January 15, 2025 • 23 mins
Featuring Dr. Shieva Ghofrany, OBGYN & Co-founder of Tribe Called V, and moderated by Meaghan Repko DeShong, Tina's Wish Board Member & Partner at Joele Frank, Wilkinson Brimmer Katcher.
Learn more about Dr. Ghofrany at:
https://www.instagram.com/drshievag/
https://telleveryamazinglady.org/
https://www.tribecalledv.com/
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:29):
Hi everyone. My name is Megan Repko and I am so
excited to be hosting today'sepisode of What To Know Down
Below. I am one of Tina'swishes board members , um, but
I've been passionate aboutTina's Wish and finding early
detection of ovarian cancer ,um, because I personally went
(00:51):
through a situation where it,it impacted me personally. Um,
and today's topic actually ishow we found out that , um,
there was some growths andother things that were very
concerning to my ob GYN I'm sothrilled to be here with our
subject matter expert today fortoday's episode. She's a board
(01:12):
certified OB GYN, Dr. Shiva.
Welcome Dr . Go . Thank you,
Speaker 3 (01:19):
Megan . I'm so excited to be here.
Speaker 2 (01:21):
So today we are going to be talking about
uterine Fibroids. I'll tell youa little bit, this is how my
whole thing started with Tina'swish actually is. Um, I , I
wanted to freeze my eggs , um,and I was in my mid thirties,
which is probably too late toreally never too late, but I
wish I'd done it earlier. Um,and I went to my OB GYN and she
(01:46):
said to me, no joke. Um, hasanybody told you you have a
bulky uterus? And I was like,no , no one's ever told me .
And it
Speaker 3 (01:53):
Doesn't sound like a compliment at the time. Right?
You're
Speaker 2 (01:56):
Like, really?
Exactly. Um, but that, but she,you know, started the whole
process and I went and I got anultrasound and then that's when
kind of all this stuff kind ofcame to fruition where I had 13
fibroids mm-hmm .
And, and I had a tumor on myovary mm-hmm .
(02:16):
Um, that was connected to myovary and my fallopian tube.
And so I then obviouslyimmediately went to an
oncologist specialist, all thisstuff had the surgery to get
things removed . Um, and thething is, is that I feel like
it's a topic that people don'ttalk about, right? And like,
(02:38):
people don't know they havethem, but they don't know how
to even go. Like what? Likewhat are the symptoms? So I'm
excited to talk to you todaybecause I hope we can educate
someone so they don't gothrough the length of time I
did , um, of having a bulkyuterus. .
Speaker 3 (02:55):
Yes. I think that's wise. Good.
Speaker 2 (02:58):
So I guess to start, can you explain to our audience
what fibroids are?
Speaker 3 (03:04):
Yes. So I'll give you a quick background about
myself just so it makes sensein the context also, because I
always joke, I am like not onlythe doctor but also the patient
because I am now almost 55.
I've been a doctor for 25 yearsin OB GYN in private practice.
But I myself had endometriosis.
I had six miscarriages. I'vehad HPV, like 80 to 90% of us.
(03:28):
Um, multiple other thingsculminating I hope culminating
I say in ovarian cancer eightyears ago when I was 46. So
it's really given me adifferent lens because of
course I understood everythingmedically speaking. But I also,
very early in my career andeven before my career when I
had endometriosis, had a lot ofinsight into our mindset and
our psyche as women with all ofthese issues. And the single
(03:50):
biggest thing I've not onlylearned early on, but it's been
consistently reiterated to meevery day , is that no matter
how educated a woman is,regardless of age,
socioeconomic status, you know,race, it doesn't matter. Women
don't have an opportunity tolearn about their OBGYN issues.
Mostly because the teachersdon't know it, the moms don't
know it. And the OBGYNs don'thave time to preemptively teach
(04:14):
everyone about all theseissues. So then when they come
up, they sound scary, right?
And they sound jarring and theysound shocking. And most women
will say things like, no oneever told me. I never knew. And
so like, I always joke with mypatients and they joke back
like I told you, I'm tellingyou. 'cause I try to talk about
all these things frequently andkind of casually so that when
(04:35):
they come up they don't soundas scary. So the statistics on
fibroids are in a way shockingwhen you don't know them, but
not at all shocking to OB GYNsbecause, and you might know
this now, Megan , 70% of allwomen and 80% of black women
have fibroids. And just to goback, fibroids are benign.
Meaning they're not malignant,they're not cancer. We'll touch
(04:57):
upon the cancerous analogy to afibroid in a little bit. But
they are benign growths of themuscle of the uterus. And the
word growth is the same astumor. So that makes it really
confusing, right? So first andforemost, when people hear the
word tumor, they think it'scancer. It's not always cancer.
Tumor just means growth.
Fibroids are benign. Growths,again, of the muscle of the
(05:18):
uterus. 'cause the uterus ismade of muscle. I was , I have
like my handy uterus here allthe time. So if this is the
inside lining of the uterus,the fibroid can be in the
muscle, it can be growing offthe top, it can be within the
uterine lining. And then thisis the tube and the ovary. And
I suspect, 'cause you had somany, you probably had in all
different places, some withinthe lining, some within the
(05:39):
muscle , some outside. And asyou know, they can hide because
even someone with a bulkyuterus, even if someone is lean
, they, I think that as womenwhat we tend to do is we then
reflect back and go, you know,I did have x , y , Z symptom .
Maybe like in my case, I had a17 centimeter , um, cyst in my
(06:01):
ovary, 17 centimeters, which isthe size of like a big
grapefruit in medical school.
And of course I looked backonce they told me and I was
like, you know, I have beenpeeing more frequently or I did
like, I was lying in fetalposition during my period. So I
suspect you probably look backand go, you know, I did have
some pressure, some bloating,maybe some bleeding. I dunno if
you had pain, right? You'renodding your head. So you had
(06:23):
some of these, right? Yeah.
Yeah.
Speaker 2 (06:25):
I, I mean very heavy periods, all that stuff. And I
just thought it was normal.
Yeah . Right. Because I, Ithink I've had them for, I had
had them for so long that, andby the way to touch on your
point, like, and, and my motheris a amazing mom, right ? But
when I told her about this, shewas like, oh, that makes sense.
I had those and I was like, mom, you didn't think of telling
(06:48):
me .
Speaker 3 (06:49):
And I bet , and I'm sure your mother was amazing ,
but you probably also at somepoint said to your mom, mom, my
period's really heavy and yourmom or your doctor or your
friends or anyone probablyinnocently said, oh, periods
are terrible, periods areheavy. You know, we are really,
yeah , we are really used toand expected as women to just
withstand right. Pain,pressure, bloating, bleeding.
(07:12):
This is just part of the femaleexperience. And while it is
part of the female experience,we need to do better at
learning and teaching thatthere is something outside of
the norm that might be part ofthe experience. Shouldn't be
scary, but we can actuallyidentify it, teach you about
it, sometimes fix it, right.
And at least not be scared andblindsided. Right?
Speaker 2 (07:33):
Yeah. I mean, you answered a lot of my questions
right there, so I appreciatethat. Um, but I guess, I guess
'cause see for me it was alittle bit different, right?
Like I was going to prepare mybody to do something right in
egg retrieval, but liketypically how would a fibroid
(07:54):
be diagnosed? Right?
Speaker 3 (07:55):
Well, so, and, and this is where it's important to
recognize that fibroids ingeneral for millions of women
are totally asymptomatic.
Meaning they don't haveappreciable pain, pressure,
bloating, bleeding. When I sayappreciable, that word is
really subjective. So when,when someone says to me like,
how much is too much, theanswer is objectively with
bleeding. We say asgynecologists, if it's longer
(08:17):
than seven days, more frequentthan every 21 to 25 days, or
you're bleeding heavier thanyou're used to , that is
objectively what we think istoo much. But the truth is
there are people who bleed lessthan that and it's still
uncomfortable for them. So Isay to patients all the time,
if it's anything other thanwhat you feel like you should
have, please tell me. And Ihave a very low threshold to
then send a patient for anultrasound, which is the best
(08:40):
way for us to diagnose it. Thetruth is that there are
millions of women who really,even when I kind of probe them,
they're like, I mean, I didn'tthink they were that bad. It
really didn't bother me. And wediscover them only again during
a fertility workup or whenthey're pregnant or sometimes
they're done, done with theirpregnancy and I'm doing a
C-section. And during theC-section we'll find a fairly
good sized one that if it'shanging off the top or the back
(09:03):
of the uterus might not haveeven shown up during the
ultrasounds during pregnancy.
So again, I'm glad that I cansay it's so incredibly common.
It's so incredibly common.
Please don't freak out ifanyone's listening and they, in
the future here they have themor they just found out they had
them that said, if you havebloating, pain, pressure on
your bladder, pressure on yourrectum, dis difficulty with sex
(09:25):
or any kind of heavy orirregular bleeding and any kind
means whatever you considerhaving irregular, please go see
your doctor. I always joke andyou feel free to say, I heard a
doctor on a podcast say, askfor an ultrasound because you
should have an ultrasound done.
And that's the best way theycan look at it and then decide
with you what to do. What oftenhappens is you go to your
gynecologist, you have aregular pelvic exam where we
(09:47):
put our hand inside, right? Andwe touch on the outside of your
pelvis and we don't do enoughto say to you, okay, I don't
feel anything. But that doesnot mean that there can't be
something growing in there thatwe might not feel. So, because
we don't say anything. Youtacitly believe as a patient
that like, everything's fine,we for forget that you don't
realize that fine still couldmean fibroids. Right? Right .
(10:10):
And so that happens a lot. Andthat also happens with things
like ovarian cysts. Um, soagain, the best way to diagnose
it is with an ultrasound. Andthe most likely time to
diagnose it would be pain,pressure, bloating, bleeding.
Speaker 2 (10:24):
Okay. So then if I , if , if your patient then goes
and gets this ultrasound mm-hmm . Comes back,
yes. They've got some fibroids.
Yes . What is the treatment?
What's the best, like, and I, Iassume it might vary. Yes .
Yeah . Right. But so I , I knowthat's like kind of a big
question but Well, and
Speaker 3 (10:43):
My answer is gonna be almost every time someone
says what's the best, my answeris almost always for almost
everything OB GYN related . Itdepends, right? So let's say
someone literally just came into me and I said to them, huh ,
I feel like your uterus feels alittle bit bulky, a little bit
bigger than usual. I think it'slikely nothing. Tell me about
your periods. And when I say Ithink it's likely nothing, what
I mean is it's likely nothingdangerous. But I often say to
(11:05):
patients, it's likely nothingbut let's check it out. So I
will say to them, tell me aboutyour symptoms. Let's assume
they still have no symptoms. Iwould then send them still for
a pelvic ultrasound because Idon't know, is it fibroids, is
it a cyst, is it somethingelse? Now we found fibroids and
they really say to me, I don'thave heavy periods that bother
me. I don't have pain, I don'thave pressure or bloating. And
(11:26):
to the degree that we can tellthe fibroids are not in the
uterine lining, like meaningnot in here, but let's say
they're only in here in themuscle or outside, then a
patient might not do anything.
I say if they're not in here.
Because if they're in here,they tend to almost always
cause heavier bleeding 'causethey increase the surface area
of the line . So let's say nopain, pressure, bloating,
they're fine. And let's saythey even say, but I wanna get
(11:48):
pregnant. The answer is ifthey're in the muscle or
outside, they're most likelynot gonna cause harm or
fertility issues. I say mostlikely because there's a little
bit of emerging data thatmultiple fibroids, even not
within the lining of theuterus, might decrease
fertility. But it's also hardto say that because our patient
population's getting older andeverything. So one option is do
nothing. Second option isresect them either through the
(12:12):
uterine lining, somethingcalled an operative
hysteroscopy where we scrapethem out or shade them out.
They can also actually befrozen or burned through the
uterine lining. Not as ideal.
If you're planning on gettingpregnant, they can be
surgically operated on meaninglaparoscopically or robotically
through those little holeswhere we then remove them and
have to sew up that part of theuterus. There's also
(12:32):
medication, as you probablyknow, for example, you could
take the birth control pill,which won't shrink them, but
will at least hopefully controlthe bleeding. You can take
medication like injections of amedication called Lupron, and
there's oral versions now ofit. And that literally is an
anti hormone . It basicallyantagonizes your own body's
hormones that are stimulatingthe fibroid and it shrinks
(12:54):
them, but it temporarily makesyou feel like you're
menopausal. Um, but the goodnews is there are ways to treat
it and the better news is youdon't always have to treat it.
It just depends.
Speaker 2 (13:03):
Yeah. Okay. Um, if someone has fibroids, are they
all , like, would they be moresusceptible to other
gynecological issues? You know,because I feel like right,
Speaker 3 (13:17):
You had like, you had both,
Speaker 2 (13:18):
I don't wanna use like when they're s smokers
fire kind of thing. Like, youknow ,
Speaker 3 (13:22):
Well, great question. And the answer is no.
Meaning fibroids themselvesdon't predispose you, for
example, to, to cyst in yourovaries. Okay? Mm-hmm
. And peopleoften misconstrue that. Meaning
I have patients all the timewho say, oh, I had a cyst in my
uterus. Or they'll say I had afibroid in my ovary. And just
to clarify, fibroids aremuscular growth. So they're in
the uterus, which is made .
Muscle cysts are typicallyeither fluid, fluid-filled or
(13:45):
blood filled or some othersolid components. But they're
in the ovary, so they'reunrelated. But the truth is,
70% of women have fibroids andprobably more will have cysts
in their lifetime. But many ofthe cysts are undetected. So
they just are again, part ofthe female experience that we
can address. There are otherfeatures of fibroids, like we
(14:05):
think that maybe, for example,vitamin D deficiency can
increase the chance offibroids, but that's also very
funny data because most of usare vitamin D deficient because
we're not laying naked in thesun. And so vitamin D
deficiency can also increasethe risk of other things. So
there's a lot we don't knowbecause again, a lot of these
issues just kind of runtogether. One thing that is
(14:26):
definitively true is thatfibroids do not become cancer.
And it's really important forpeople to know that again, they
get very anxious and think,well, if I leave them alone,
will they turn into cancer?
Regular fibroids will not turninto cancer. There's a big but
though if someone has justdiscovered they have fibroids
every now and then, what thedoctor might think is a fibroid
(14:46):
could theoretically be amalignant counterpart that is,
that will look initially like afibroid, something called a Lao
myo sarcoma, which is acancerous tumor in the uterine
lining. And initially, again,every now and then it can look
like a fibroid. So when youhear people say, I had a
fibroid that became cancer,what really likely happened is
(15:07):
it was misdiagnosed from thebeginning as a fibroid. They
think it turned into cancerwhen it was from the very
beginning cancers. And thedifferentiating factor is if
you see something rapidlygrowing, then you really have
to make sure that it's just afibroid. So those ones are not
ones that most of us as doctorswould just sit on and say, oh,
let's just wait. If you're not,if it's not bothering me , if I
see a new fibroid, then Iusually will say to patients,
(15:30):
okay, let's just have a shortinterval where we'll look again
maybe in anywhere from like twoto six months, assuming no
other SI and no other symptoms.
And then if it's rapidlygrowing, we would absolutely
consider interventionsurgically to make sure it's
not cancer. But again, thattype of cancer very rare,
thankfully.
Speaker 2 (15:47):
Right. And because I think that's a myth then that
we can sort of debunk rightthere, right? Is that they're
they're different things .
They're
Speaker 3 (15:56):
Different things.
Yeah . Right . They , they ,they are similar but very
different. And that's whythere's a little confusion.
Mm-hmm . Yeah .
Speaker 2 (16:02):
Okay . That makes a lot of sense. Um, is there
anything that someone could doto lower their risk or prevent
the pro , like developing afibroid? Or is it, are , are
they hereditary? Like how do I, I
Speaker 3 (16:20):
Mean, again, here's what's interesting. When you
think about hereditary things,it wouldn't, it , they could be
hereditary and yet we don'tnecessarily think they are
because 70% of women have them.
Right? So things like ovariancyst and fibroids, again, are
just so common that it's hardto say if there's a heredi true
hereditary component. Now, allthat said, like I said, vitamin
D deficiency, things like theythink maybe dietary changes
(16:44):
like eating diets that are,that are high in trans fat or
processed food might increasethe risk of fibroids. But
again, that data is, it's morecausation. I mean, it's more
correlation probably thancausation. There are large
groups of people who are moreat risk for fibroids, like
black women. And unfortunatelytheir vitamin D levels tend to
be lower because of the , theirskin's ability to absorb and tr
(17:04):
and create the vitamin D three.
And we know that unfortunatelybecause of different resources,
their diets might be different.
Right. So is it causation orcorrelation? We don't know. So
could I say right now to anyperson, here's what you could
do. The honest answer is I can,I can say that I think most of
us should have our vitamin Dthree levels checked, which is
a controversial thing to saybecause there's pros and cons
in all of the data andliterature. I can say that we
(17:26):
should try to limit ouralcohol, limit, our trans fat
increase leafy green vegetablesand our really good quality
fats and protein. But can I saydirectly it's gonna prevent it?
No, I see some of my healthiestpatients and they still have
fibroids, which is in keepingwith the data, which is why I ,
I mean I say this a lot, I allat once want to be casual and
calm about it, while also veryclear and give information that
(17:50):
yes, you might have it. Yes,it's very common. No, it's not
likely to cause harm. But yes,you might have symptoms and
also, yes, you can get treatedright, all of it at once. But
if we approach it by giving youpreemptive information, like
how much better would it havebeen had you known from the
beginning as you have embarkedon being a woman , that
these are the things that mighthappen to you, then you
wouldn't have had to go throughthe freakout period. It
(18:11):
would've still been annoyingand frustrating, but it
wouldn't have been as anxietyprovoking. Right?
Speaker 2 (18:17):
Yeah. Yeah, I can, I can attest to that. Yeah , for
sure. Um, all right . Rapidfire. Yes . What are the top
three takeaways you hope ourlisteners remember from this
conversation? Because you'vegiven so much good information.
I think like if we could pickthree. Okay . What do you, what
(18:40):
would you say?
Speaker 3 (18:40):
Okay, so two with fibroids and one in general,
one fibroids, very, verycommon. If you find out you
have , so one is that they'revery, very common. Two is if
you find you have them, don'tbe scared at all because the
odds are you either will needno treatment or you'll need
some treatment that will helpyou either feel better or be
safer and healthier because weknow that you can bleed
heavily, have anemia, thingslike that. And the third
(19:01):
correlates to it, but is ingeneral try to learn more about
your body. And I say thatcautiously 'cause it's very
hard, right? Again, yourOBGYNs, we're seeing patients
every 15 minutes becauseinsurance is not because we
don't love you and wanna seeyou more, but it's hard to
preemptively teach you thesethings. So this is where the
internet and Dr . Google couldactually teach you good things
(19:22):
and instead people are Googlingthe wrong things. But learn
about your body and advocatefor yourself. If someone says
to you, oh yeah, you told methat you bleed X, Y , z and you
told me that it's heavy andannoying, but you're fine. I
hate to say like, don't believethem, but it's your body. So if
you don't feel like it's fine,then say to them, I think I
need a pelvic ultrasound. Orfind a doctor who will really,
really listen to you. In theend, you might still be fine,
(19:44):
quote unquote , meaning you'resafe, you're healthy and
everything, but maybe you'refine with fibroids. Maybe you
don't have fibroids, but youdeserve the discovery of what
is going on.
Speaker 2 (19:52):
Yeah, I love that. I think advocating for oneself,
and I think sometimes womendon't do it. Yeah . That well,
and that applies medical, itapplies at work, it applies to
so many things. And so for me,I think that is something, and
I think from a Tina's wishperspective, you know, as a
whole it's, you know,advocating for oneself with
(20:15):
medical, you know, kind ofdevelopments or concerns or
anything else. It's just soimportant .
Speaker 3 (20:21):
Well, and to that point, since Tina's wish is
really about ovarian cancer,and since I love to talk about
ovarian cancer, my other littletidbit would be this. Let's
just say for the sake ofargument that your doctorate
said, oh, you have a bulkyuterus, but you don't have any
symptoms. End of sentence. Iwould personally say to every
woman out there, if you hearanything other than your pelvic
exam feels perfect, you don'thave pain, pressure, bloating,
(20:43):
bleeding, anything other thanthat. Please, please, please
ask for a pelvic ultrasound. Asyou probably know, Megan , it
is not a standard screeningtool. We can't screen everyone
with it, but we should have avery low threshold to ask for
it. And we should have a highindex of suspicion to look for
the things that we are worriedabout. Fibroids, I'm not as
worried about as we knowovarian cancer , we do worry
(21:03):
about and we have no screeningtool for it .
Speaker 2 (21:06):
So I think to your point, advocating is, is
really, I I asked you forthree, but I think that fourth
one is also great. So Iappreciate you for, for
throwing that in there. Yeah .
Speaker 3 (21:16):
Thank you.
Speaker 2 (21:18):
Well, thank you so much Dr . Gorani . I, it really
has been a pleasure. And Ithink these are topics that
people just don't talk aboutenough. Yeah . And I get, this
is what I try to tell peoplethat I work with is like, when
you're uncomfortable, it'sactually when you learn the
most. Yeah . And so, likeunderstanding a little bit more
about these things and ifyou're going to your doctor and
(21:40):
asking these questions and kindof feeling more empowered to
advocate for yourself, but alsoto your point, is not going in
a state of stress or worry. Um,but it's, but it's also better
to just be educated andunderstand kind of these
different gynecological thingsthat we've got going we could
have going on. Yeah .
Speaker 3 (22:01):
I mean, it's a difference. I always say
between preemptive versusreactive. Like that's why I
like to try to give my patientspreemptive knowledge knowing
that they're only gonnaactually listen to this much.
Because as you said, we tend tobe like on high . We're like,
yeah, yeah, yeah. Not gonnahappen to me. And then it
happens and we have reactiveknowledge, but at least if
we've laid the groundwork witha little bit of preemptive
knowledge, then it's in theback of your mind and you can
(22:22):
decrease your anxiety. Yeah,
Speaker 2 (22:24):
I agree. Well, hopefully for all of our
listeners , um, you're feelinga little bit more empowered in
your own health and you'velearned something. And I'd also
invite you, 'cause we are goingto do another podcast , um,
where we discuss everything youneed . Well, hopefully it'll be
everything you need to knowabout ovarian cysts, which as
(22:45):
Dr. Gorani mentioned, are alsovery common. Mm-hmm
Speaker 3 (22:48):
. Yes
.
Speaker 2 (22:49):
So thank you all for joining. Thank you .
Speaker 4 (22:57):
For
Speaker 1 (22:58):
More information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
Welcome to What To Know Down Below by Tina's Wish.
We're here to empower you withthe knowledge and tools you
need to advocate for your owngynecologic health. Knowledge
is power and we encourageeveryone to join us in learning
more about what you need toknow down below.
Speaker 2 (00:29):
Hi everyone. My name is Megan Repko and I am so
excited to be hosting today'sepisode of What To Know Down
Below. I am one of Tina'swishes board members , um, but
I've been passionate aboutTina's Wish and finding early
detection of ovarian cancer ,um, because I personally went
(00:51):
through a situation where it,it impacted me personally. Um,
and today's topic actually ishow we found out that , um,
there was some growths andother things that were very
concerning to my ob GYN I'm sothrilled to be here with our
subject matter expert today fortoday's episode. She's a board
(01:12):
certified OB GYN, Dr. Shiva.
Welcome Dr . Go . Thank you,
Speaker 3 (01:19):
Megan . I'm so excited to be here.
Speaker 2 (01:21):
So today we are going to be talking about
uterine Fibroids. I'll tell youa little bit, this is how my
whole thing started with Tina'swish actually is. Um, I , I
wanted to freeze my eggs , um,and I was in my mid thirties,
which is probably too late toreally never too late, but I
wish I'd done it earlier. Um,and I went to my OB GYN and she
(01:46):
said to me, no joke. Um, hasanybody told you you have a
bulky uterus? And I was like,no , no one's ever told me .
And it
Speaker 3 (01:53):
Doesn't sound like a compliment at the time. Right?
You're
Speaker 2 (01:56):
Like, really?
Exactly. Um, but that, but she,you know, started the whole
process and I went and I got anultrasound and then that's when
kind of all this stuff kind ofcame to fruition where I had 13
fibroids mm-hmm
And, and I had a tumor on myovary mm-hmm
(02:16):
Um, that was connected to myovary and my fallopian tube.
And so I then obviouslyimmediately went to an
oncologist specialist, all thisstuff had the surgery to get
things removed . Um, and thething is, is that I feel like
it's a topic that people don'ttalk about, right? And like,
(02:38):
people don't know they havethem, but they don't know how
to even go. Like what? Likewhat are the symptoms? So I'm
excited to talk to you todaybecause I hope we can educate
someone so they don't gothrough the length of time I
did , um, of having a bulkyuterus.
Speaker 3 (02:55):
Yes. I think that's wise. Good.
Speaker 2 (02:58):
So I guess to start, can you explain to our audience
what fibroids are?
Speaker 3 (03:04):
Yes. So I'll give you a quick background about
myself just so it makes sensein the context also, because I
always joke, I am like not onlythe doctor but also the patient
because I am now almost 55.
I've been a doctor for 25 yearsin OB GYN in private practice.
But I myself had endometriosis.
I had six miscarriages. I'vehad HPV, like 80 to 90% of us.
(03:28):
Um, multiple other thingsculminating I hope culminating
I say in ovarian cancer eightyears ago when I was 46. So
it's really given me adifferent lens because of
course I understood everythingmedically speaking. But I also,
very early in my career andeven before my career when I
had endometriosis, had a lot ofinsight into our mindset and
our psyche as women with all ofthese issues. And the single
(03:50):
biggest thing I've not onlylearned early on, but it's been
consistently reiterated to meevery day , is that no matter
how educated a woman is,regardless of age,
socioeconomic status, you know,race, it doesn't matter. Women
don't have an opportunity tolearn about their OBGYN issues.
Mostly because the teachersdon't know it, the moms don't
know it. And the OBGYNs don'thave time to preemptively teach
(04:14):
everyone about all theseissues. So then when they come
up, they sound scary, right?
And they sound jarring and theysound shocking. And most women
will say things like, no oneever told me. I never knew. And
so like, I always joke with mypatients and they joke back
like I told you, I'm tellingyou. 'cause I try to talk about
all these things frequently andkind of casually so that when
(04:35):
they come up they don't soundas scary. So the statistics on
fibroids are in a way shockingwhen you don't know them, but
not at all shocking to OB GYNsbecause, and you might know
this now, Megan , 70% of allwomen and 80% of black women
have fibroids. And just to goback, fibroids are benign.
Meaning they're not malignant,they're not cancer. We'll touch
(04:57):
upon the cancerous analogy to afibroid in a little bit. But
they are benign growths of themuscle of the uterus. And the
word growth is the same astumor. So that makes it really
confusing, right? So first andforemost, when people hear the
word tumor, they think it'scancer. It's not always cancer.
Tumor just means growth.
Fibroids are benign. Growths,again, of the muscle of the
(05:18):
uterus. 'cause the uterus ismade of muscle. I was , I have
like my handy uterus here allthe time. So if this is the
inside lining of the uterus,the fibroid can be in the
muscle, it can be growing offthe top, it can be within the
uterine lining. And then thisis the tube and the ovary. And
I suspect, 'cause you had somany, you probably had in all
different places, some withinthe lining, some within the
(05:39):
muscle , some outside. And asyou know, they can hide because
even someone with a bulkyuterus, even if someone is lean
, they, I think that as womenwhat we tend to do is we then
reflect back and go, you know,I did have x , y , Z symptom .
Maybe like in my case, I had a17 centimeter , um, cyst in my
(06:01):
ovary, 17 centimeters, which isthe size of like a big
grapefruit in medical school.
And of course I looked backonce they told me and I was
like, you know, I have beenpeeing more frequently or I did
like, I was lying in fetalposition during my period. So I
suspect you probably look backand go, you know, I did have
some pressure, some bloating,maybe some bleeding. I dunno if
you had pain, right? You'renodding your head. So you had
(06:23):
some of these, right? Yeah.
Yeah.
Speaker 2 (06:25):
I, I mean very heavy periods, all that stuff. And I
just thought it was normal.
Yeah . Right. Because I, Ithink I've had them for, I had
had them for so long that, andby the way to touch on your
point, like, and, and my motheris a amazing mom, right ? But
when I told her about this, shewas like, oh, that makes sense.
I had those and I was like, mom, you didn't think of telling
(06:48):
me .
Speaker 3 (06:49):
And I bet , and I'm sure your mother was amazing ,
but you probably also at somepoint said to your mom, mom, my
period's really heavy and yourmom or your doctor or your
friends or anyone probablyinnocently said, oh, periods
are terrible, periods areheavy. You know, we are really,
yeah , we are really used toand expected as women to just
withstand right. Pain,pressure, bloating, bleeding.
(07:12):
This is just part of the femaleexperience. And while it is
part of the female experience,we need to do better at
learning and teaching thatthere is something outside of
the norm that might be part ofthe experience. Shouldn't be
scary, but we can actuallyidentify it, teach you about
it, sometimes fix it, right.
And at least not be scared andblindsided. Right?
Speaker 2 (07:33):
Yeah. I mean, you answered a lot of my questions
right there, so I appreciatethat. Um, but I guess, I guess
'cause see for me it was alittle bit different, right?
Like I was going to prepare mybody to do something right in
egg retrieval, but liketypically how would a fibroid
(07:54):
be diagnosed? Right?
Speaker 3 (07:55):
Well, so, and, and this is where it's important to
recognize that fibroids ingeneral for millions of women
are totally asymptomatic.
Meaning they don't haveappreciable pain, pressure,
bloating, bleeding. When I sayappreciable, that word is
really subjective. So when,when someone says to me like,
how much is too much, theanswer is objectively with
bleeding. We say asgynecologists, if it's longer
(08:17):
than seven days, more frequentthan every 21 to 25 days, or
you're bleeding heavier thanyou're used to , that is
objectively what we think istoo much. But the truth is
there are people who bleed lessthan that and it's still
uncomfortable for them. So Isay to patients all the time,
if it's anything other thanwhat you feel like you should
have, please tell me. And Ihave a very low threshold to
then send a patient for anultrasound, which is the best
(08:40):
way for us to diagnose it. Thetruth is that there are
millions of women who really,even when I kind of probe them,
they're like, I mean, I didn'tthink they were that bad. It
really didn't bother me. And wediscover them only again during
a fertility workup or whenthey're pregnant or sometimes
they're done, done with theirpregnancy and I'm doing a
C-section. And during theC-section we'll find a fairly
good sized one that if it'shanging off the top or the back
(09:03):
of the uterus might not haveeven shown up during the
ultrasounds during pregnancy.
So again, I'm glad that I cansay it's so incredibly common.
It's so incredibly common.
Please don't freak out ifanyone's listening and they, in
the future here they have themor they just found out they had
them that said, if you havebloating, pain, pressure on
your bladder, pressure on yourrectum, dis difficulty with sex
(09:25):
or any kind of heavy orirregular bleeding and any kind
means whatever you considerhaving irregular, please go see
your doctor. I always joke andyou feel free to say, I heard a
doctor on a podcast say, askfor an ultrasound because you
should have an ultrasound done.
And that's the best way theycan look at it and then decide
with you what to do. What oftenhappens is you go to your
gynecologist, you have aregular pelvic exam where we
(09:47):
put our hand inside, right? Andwe touch on the outside of your
pelvis and we don't do enoughto say to you, okay, I don't
feel anything. But that doesnot mean that there can't be
something growing in there thatwe might not feel. So, because
we don't say anything. Youtacitly believe as a patient
that like, everything's fine,we for forget that you don't
realize that fine still couldmean fibroids. Right? Right .
(10:10):
And so that happens a lot. Andthat also happens with things
like ovarian cysts. Um, soagain, the best way to diagnose
it is with an ultrasound. Andthe most likely time to
diagnose it would be pain,pressure, bloating, bleeding.
Speaker 2 (10:24):
Okay. So then if I , if , if your patient then goes
and gets this ultrasound mm-hmm
yes. They've got some fibroids.
Yes . What is the treatment?
What's the best, like, and I, Iassume it might vary. Yes .
Yeah . Right. But so I , I knowthat's like kind of a big
question but Well, and
Speaker 3 (10:43):
My answer is gonna be almost every time someone
says what's the best, my answeris almost always for almost
everything OB GYN related . Itdepends, right? So let's say
someone literally just came into me and I said to them, huh ,
I feel like your uterus feels alittle bit bulky, a little bit
bigger than usual. I think it'slikely nothing. Tell me about
your periods. And when I say Ithink it's likely nothing, what
I mean is it's likely nothingdangerous. But I often say to
(11:05):
patients, it's likely nothingbut let's check it out. So I
will say to them, tell me aboutyour symptoms. Let's assume
they still have no symptoms. Iwould then send them still for
a pelvic ultrasound because Idon't know, is it fibroids, is
it a cyst, is it somethingelse? Now we found fibroids and
they really say to me, I don'thave heavy periods that bother
me. I don't have pain, I don'thave pressure or bloating. And
(11:26):
to the degree that we can tellthe fibroids are not in the
uterine lining, like meaningnot in here, but let's say
they're only in here in themuscle or outside, then a
patient might not do anything.
I say if they're not in here.
Because if they're in here,they tend to almost always
cause heavier bleeding 'causethey increase the surface area
of the line . So let's say nopain, pressure, bloating,
they're fine. And let's saythey even say, but I wanna get
(11:48):
pregnant. The answer is ifthey're in the muscle or
outside, they're most likelynot gonna cause harm or
fertility issues. I say mostlikely because there's a little
bit of emerging data thatmultiple fibroids, even not
within the lining of theuterus, might decrease
fertility. But it's also hardto say that because our patient
population's getting older andeverything. So one option is do
nothing. Second option isresect them either through the
(12:12):
uterine lining, somethingcalled an operative
hysteroscopy where we scrapethem out or shade them out.
They can also actually befrozen or burned through the
uterine lining. Not as ideal.
If you're planning on gettingpregnant, they can be
surgically operated on meaninglaparoscopically or robotically
through those little holeswhere we then remove them and
have to sew up that part of theuterus. There's also
(12:32):
medication, as you probablyknow, for example, you could
take the birth control pill,which won't shrink them, but
will at least hopefully controlthe bleeding. You can take
medication like injections of amedication called Lupron, and
there's oral versions now ofit. And that literally is an
anti hormone . It basicallyantagonizes your own body's
hormones that are stimulatingthe fibroid and it shrinks
(12:54):
them, but it temporarily makesyou feel like you're
menopausal. Um, but the goodnews is there are ways to treat
it and the better news is youdon't always have to treat it.
It just depends.
Speaker 2 (13:03):
Yeah. Okay. Um, if someone has fibroids, are they
all , like, would they be moresusceptible to other
gynecological issues? You know,because I feel like right,
Speaker 3 (13:17):
You had like, you had both,
Speaker 2 (13:18):
I don't wanna use like when they're s smokers
fire kind of thing. Like, youknow ,
Speaker 3 (13:22):
Well, great question. And the answer is no.
Meaning fibroids themselvesdon't predispose you, for
example, to, to cyst in yourovaries. Okay? Mm-hmm
I have patients all the timewho say, oh, I had a cyst in my
uterus. Or they'll say I had afibroid in my ovary. And just
to clarify, fibroids aremuscular growth. So they're in
the uterus, which is made .
Muscle cysts are typicallyeither fluid, fluid-filled or
(13:45):
blood filled or some othersolid components. But they're
in the ovary, so they'reunrelated. But the truth is,
70% of women have fibroids andprobably more will have cysts
in their lifetime. But many ofthe cysts are undetected. So
they just are again, part ofthe female experience that we
can address. There are otherfeatures of fibroids, like we
(14:05):
think that maybe, for example,vitamin D deficiency can
increase the chance offibroids, but that's also very
funny data because most of usare vitamin D deficient because
we're not laying naked in thesun. And so vitamin D
deficiency can also increasethe risk of other things. So
there's a lot we don't knowbecause again, a lot of these
issues just kind of runtogether. One thing that is
(14:26):
definitively true is thatfibroids do not become cancer.
And it's really important forpeople to know that again, they
get very anxious and think,well, if I leave them alone,
will they turn into cancer?
Regular fibroids will not turninto cancer. There's a big but
though if someone has justdiscovered they have fibroids
every now and then, what thedoctor might think is a fibroid
(14:46):
could theoretically be amalignant counterpart that is,
that will look initially like afibroid, something called a Lao
myo sarcoma, which is acancerous tumor in the uterine
lining. And initially, again,every now and then it can look
like a fibroid. So when youhear people say, I had a
fibroid that became cancer,what really likely happened is
(15:07):
it was misdiagnosed from thebeginning as a fibroid. They
think it turned into cancerwhen it was from the very
beginning cancers. And thedifferentiating factor is if
you see something rapidlygrowing, then you really have
to make sure that it's just afibroid. So those ones are not
ones that most of us as doctorswould just sit on and say, oh,
let's just wait. If you're not,if it's not bothering me , if I
see a new fibroid, then Iusually will say to patients,
(15:30):
okay, let's just have a shortinterval where we'll look again
maybe in anywhere from like twoto six months, assuming no
other SI and no other symptoms.
And then if it's rapidlygrowing, we would absolutely
consider interventionsurgically to make sure it's
not cancer. But again, thattype of cancer very rare,
thankfully.
Speaker 2 (15:47):
Right. And because I think that's a myth then that
we can sort of debunk rightthere, right? Is that they're
they're different things .
They're
Speaker 3 (15:56):
Different things.
Yeah . Right . They , they ,they are similar but very
different. And that's whythere's a little confusion.
Mm-hmm
Speaker 2 (16:02):
Okay . That makes a lot of sense. Um, is there
anything that someone could doto lower their risk or prevent
the pro , like developing afibroid? Or is it, are , are
they hereditary? Like how do I, I
Speaker 3 (16:20):
Mean, again, here's what's interesting. When you
think about hereditary things,it wouldn't, it , they could be
hereditary and yet we don'tnecessarily think they are
because 70% of women have them.
Right? So things like ovariancyst and fibroids, again, are
just so common that it's hardto say if there's a heredi true
hereditary component. Now, allthat said, like I said, vitamin
D deficiency, things like theythink maybe dietary changes
(16:44):
like eating diets that are,that are high in trans fat or
processed food might increasethe risk of fibroids. But
again, that data is, it's morecausation. I mean, it's more
correlation probably thancausation. There are large
groups of people who are moreat risk for fibroids, like
black women. And unfortunatelytheir vitamin D levels tend to
be lower because of the , theirskin's ability to absorb and tr
(17:04):
and create the vitamin D three.
And we know that unfortunatelybecause of different resources,
their diets might be different.
Right. So is it causation orcorrelation? We don't know. So
could I say right now to anyperson, here's what you could
do. The honest answer is I can,I can say that I think most of
us should have our vitamin Dthree levels checked, which is
a controversial thing to saybecause there's pros and cons
in all of the data andliterature. I can say that we
(17:26):
should try to limit ouralcohol, limit, our trans fat
increase leafy green vegetablesand our really good quality
fats and protein. But can I saydirectly it's gonna prevent it?
No, I see some of my healthiestpatients and they still have
fibroids, which is in keepingwith the data, which is why I ,
I mean I say this a lot, I allat once want to be casual and
calm about it, while also veryclear and give information that
(17:50):
yes, you might have it. Yes,it's very common. No, it's not
likely to cause harm. But yes,you might have symptoms and
also, yes, you can get treatedright, all of it at once. But
if we approach it by giving youpreemptive information, like
how much better would it havebeen had you known from the
beginning as you have embarkedon being a woman
these are the things that mighthappen to you, then you
wouldn't have had to go throughthe freakout period. It
(18:11):
would've still been annoyingand frustrating, but it
wouldn't have been as anxietyprovoking. Right?
Speaker 2 (18:17):
Yeah. Yeah, I can, I can attest to that. Yeah , for
sure. Um, all right . Rapidfire. Yes . What are the top
three takeaways you hope ourlisteners remember from this
conversation? Because you'vegiven so much good information.
I think like if we could pickthree. Okay . What do you, what
(18:40):
would you say?
Speaker 3 (18:40):
Okay, so two with fibroids and one in general,
one fibroids, very, verycommon. If you find out you
have , so one is that they'revery, very common. Two is if
you find you have them, don'tbe scared at all because the
odds are you either will needno treatment or you'll need
some treatment that will helpyou either feel better or be
safer and healthier because weknow that you can bleed
heavily, have anemia, thingslike that. And the third
(19:01):
correlates to it, but is ingeneral try to learn more about
your body. And I say thatcautiously 'cause it's very
hard, right? Again, yourOBGYNs, we're seeing patients
every 15 minutes becauseinsurance is not because we
don't love you and wanna seeyou more, but it's hard to
preemptively teach you thesethings. So this is where the
internet and Dr . Google couldactually teach you good things
(19:22):
and instead people are Googlingthe wrong things. But learn
about your body and advocatefor yourself. If someone says
to you, oh yeah, you told methat you bleed X, Y , z and you
told me that it's heavy andannoying, but you're fine. I
hate to say like, don't believethem, but it's your body. So if
you don't feel like it's fine,then say to them, I think I
need a pelvic ultrasound. Orfind a doctor who will really,
really listen to you. In theend, you might still be fine,
(19:44):
quote unquote , meaning you'resafe, you're healthy and
everything, but maybe you'refine with fibroids. Maybe you
don't have fibroids, but youdeserve the discovery of what
is going on.
Speaker 2 (19:52):
Yeah, I love that. I think advocating for oneself,
and I think sometimes womendon't do it. Yeah . That well,
and that applies medical, itapplies at work, it applies to
so many things. And so for me,I think that is something, and
I think from a Tina's wishperspective, you know, as a
whole it's, you know,advocating for oneself with
(20:15):
medical, you know, kind ofdevelopments or concerns or
anything else. It's just soimportant .
Speaker 3 (20:21):
Well, and to that point, since Tina's wish is
really about ovarian cancer,and since I love to talk about
ovarian cancer, my other littletidbit would be this. Let's
just say for the sake ofargument that your doctorate
said, oh, you have a bulkyuterus, but you don't have any
symptoms. End of sentence. Iwould personally say to every
woman out there, if you hearanything other than your pelvic
exam feels perfect, you don'thave pain, pressure, bloating,
(20:43):
bleeding, anything other thanthat. Please, please, please
ask for a pelvic ultrasound. Asyou probably know, Megan , it
is not a standard screeningtool. We can't screen everyone
with it, but we should have avery low threshold to ask for
it. And we should have a highindex of suspicion to look for
the things that we are worriedabout. Fibroids, I'm not as
worried about as we knowovarian cancer , we do worry
(21:03):
about and we have no screeningtool for it .
Speaker 2 (21:06):
So I think to your point, advocating is, is
really, I I asked you forthree, but I think that fourth
one is also great. So Iappreciate you for, for
throwing that in there. Yeah .
Speaker 3 (21:16):
Thank you.
Speaker 2 (21:18):
Well, thank you so much Dr . Gorani . I, it really
has been a pleasure. And Ithink these are topics that
people just don't talk aboutenough. Yeah . And I get, this
is what I try to tell peoplethat I work with is like, when
you're uncomfortable, it'sactually when you learn the
most. Yeah . And so, likeunderstanding a little bit more
about these things and ifyou're going to your doctor and
(21:40):
asking these questions and kindof feeling more empowered to
advocate for yourself, but alsoto your point, is not going in
a state of stress or worry. Um,but it's, but it's also better
to just be educated andunderstand kind of these
different gynecological thingsthat we've got going we could
have going on. Yeah .
Speaker 3 (22:01):
I mean, it's a difference. I always say
between preemptive versusreactive. Like that's why I
like to try to give my patientspreemptive knowledge knowing
that they're only gonnaactually listen to this much.
Because as you said, we tend tobe like on high . We're like,
yeah, yeah, yeah. Not gonnahappen to me. And then it
happens and we have reactiveknowledge, but at least if
we've laid the groundwork witha little bit of preemptive
knowledge, then it's in theback of your mind and you can
(22:22):
decrease your anxiety. Yeah,
Speaker 2 (22:24):
I agree. Well, hopefully for all of our
listeners , um, you're feelinga little bit more empowered in
your own health and you'velearned something. And I'd also
invite you, 'cause we are goingto do another podcast , um,
where we discuss everything youneed . Well, hopefully it'll be
everything you need to knowabout ovarian cysts, which as
(22:45):
Dr. Gorani mentioned, are alsovery common. Mm-hmm
Speaker 3 (22:48):
Speaker 2 (22:49):
So thank you all for joining. Thank you .
Speaker 4 (22:57):
For
Speaker 1 (22:58):
More information about gynecologic health, visit
tina's wish.org/what to know .
That's tina's wish.org/wH-A-T-T-O-K-N-O-W . And like,
follow or subscribe whereveryou listen to your favorite
podcasts.
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