne (35:51):
Yeah, it is, and you hit on a major question that I was
gonna ask you and which was theimpact of treatment on fertility
and pregnancy.
But I do want to ask on thatsame vein, once you've had.
So let's say you are a womanwho wants to preserve fertility
(36:15):
and you get pregnant, what aresome things that you have to
consider?
I mean, are they at higher risk?
Can they have a vaginaldelivery?
Do they have to do a c-section?
Can you speak to that?
Kiarra (36:28):
Yeah.
So, for example, if someone wetalked about this a little bit
earlier say a person had afibroid in a place that was
impacting their fertility, theykept having pregnancy losses or
they just couldn't get pregnant,and so they underwent a
myomectomy with hopes ofremoving the fibroid to make,
(36:52):
essentially, a more friendlyenvironment inside of the uterus
, make more space for the babyto grow, potentially remove any
Hinderances that may beoccurring in the uterus, it's
all going to depend on Exactlyhow the myomectomy was done.
So let's just say I Told I gavethe balloon reference for the.
(37:14):
That is when I was.
I'm always drawing pictures.
I'm always drawing my littleballoons, a little arms hanging
off the side for the tubes ofthe ovaries.
But if we, if we can all imagine, if we imagine a balloon, and
now we're on the inside of theballoons, we have this big kind
of open, oval, circular space,imagine a string with a ball
(37:40):
hanging on it.
So that would be the example oflike one type of submucosal
fibroid.
So sometimes we go in historyvia Stroscopy and we can see
that we have this fibroid andit's on a stock, like it's on
this little string or a largerstring, and we can essentially
(38:01):
almost cut the string or cut thestock and then remove the
fibroid.
We haven't made any incisioninto the uterus or anything like
that.
So someone like that couldlikely go on and and have a full
term term pregnancy and wewouldn't have to be considering
(38:21):
any other options in terms ofmode of delivery.
Now say you have someone whohas a 10 centimeter fibroid and
the decision is made to whetherit's laparoscopically or Via an
open myomectomy, like thatC-section scar, and we have to
incise through the muscle of theuterus.
(38:41):
We've essentially created alarge scar now on the uterus to
get that fibroid out andalthough we've repaired it with
suture, it's still gonna be aweakened point in the uterine
muscle and for someone like that, we typically would not
recommend that they labor orhave a trial of labor to attempt
(39:01):
to have a vaginal delivery, asthere's an increased risk of
uterine rupture.
Maleeha (39:08):
Okay, wow, that was like.
Well, I think I got CME creditthere for like.
I need credits.
Okay, year is ending.
No, I learned a lot there, cuzI don't think you know I'm at
the head of the bed all the timedoing the anesthesia.
I don't think I was at allaware of how many options and
(39:28):
how tailored Specifically to thepatient these decisions are.
Yeah, which is why theseconversations are so incredibly
important, because it soundslike your options can be From
one end of the spectrum of leaveit alone to all the way to the
other end, which is aHistorectomy, and you have many
(39:50):
options in between that aretailored to not only what's
Medically appropriate, butwhat's appropriate for you, your
goals, your desires, yourcapacity to undergo care, all of
these things and I love that.
I mean that I didn't realize howmuch there is available to us.
Yeah you know, if you'relistening out there, definitely
(40:13):
have that conversationcontinuously with your OB guide.
I'm one last question I gottaask, cuz Deanna and I are really
into this now, and that's aboutlifestyle.
We have been making a lot oflifestyle modifications Since we
(40:33):
started this podcast becausewe've been getting some really
good insider tips that haveaffected us.
And you mentioned vitamin D.
We are all melanated, so I dofeel that I need to start taking
some vitamin D supplementation.
You're not the first doctor toTell me that, and that's funny
(40:54):
cuz I live in Phoenix, which islike I'm like there is no more
son.
That's possible.
Somehow my body's really goodat blocking vitamin D absorption
.
Kiarra (41:05):
Oh yeah.
Maleeha (41:07):
Yeah, so is there.
Are there any other lifestylechanges that one can make that
could maybe impact ourlikelihood of getting fibroids
or managing them?
Kiarra (41:18):
Yeah, I mean there's no, I wouldn't say there's like a
plethora of data on Do this andyour fibroids will magically go
away.
I've seen, you know somestudies here there's I know
right um, but you know that'snot surprising.
It's, it's a, it's a women'shealth issue, and you know.
Maleeha (41:39):
How much research is there?
Kiarra (41:42):
You know that's, that's a whole nother time.
Maleeha (41:43):
Yes.
Kiarra (41:45):
You know I've seen a few studies here and there that are
talking about plant-based dietsand that may help decrease the
risk of fibroids.
I've said for a while now, andI've mentioned this to a few
other people, I would reallylove to see a randomized control
trial Looking at plant-baseddiets and, for the listeners, a
(42:09):
randomized control trial is likethe gold standard in In
medicine when we're looking atstudies and things like that and
we're looking, we have a studygroup and then we have like a
control group and I would Iwould love to see the outcome of
Of people that have fibroidsthat have been given a
plant-based diet versus likekind of a typical American diet.
(42:31):
Yeah, and you know, might takea long, you know long time to
really see some results.
I'm not sure exactly how thatwould be conducted, but I have.
I have anecdotally have I've hadseveral patients that ate
plant-based and they came to meafter the fact with symptoms and
they were like I was doingreally great when I was vegan
(42:53):
for the past year and I startedeating meat again and Now I have
all these symptoms, my bleedingis heavy, etc.
And so I've I've I've had lotsof people anecdotally tell me
that they've noticed significantchanges in their Not
necessarily just if they've hadfibroids, but it's usually like
heavy menstrual bleeding.
(43:14):
They've had different.
They've noticed changes.
So I would love to see there besome more Really, really solid
evidence in terms of diet,because we always in medicine
are talking to people abouttheir diets and exercise and
yeah, it gets a little annoyingto hear when, when you go to the
doctor and you All they tellyou is lose weight, eat better,
(43:36):
and you're like, how OK, well,I'm trying to do that, but if
you can say, hey, we have seenthat this specifically will help
, I think that gives people alittle bit more hope and a
little bit more to hang on to.
So I would love to see some moreresearch in that area.
I think, in general, alwaysmaking sure you're exercising,
(43:57):
moving your body, good sleephygiene to kind of lower stress
levels I think all of that isjust generally beneficial for
everything.
For everything, yeah, and thenwe talked a little bit about
vitamin D.
So I think certainly vitamin Dsupplementation is probably
needed for many people,especially if you live in cold
(44:18):
cities like Chicago and thewinter is dark and no sun and
it's cold outside, but sovitamin D supplementation may be
helpful.
But even before you start, ifyou're doing a yearly checkup
and you're getting some bloodwork done, getting your vitamin
D level checked, kind of seeingwhere you are there so I think
(44:39):
all of those things can make adifference.
Dionne (44:41):
Absolutely, Dr Kira.
This has been such a wonderfulconversation.
I have learned so much, even asa physician, and I feel like I
just had my sidebar consult withyou and I know our audience has
just.
They're just going to walk awaywith so much more knowledge and
(45:02):
we just appreciate you comingon our show today.
We really do.
Kiarra (45:07):
Absolutely, absolutely.
It has been my pleasure.
Maleeha (45:11):
Woo, that was a lot.
I'm ready to talk to mypatients.
I feel like you're agynecologist now.
This is what always happens tome after one of these episodes.
Yeah, I feel like an honoraryobi-gyne and I'll start asking.
When I did the colonoscopy?
Dionne (45:28):
episode I was pushing colonoscopy on everybody.
Maleeha (45:34):
And there's one thing I do check, it's hemoglobin all
the time.
So, no, that's great advice.
We learned so much and I hopeeveryone listening walks away
feeling more knowledgeable andempowered to make informed
decisions and also understandthe importance of having these
conversations with your doctor.
Definitely find a doctor youtrust that will help you through
(45:57):
the journey.
I think that it's importantthat you feel comfortable
talking to them.
You feel like your concerns arebeing heard.
I think that's very important.
And if you do have fibroids,it's more than just a physical
issue.
It could be impacting yourfamily planning.
It could be impacting yourmental health.
It's not just the fibroid thatneeds to be addressed.
Dionne (46:19):
Absolutely.
Maleeha (46:20):
Yeah, that ends today's segment For more IV drip, head
to our website at theivdripco orfollow us on Instagram at
theivdrip underscore podcast.
Email us your questions andcomments at the info at
theivdripco or send us a DM.
We love hearing from you all,so share with us your
experiences.
(46:40):
Most importantly, don't forgetto subscribe to our podcast.
You can find it on allstreaming platforms.
Leave a review and spread thelove.
Dionne (46:50):
Now for the tip of the day.
Dr Kira, will you do us thehonor?
Kiarra (46:56):
Absolutely.
This is short and sweet.
My tip of the day is startsomewhere.
You know that thing that you'vebeen needing to do, that you've
been putting off and you keepsaying I'm going to do it
tomorrow, I'm going to startnext week.
Start it right now.
Maybe not at 8 30 tonight,Maybe you can start tomorrow.
Dionne (47:18):
But start Love it.
I love that.
Maleeha (47:22):
You were speaking to me , I know.
I kind of felt like you weretalking to me a little bit.
I was like, listen, I'm talkingto myself, I'm going to start
tomorrow.
Maleeha.
You may be able to relate tothis, given that you and I are
both first generation Americans.
When I got my period for thefirst time, my mom sat me down
and told me about this milestonein my development from
adolescence to womanhood.
She explained the implicationsand, as a very strict immigrant
(00:20):
mother, it was mainly a warningthat now I'm able to get
pregnant and I had better, notPeriod Pretty straightforward, I
mean.
She also explained how to carefor myself and the products I'd
need and how to use them.
But that was basically all thediscussion surrounding periods
(00:41):
for me.
Maleeha (00:42):
Oh, you know, Dionne, I actually remember a very matter
of fact short version down,very down to business.
I think it left me with waymore questions than answers in
truth.
But you know, like a true goodimmigrant child, I was like not
about to ask my mom any of thosequestions, like I saved them
(01:03):
for my friends.
But thank God we actually had anurse in fifth grade who gave
us our talk, the talk.
I don't know if they do thatanymore, but thank God for her.
Dionne (01:16):
Yeah, that.
Yeah, we have that too, I meanwe have to look out for our
safety because there's certainyou have cousins for that.
But anyways, clearly, as I gotolder, I noticed symptoms of
cramping, heavier men's sees attimes and sometimes pain.
It wasn't until college that Ihad an ultrasound done and they
(01:39):
discovered that I had a fibroid.
I then became one of 26 millionwomen in America who have this
condition.
It's estimated that one in fourwomen will get a fibroid.
It is one of the most commonpelvic conditions affecting
women around the world, and formany it can come with
debilitating symptoms.
Maleeha (01:59):
Absolutely Dionne.
I mean, I think this is areally important topic that
doesn't get discussed enough,even though it affects so many
women.
I think it's just assumedperiods equal pain.
Dionne (02:13):
Right, yeah, right, and we're always hysterical, right?
That's always good.
Kiarra (02:20):
That's a whole other topic.
Dionne (02:25):
But anyways, today we have the pleasure of having Dr P
R King, a board certifiedobstetric and gynecology
physician based in Chicago, toshare her expertise on this
common condition in the realm ofwomen's health.
We are so lucky to have her, asshe is a sought after media
expert in the women's health andwellness space.
(02:45):
She's also a speaker anddigital content creator,
focusing on fashion, wellnessand lifestyle.
She passionately cares forwomen and believes that
education is empowerment, andactively works to ensure her
community is informed.
So join us on this episodewhere we really get into this
topic of fibroids.
Maleeha (03:08):
This is the IV drip, a podcast designed to give you the
dish on health topics you needto know, but didn't know to ask.
Dionne (03:18):
We are your hosts, Dr Malihem Mohidin and Dr Deanna
Becky, both Harvard, trainanesthesiologists and besties.
Join us as we explore hottopics that are rarely discussed
but can have a huge impact onyour life.
Maleeha (03:32):
Dr King, welcome to our podcast.
Kiarra (03:35):
Thank you so much for having me.
I'm really excited to be onwith you all and talk about this
topic.
It's something we see all thetime clinically, but sometimes
the general public won't reallyknow as much about fibroids.
They'll know they're havingsymptoms, but they won't really
know what the symptoms mean.
(03:57):
So I'm really glad that we'llbe able to break some of that
down today.
Maleeha (04:01):
Oh, you are so right.
I mean, I think, reflectingback on just what Dionne said
about her conversation with hermom, it's pretty common to just
get like the bare minimum aboutthe basics of women's health,
and not even that much of it.
And it's really not until weencounter a problem in our own
(04:22):
health that we even begin tolearn about the conditions that
are specific to women's health.
You know, and although now wehave social media and platforms
like ours, wink Wink and yourswe hope that's starting to
change that there's more outletsout there and more access to
information.
Kiarra (04:42):
Absolutely.
I couldn't agree more.
A lot of my time when I wasclinically active, and even now,
is spent educating whetherthat's educating via social
media, as you mentioned.
I have so many friends.
I'm like their personal, likecurbside console, yes, and I get
so many, so many text messageslike hey, my doctor said this,
(05:06):
or my fibroids are this size, orwould you take a really quick
look at my ultrasound report.
But you know, not everyone hasaccess to a friend who's a
gynecologist and so you know Ilove to be able to share
information currently, you know,via social media or my blog
that is relatable and thatpeople can get actual
(05:27):
information from.
I know you all can imaginePeople are.
You know, they go go to GoogleUniversity, youtube University,
and they get a lot ofinformation and listen.
I can fully appreciate thatbecause they're generally is a
paucity of information, orpeople do go to their doctor's
(05:49):
office and they don't feel likethey're heard or that they get
questions answered.
The people are just, they'regenuinely searching for
information, for something tomake what they're going through
make sense, and so I can providesome insight on on that in any
way here via you all's wonderfulpodcast, then I'm always happy
to do so.
Maleeha (06:10):
Well, we appreciate it.
Dionne (06:13):
Absolutely.
Our audience is lucky to haveyou.
They get a glimpse of what youdo in the clinic and what your
friends get to know.
So we are so happy to have you.
Maleeha (06:23):
Let's get into it.
Dionne (06:25):
Shall we.
Maleeha (06:26):
So let's start at the basics, and you're going to have
to break this down into laymanspeak.
You know no medical speak here.
Okay, so what exactly arefibroids?
I mean, we've heard this termthrown around, but what does it
really mean?
Kiarra (06:43):
So fibroids I'm going to use the medical term simply
because sometimes people lookthese up and they see it and
they're like well, what is that?
It's the medical term sounds alot more scary or Leioma.
They are not malignant, whichmeans they are not cancer, and
they're basically benign tumorsof the uterus, of the smooth
(07:05):
muscle of the uterus, andthey're very common and
reproductive age women they'rethe most common pelvic mass in
reproductive age women.
Yep.
Dionne (07:17):
Wow, I actually did not know that and you're right.
When people hear that wordtumor, they get so scared and,
like you said, they go to Googleuniversity to get more
information and sometimesthey're wrong information.
But can they become malignant?
Can fibroids convert?
Maleeha (07:35):
Cancerous yes.
Kiarra (07:37):
So the likelihood of finding cancer in a fibroid is
incredibly small.
When I was in training, wealways just quote it less than
1% just because that was a.
You know that it is less than1%, but it's really less than
like 0.1%, which is really tinythat there would be cancer found
(08:00):
in a fibroid.
Now there are other cancerousgrowths of the uterus but again,
typically fibroids are notcancerous at all.
Dionne (08:12):
That is reassuring.
That is reassuring.
Yeah, it's 0.1%.
Maleeha (08:15):
It's like one in 1,000.
Dionne (08:17):
Yes, exactly Right.
Maleeha (08:19):
Okay, so we mentioned earlier that about one in four
women can develop fibroids,which is a much higher statistic
.
Who are the women that are athigh risk for getting these, and
is this a hereditary issue, oris it a population, like certain
segments of the population aremore prone to fibroids?
(08:42):
Can you elaborate on that?
Kiarra (08:45):
So, as I mentioned a little bit earlier, women of
reproductive age are at thehighest risks.
Fibroids are hormonallydependent and so in someone who
is an adolescent or prepuberantor someone who is postmenopausal
, you're not having thoseeffects of the female
(09:06):
reproductive hormones on theuterus that Sure have the
potential to promote or enhancefibroid growth.
So definitely, age, familyhistory can be one.
Black women, african Americanwomen are at a higher risk, and
(09:27):
obesity can be another factorAgain, because women with higher
BMIs have more fat, which canbasically store more estrogen,
which can again enhance thegrowth of fibroids.
Dionne (09:42):
Hmm, Can I just say you just made me look forward to
menopause.
Well then, you At least there'sone positive thing about it,
right?
Kiarra (09:51):
We'll have to come back so we can talk about menopause.
And then you maybe yes, Paulyou maybe kind of figure out do
I want to switch back?
Do I want to switch back?
Dionne (09:58):
I might take back my words.
Take your answer back.
Yeah Well, you brought up thatAfrican American women in
particular tend to have a higherrisk and we know, with a lot of
medical conditions, africanAmericans tend to be impacted
more significantly.
Why, with fibroids?
(10:19):
Why, in this case, do AfricanAmericans tend to have a higher
risk of developing fibroid?
Kiarra (10:25):
Sure, so it's not fully known.
Some of the things we do knoware that black women tend to
suffer from fibroids more thantheir white counterparts.
There was an article in theGray Journal and for those of
you who are like, what is theGray Journal?
It's a major publication withinthe world of OB-GYN it's the
(10:48):
American Journal of Obstetricsand Gynecology, and one of the
articles I read, they noted that, despite the racial differences
in symptoms and incidents,relatively little data have been
published regarding thebiological basis of fibroids in
African American women, and inthat same article they mentioned
that African American womenwere two to three times more
(11:11):
likely to undergo hysterectomyfor fibroids than other racial
groups.
And another interesting thing isoften they have more severe
symptoms at the time of clinicalpresentation.
There's also some growingevidence that vitamin D
deficiency and its subsequentcorrection may impact fibroid
(11:38):
size, and so when you thinkabout who may be at higher risk
for vitamin D deficiency, youcan look at people that have
more melanin in their skin.
So you have to wonder how deepis that correlation?
And I think certainly there'smore studies that are needed to
(11:59):
really kind of get down to thenitty gritty of how all of that
works.
Because if vitamin D is a majorfactor, then that's something
we can easily target and prevent.
Maleeha (12:12):
Yeah, absolutely, that's very interesting.
Vitamin D.
I mean, that's like super ontrend too.
I feel like everything isvitamin D related to a vitamin D
deficiency, so that's a reallyinteresting point, I mean, okay,
so what are some commonsymptoms of fibroids?
I know Dionne mentioned earliershe had cramping and abnormal
(12:34):
periods.
What are some other commonsigns and symptoms?
Kiarra (12:39):
So for many women fibroids are asymptomatic,
meaning they don't have symptomsat all.
They have no idea that thefibroid is there, the only
reason they know they mayundergo an ultrasound.
Let's say they find out,they're pregnant and they're
having their first ultrasoundand it's noted that there's a
fibroid there, but prior to thatthey had no idea.
(13:01):
So the people that do tend tohave symptoms will have heavy
periods, painful periods.
They may have pain or pressureoutside of their menstrual cycle
.
So many women will have crampingwith their menstrual cycle, but
they may have pain or pressurethat exists all month, or all
(13:25):
year for that matter.
They may have pressure on thebladder so they may have to go
to the bathroom more frequentlybecause the fibroid is pressing
into the bladder, or they mayhave constipation or difficulty
having bowel movements.
For the same reason, I alwaystell people if you can imagine
(13:46):
looking at someone on the side.
The bladder sits towards thefront of the body, the uterus is
sandwiched in between andbasically the rectum is behind,
and so you can imagine if youhave this really big and bulky
uterus, it might press on thebladder in the front or may
press on the rectum behind andit can cause some intestinal
(14:10):
issues there and for some peoplethey can have pain that is
radiating pain.
I know you all asanesthesiologists, know all
about radiation, pain radiating,but some people can have pain
radiating down their back.
I wouldn't say it's exclusiveto fibroids, but certainly one
may be more likely to have moresignificant pain with fibroids
(14:33):
than someone who doesn't.
Wow.
Dionne (14:36):
You know, compared to this list, when I think back to
the symptoms that I mentioned, Ithink I had a pretty mild Thank
God.
I can't imagine dealing withhalf of these things, to be
honest.
Kiarra (14:48):
So a lot of these symptoms can be downright
debilitating for some people,and I actually did mention some
people develop shortness ofbreath or lightheadedness.
Some people actually pass outbecause of the heavy menstrual
bleeding.
It can lead to symptomaticanemia, which can cause all of
(15:08):
those symptoms shortness ofbreath, lightheadedness and
sometimes that is the first timepeople find out that they have
fibroids because they're walkingaround and they're totally
exhausted and fatigued and outof breath for so long.
And they just chalk it up toI've been working really hard at
work, or I'm a mom and I'malways busy and I'm always
(15:29):
exhausted.
And they finally go get checkedout and their doctor's like
we're going to run a few tests.
All your blood counts seven.
What's going on?
Are your periods heavy?
Well, not really.
Or they've been that way all mylife.
So I didn't really think muchof it.
(15:50):
Lo and behold, they go and havean ultrasound and they have
large fibroids that are leadingto heavy bleeding and
symptomatic anemia, and so theycan absolutely be debilitating
for some.
Maleeha (16:04):
I have seen this firsthand.
So much, deanna.
I was just telling you thisstory.
I had a friend who's literallya friend who's a physician and
her sister is a teacher andworks.
you know how teachers work shortof breath, dizzy chalked it up
to overwork, went to get labsand her hemoglobin was six,
(16:27):
which is really low for those ofyou who are out there and you
know, I think this wasinteresting about women's health
and this is why it's soimportant to talk about this
stuff is that these things areso related to our overall health
.
For women, you absolutely haveto ask these questions, and
you're right.
Like how would you know you'remenstruating too much if you're
only looking at your own pads,and you know what I mean?
(16:49):
Like who are you comparing itto?
Exactly, exactly, and these areso important and it is important
that you go to a provider whois paying attention to these
things, who was watching yourblood counts, and have these
conversations.
You know, and fibroids canaffect things that a lot of
women are dealing with now, likefertility, and can you talk a
(17:12):
little bit to us about how yousee fibroids affecting fertility
in women?
Kiarra (17:17):
Absolutely so.
Fibroids can impact fertilityas well as pregnancy for some
women who are dealing withinfertility and fibroids.
If those fibroids are in aplace that are one blocking the
openings of the fallopian tube,that can make it challenging for
sperm to reach the egg or for afertilized egg to get back into
(17:42):
the uterus and implant properly.
Additionally, if the fibroidsaren't really in the areas of
the tubal openings and they are,say, scattered throughout the
uterus, that can make it not aseasy for a fertilized egg to
find a place that's nice toimplant.
And so this sometimes willhappen with patients who have.
(18:07):
They can even have smallfibroids.
So sometimes people think like,oh, I have this one big fibroid
, it's really bad.
Sometimes even smaller fibroids.
If they're multiple and they'rekind of scattered throughout the
uterus, it can make it hard,once an egg has been fertilized,
for that embryo to find a placeto implant, so they may have a
(18:29):
higher risk of pregnancy loss inthat case, when someone does
become pregnant with fibroids inplace, then, like I mentioned a
little bit earlier, typicallyan ultrasound will be done most
of the times in early pregnancyand if fibroids are noted, then
(18:49):
that is someone that we're gonnamonitor throughout pregnancy,
because fibroids for some peoplecan grow during pregnancy, for
some people they can stay thesame size and for some people
they'll shrink or what we'llcall degenerate.
And so the biggest thing we'reconcerned about is the fibroid's
growing because, especially ifyou're already starting off with
(19:11):
a large fibroid, if thatfibroid continues to grow now
you're concerned is that fibroidgrowth going to impact the
growth of the fetus, and so thegrowth ultrasounds will allow us
to look at the fibroid size,look at the size of the baby,
make sure baby seems to still bedoing okay in terms of all of
(19:31):
the growth parameters.
Dionne (19:33):
Yeah, I had someone close to me deal with that exact
scenario where her fibroid wasgrowing during pregnancy and she
had to get on bed rest.
Luckily, baby made it to term,she had a safe delivery, but it
was scary.
It was scary for her.
So you're absolutely right.
(19:54):
I mean these are things againthat we don't learn about, even
when we do our women's healthclasses in fifth grade, right?
So this is super important, I'mjust saying, because there's
just so much related to fibroidsthat you don't learn about.
So I'm glad we're talking aboutit.
Maleeha (20:17):
I mean, which highlights the importance of
pre-dental care right.
I mean that's another episodeentirely, but you definitely
pointed out the importance ofmonitoring things serially and
understanding it's a dynamicprocess and the importance of
kind of having that continuum ofcare is so critical.
Dionne (20:37):
So how are fibroids diagnosed?
I mean, you mentioned it alittle bit, but if you can kind
of be more specific, you know,like the different modalities,
maybe the different ways.
Kiarra (20:48):
So generally, a patient's gonna come in to the
office and they may be comingfor an annual wellness exam.
They may be coming with aconcern for an annual wellness
exam.
If the patient is not aware ofany fibroids and we're doing a
(21:09):
pelvic exam, we may find them.
Incidentally, meaning we happento feel something unusual, we
feel a mass, we feel somethingsolid that doesn't quite feel
like the uterus and the patienthadn't reported any symptoms.
Or the patient may be comingand they may say for the past
six months I've had really heavyperiods, I'm passing clots I
(21:32):
never passed large clots before.
I'm peeing all the time inwhich we say, okay, we're gonna
check things out, we'll do anexam, we'll get some labs and
then we'll do an ultrasound.
So a pelvic exam is absolutelyone way.
If you've ever had a pap smear,part of the pelvic exam is
(21:55):
using a speculum and then theother part is when the physician
or midwife or nurse uses theirhands to palpate inside the
vagina and on top of the abdomenand what we're feeling for is
the uterine position, theuterine size we're feeling.
Do we feel any masses nearwhere the ovaries are?
(22:16):
So that's one way Probably themost typical way that we will
confirm if we suspected it onpelvic exam.
We are gonna confirm with apelvic ultrasound, which is very
sensitive, meaning it can pickup things like fibroids very
(22:37):
easily, and so when someone hasa pelvic ultrasound they will go
to the radiology department andthere will be a probe that's
either placed on the abdomen orsometimes we use a vaginal probe
and basically that creates animage of the pelvic organs and
we can see the uterus.
We can see the ovaries.
(22:57):
Sometimes you can see the tubesa little bit.
You usually don't see those sowell on ultrasound unless
there's fluid or something inthem, but you can see the uterus
and then you can see, oh, thereis a large mass in the uterus
that shouldn't be there.
And, based on differentcriteria, we can know this is a
fibroid or this is assist on theovary and it's just kind of
(23:23):
smashing against the uterus.
So we're able to use tools tohelp us come to a diagnosis.
We can also use things likehistroscopy.
Now, again, that isn'tsomething that we would take
someone straight to, histroscopyand we can talk about what that
is also, but that is one waythat we can diagnose and treat
(23:46):
fibroids.
Maleeha (23:47):
Sure, and you kind of walked us through.
First it's patient history,then followed by a physical exam
pap smear.
The next step would be likeultrasound and potentially,
based on those findings, you godown different pathways.
Exactly, sounds like it.
But you mentioned histroscopy.
(24:07):
Deanna and I are familiar withthat.
We do those procedures all thetime.
Dionne (24:11):
Yeah, I didn't buy that.
Maleeha (24:14):
So, but in terms of explaining it, I'm going to
yield the floor to you.
Kiarra (24:20):
Absolutely so.
It's essentially anytime yousee the word scope in any
medical thing, there's a cameraof some sort involved.
So a histroscopy.
It sounds almost likehysterectomy but that generally
is a procedure when you hearthat hyster prefix is going to
(24:40):
be a procedure describing theuterus.
So a hysterectomy isessentially when we take a
surgical camera and we insert itthrough the cervix and then
into the uterus and it basicallyallows us to get a video
picture of the inside of theuterus so we can see the
(25:03):
openings of where the tubes openinto the uterus and we can see
the inside of the uterine cavity.
Generally in someone withoutfibroids it's just a very smooth
, I don't know.
It kind of looks like Mars,maybe.
I mean, maybe Mars isn't smooth, so maybe I should have said
(25:25):
Mars.
But it is a very the colormatches Very smooth the color
matches.
So it's a very smooth pinksurface and then, depending on
where a woman is in hermenstrual cycle, sometimes it'll
look a little fluffier, if youwill, but when we see fibroids
(25:46):
we'll basically see these almostlike outpouchings into the
uterine cavity, so it no longerlooks like a smooth surface and
so, as I mentioned, sometimesthat can be a way that we
diagnose a fibroid.
We may be taking someone for ahysterectomy for a completely
different reason and we say, oh,they have a small fibroid there
.
If we've gotten that far andnot realized that there was a
(26:07):
fibroid, they probably weren'tsymptomatic, or symptomatic to
the point where they noted it,or we didn't note any laboratory
abnormalities in terms ofanemia.
And so when we're at that point, if someone is coming say they
have known fibroids that areinside the uterus, we can
actually use hystereoscopy totreat as well and we can remove
(26:31):
fibroids, and we can also removethings that are known as polyps
that are inside the uterus aswell with the hystereoscopy.
Maleeha (26:39):
Sure, I mean for all of you guys listening out there.
It's kind of like thecolonoscopy for the uterus Right
and now it's changing.
Dionne (26:46):
You are under anesthesia .
Maleeha (26:48):
Yeah, you're under anesthesia, so don't worry, ok.
But I mean, I think people aremore familiar with colonoscopies
generally, but it's the sameidea we're taking a look and
we're seeing what we see andpotentially treating as well,
which is great.
Kiarra (27:03):
Exactly.
Maleeha (27:04):
You know, like you mentioned, there is a
possibility to treat the issuewhile you're doing the
hystereoscopy.
Is there?
Is hystereoscopy the go-to forsurgical removal of the fibroids
?
Are there other ways to exciseor melt the fibroids or make
them?
Kiarra (27:26):
You know, these days there are lots of options.
Back in the day when I say backin the day, let's say like
56,000 years ago people justthey got hysterectomies and
probably myomectomies to somepoint, but a lot of times people
just got a hysterectomy andthat was it.
You took the uterus out and youwere done.
Nowadays, you know, people havea lot more options, which I
(27:48):
think is great, because noteveryone wants to undergo a
major, definitive surgery.
The types of recommendationsthat we talk about in terms of
treatment depend on severalthings Depends on fibroid size
and location, and so this isthis is how I typically walk a
(28:09):
patient through.
What do we do now that you havefibroids?
So, first of all, again, ifthey're found, incidentally, and
or they're not bothering thepatient in terms of symptoms,
you really don't have to doanything at all.
If someone has a one centimeterfibroid and they're not having
any concerns, no heavy bleeding,we are not going.
(28:32):
Well, first, do no harm, right.
So we're not going like we'regoing to go take out this one
centimeter fibroid and just tosay you don't have a fibroid
there, so we don't always haveto do anything.
That is certainly a patientthat I would say hey, you have a
small fibroid.
It doesn't seem to be botheringyou now Keep an eye out on your
(28:53):
symptoms.
If you notice heavy bleeding,large clots that you have not
experienced before, changes inyour bladder and bowel function,
pain outside of your typicalmenstrual cramps, anything
that's unusual surrounding yourpelvic organs, any symptoms, let
(29:15):
us know.
This is not like, okay, youhave a small fibroid.
We never need to check again,because fibroids can absolutely
grow, and so that would be thetype of person that would be
what I would do for someone whois asymptomatic.
Even you know, if I always tellpatients fibroids or the uterus
is like a balloon, if you thinkof a balloon blown up, where
(29:35):
you blow the balloon into,that's like the cervix and the
rest of the balloon is like thebody of the uterus.
So sometimes people havefibroids that are hanging on the
outside of the balloon or onthe outside of the uterus.
Those don't typically causeproblems in terms of heavy
bleeding because they're notinside the cavity.
If large enough, those canoften cause things like the
(29:58):
pressure, you know, and the masseffect onto other organs, and
so even for someone like that,if they're not really having
symptoms of pressure or pain oryou know, like I said, they
probably aren't going totypically have heavy bleeding.
We don't necessarily have to doanything for those either.
Sure, because, again, this ismajor surgery.
(30:21):
If they're generally feelingwell, they don't have any anemia
, we don't necessarily have todo anything.
Now, for the people that do havesymptomatic fibroids, we can do
a variety of things, sure, andthose things are gonna depend,
like I said, on size, location.
What are their lab values?
(30:41):
Do they have significant anemia?
If someone comes in with ahemoglobin of seven and they are
49, they don't want more kidsand they're like I am done they
may just wanna opt for ahysterectomy, like they may say.
You know what it could beanother few years before I go
through menopause, I don't wannado this anymore, and so we
(31:03):
would optimize them beforesurgery and try and get their
hemoglobin values back up beforea surgical procedure.
But we may start with the mostconservative options.
So that may be something likemaking sure they're getting in
enough iron in their diet,making sure that they're getting
enough rest and diet andexercise, all those types of
(31:24):
basic things.
And then we may start withhormonal options.
So for some people they mayrespond really well to, say, a
hormonal IUD in terms of helpingwith heavy bleeding.
Then we could go on to for somepeople, something like an
endometrial ablation may behelpful, depending on where the
(31:44):
fibroids are.
That won't necessarily treatthe fibroids but for some people
with heavy menstrual bleeding,especially if those fibroids
aren't directly in the cavity,that may help their bleeding
profile.
Then we may go to something likea myomectomy and that is
removal of the fibroid.
(32:05):
That can be donehistroscopically, which we just
talked about.
If the fibroids are in thecavity of the uterus,
myomectomies can be donelaparoscopically, so going
through a small incision in thebelly.
They can be done through anopen surgical incision, so
almost like a C-section incision, where we make incisions, we
(32:28):
get to the uterus and then weexcise the fibroids that way.
And there are a lot of othertechniques.
There are radioactive ablationtechniques where, again via
laparoscopy, you basicallyinsert a probe directly into the
fibroid and the fibroids haveto be of a certain size and
(32:49):
that's why we initiallymentioned you have to know what,
the size, location and all thatso far in terms of making any
recommendations to begin with.
But with that procedure youinsert a probe into the fibroid
and it basically helps thefibroid to degenerate over time.
Yeah, so it doesn't happenright away.
It's not like you leave thehospital from your surgery and
(33:10):
you go the next day to have anultrasound and it's magically
disappeared.
But over time it will shrinkand there are things like
uterine artery embolizationthat's not something a
gynecologist would perform butour interventional radiology
colleagues would perform andthey basically go through the
major arteries in the groin andthey find the arteries that
(33:36):
supply the uterus, which are theuterine arteries, and they
essentially put a material intothe arteries to block them off
because, again, fibroids need ablood supply.
If they're cut off from theirblood supply, then they will
essentially degenerate andshrink over time.
So, with all of those oh andthen, ultimately a hysterectomy
(33:58):
would be the most definitivestep, which is completely
removing the entire uterus.
Depending on age, you don'thave to remove the ovaries
because you wouldn't wanna putsomeone into a surgical
menopause unnecessarily.
But so we would generally walkthrough all of those different
steps and, again, depending onwhere a person's fibroids are
(34:24):
the locations, are theirsymptoms.
We can recommend what wouldwork and then also get their
input.
It's their body.
Certainly, for someone who stilldecides or desires future
childbearing, we wouldn't wannado hysterectomy and generally we
(34:47):
wouldn't wanna do a uterineartery embolization, either for
someone who desires futurechildbearing, or an endometrial
ablation, because you'reliterally impacting things that
are necessary for a healthy termpregnancy.
So if you ablate theendometrium although there are
pregnancies that are documentedafter endometrial ablation but
(35:09):
they often have issues likegrowth restriction because the
placenta that's the interface ofwhen the baby implants into the
endometrium and the placentabegins to grow you can imagine,
if you've ablated theendometrium, that once a
pregnancy is established,implantation and what that looks
like may be potentially altered.
(35:30):
So there's a lot of differenttreatment options, which I think
is amazing because our patientsare not one size fits all.
Everyone leads different lives,everyone has a different
capacity for what they cantolerate with their body, and so
I think it's fantastic that wehave so many options.
Dionne (35:51):
Yeah, it is, and you hit on a major question that I was
gonna ask you and which was theimpact of treatment on fertility
and pregnancy.
But I do want to ask on thatsame vein, once you've had.
So let's say you are a womanwho wants to preserve fertility
(36:15):
and you get pregnant, what aresome things that you have to
consider?
I mean, are they at higher risk?
Can they have a vaginaldelivery?
Do they have to do a c-section?
Can you speak to that?
Kiarra (36:28):
Yeah.
So, for example, if someone wetalked about this a little bit
earlier say a person had afibroid in a place that was
impacting their fertility, theykept having pregnancy losses or
they just couldn't get pregnant,and so they underwent a
myomectomy with hopes ofremoving the fibroid to make,
(36:52):
essentially, a more friendlyenvironment inside of the uterus
, make more space for the babyto grow, potentially remove any
Hinderances that may beoccurring in the uterus, it's
all going to depend on Exactlyhow the myomectomy was done.
So let's just say I Told I gavethe balloon reference for the.
(37:14):
That is when I was.
I'm always drawing pictures.
I'm always drawing my littleballoons, a little arms hanging
off the side for the tubes ofthe ovaries.
But if we, if we can all imagine, if we imagine a balloon, and
now we're on the inside of theballoons, we have this big kind
of open, oval, circular space,imagine a string with a ball
(37:40):
hanging on it.
So that would be the example oflike one type of submucosal
fibroid.
So sometimes we go in historyvia Stroscopy and we can see
that we have this fibroid andit's on a stock, like it's on
this little string or a largerstring, and we can essentially
(38:01):
almost cut the string or cut thestock and then remove the
fibroid.
We haven't made any incisioninto the uterus or anything like
that.
So someone like that couldlikely go on and and have a full
term term pregnancy and wewouldn't have to be considering
(38:21):
any other options in terms ofmode of delivery.
Now say you have someone whohas a 10 centimeter fibroid and
the decision is made to whetherit's laparoscopically or Via an
open myomectomy, like thatC-section scar, and we have to
incise through the muscle of theuterus.
(38:41):
We've essentially created alarge scar now on the uterus to
get that fibroid out andalthough we've repaired it with
suture, it's still gonna be aweakened point in the uterine
muscle and for someone like that, we typically would not
recommend that they labor orhave a trial of labor to attempt
(39:01):
to have a vaginal delivery, asthere's an increased risk of
uterine rupture.
Maleeha (39:08):
Okay, wow, that was like.
Well, I think I got CME creditthere for like.
I need credits.
Okay, year is ending.
No, I learned a lot there, cuzI don't think you know I'm at
the head of the bed all the timedoing the anesthesia.
I don't think I was at allaware of how many options and
(39:28):
how tailored Specifically to thepatient these decisions are.
Yeah, which is why theseconversations are so incredibly
important, because it soundslike your options can be From
one end of the spectrum of leaveit alone to all the way to the
other end, which is aHistorectomy, and you have many
(39:50):
options in between that aretailored to not only what's
Medically appropriate, butwhat's appropriate for you, your
goals, your desires, yourcapacity to undergo care, all of
these things and I love that.
I mean that I didn't realize howmuch there is available to us.
Yeah you know, if you'relistening out there, definitely
(40:13):
have that conversationcontinuously with your OB guide.
I'm one last question I gottaask, cuz Deanna and I are really
into this now, and that's aboutlifestyle.
We have been making a lot oflifestyle modifications Since we
(40:33):
started this podcast becausewe've been getting some really
good insider tips that haveaffected us.
And you mentioned vitamin D.
We are all melanated, so I dofeel that I need to start taking
some vitamin D supplementation.
You're not the first doctor toTell me that, and that's funny
(40:54):
cuz I live in Phoenix, which islike I'm like there is no more
son.
That's possible.
Somehow my body's really goodat blocking vitamin D absorption
.
Kiarra (41:05):
Oh yeah.
Maleeha (41:07):
Yeah, so is there.
Are there any other lifestylechanges that one can make that
could maybe impact ourlikelihood of getting fibroids
or managing them?
Kiarra (41:18):
Yeah, I mean there's no, I wouldn't say there's like a
plethora of data on Do this andyour fibroids will magically go
away.
I've seen, you know somestudies here there's I know
right um, but you know that'snot surprising.
It's, it's a, it's a women'shealth issue, and you know.
Maleeha (41:39):
How much research is there?
Kiarra (41:42):
You know that's, that's a whole nother time.
Maleeha (41:43):
Yes.
Kiarra (41:45):
You know I've seen a few studies here and there that are
talking about plant-based dietsand that may help decrease the
risk of fibroids.
I've said for a while now, andI've mentioned this to a few
other people, I would reallylove to see a randomized control
trial Looking at plant-baseddiets and, for the listeners, a
(42:09):
randomized control trial is likethe gold standard in In
medicine when we're looking atstudies and things like that and
we're looking, we have a studygroup and then we have like a
control group and I would Iwould love to see the outcome of
Of people that have fibroidsthat have been given a
plant-based diet versus likekind of a typical American diet.
(42:31):
Yeah, and you know, might takea long, you know long time to
really see some results.
I'm not sure exactly how thatwould be conducted, but I have.
I have anecdotally have I've hadseveral patients that ate
plant-based and they came to meafter the fact with symptoms and
they were like I was doingreally great when I was vegan
(42:53):
for the past year and I startedeating meat again and Now I have
all these symptoms, my bleedingis heavy, etc.
And so I've I've I've had lotsof people anecdotally tell me
that they've noticed significantchanges in their Not
necessarily just if they've hadfibroids, but it's usually like
heavy menstrual bleeding.
(43:14):
They've had different.
They've noticed changes.
So I would love to see there besome more Really, really solid
evidence in terms of diet,because we always in medicine
are talking to people abouttheir diets and exercise and
yeah, it gets a little annoyingto hear when, when you go to the
doctor and you All they tellyou is lose weight, eat better,
(43:36):
and you're like, how OK, well,I'm trying to do that, but if
you can say, hey, we have seenthat this specifically will help
, I think that gives people alittle bit more hope and a
little bit more to hang on to.
So I would love to see some moreresearch in that area.
I think, in general, alwaysmaking sure you're exercising,
(43:57):
moving your body, good sleephygiene to kind of lower stress
levels I think all of that isjust generally beneficial for
everything.
For everything, yeah, and thenwe talked a little bit about
vitamin D.
So I think certainly vitamin Dsupplementation is probably
needed for many people,especially if you live in cold
(44:18):
cities like Chicago and thewinter is dark and no sun and
it's cold outside, but sovitamin D supplementation may be
helpful.
But even before you start, ifyou're doing a yearly checkup
and you're getting some bloodwork done, getting your vitamin
D level checked, kind of seeingwhere you are there so I think
(44:39):
all of those things can make adifference.
Dionne (44:41):
Absolutely, Dr Kira.
This has been such a wonderfulconversation.
I have learned so much, even asa physician, and I feel like I
just had my sidebar consult withyou and I know our audience has
just.
They're just going to walk awaywith so much more knowledge and
(45:02):
we just appreciate you comingon our show today.
We really do.
Kiarra (45:07):
Absolutely, absolutely.
It has been my pleasure.
Maleeha (45:11):
Woo, that was a lot.
I'm ready to talk to mypatients.
I feel like you're agynecologist now.
This is what always happens tome after one of these episodes.
Yeah, I feel like an honoraryobi-gyne and I'll start asking.
When I did the colonoscopy?
Dionne (45:28):
episode I was pushing colonoscopy on everybody.
Maleeha (45:34):
And there's one thing I do check, it's hemoglobin all
the time.
So, no, that's great advice.
We learned so much and I hopeeveryone listening walks away
feeling more knowledgeable andempowered to make informed
decisions and also understandthe importance of having these
conversations with your doctor.
Definitely find a doctor youtrust that will help you through
(45:57):
the journey.
I think that it's importantthat you feel comfortable
talking to them.
You feel like your concerns arebeing heard.
I think that's very important.
And if you do have fibroids,it's more than just a physical
issue.
It could be impacting yourfamily planning.
It could be impacting yourmental health.
It's not just the fibroid thatneeds to be addressed.
Dionne (46:19):
Absolutely.
Maleeha (46:20):
Yeah, that ends today's segment For more IV drip, head
to our website at theivdripco orfollow us on Instagram at
theivdrip underscore podcast.
Email us your questions andcomments at the info at
theivdripco or send us a DM.
We love hearing from you all,so share with us your
experiences.
(46:40):
Most importantly, don't forgetto subscribe to our podcast.
You can find it on allstreaming platforms.
Leave a review and spread thelove.
Dionne (46:50):
Now for the tip of the day.
Dr Kira, will you do us thehonor?
Kiarra (46:56):
Absolutely.
This is short and sweet.
My tip of the day is startsomewhere.
You know that thing that you'vebeen needing to do, that you've
been putting off and you keepsaying I'm going to do it
tomorrow, I'm going to startnext week.
Start it right now.
Maybe not at 8 30 tonight,Maybe you can start tomorrow.
Dionne (47:18):
But start Love it.
I love that.
Maleeha (47:22):
You were speaking to me , I know.
I kind of felt like you weretalking to me a little bit.
I was like, listen, I'm talkingto myself, I'm going to start
tomorrow.
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