Menopause and Fibroids: Should I Wait to Treat My Fibroids?

Many women who suffer from uterine fibroids—noncancerous tumors that grow in or on the muscle walls of the uterus—put off treatment because they are approaching menopause. While fibroids have been shown to shrink after “The Change,” this is not always the case.

Fibroids grow in part due to the amount of estrogen in a woman’s body. So, the changes in hormones that come with menopause can cause them to stop growing and even shrink. Every woman’s body is different, though, and fibroids can continue to grow. Some doctors believe there is an unknown substance secreted by fat cells that mimics the effect of estrogen on fibroids and makes them grow. Hormone replacement therapy during menopause can also cause fibroids growth.

And even if fibroids do shrink, this may not mean that the problems and symptoms associated with them will disappear completely. Some women continue to experience painful symptoms—including pelvic pressure, urinary urgency, and abdominal bloating—even after menopause.

Putting off treatment is not always in a woman’s best interest. Besides not knowing whether the fibroids will actually shrink after menopause, fibroids may actually grow in the years leading up to menopause due to increased estrogen production.

Right before menopause, when estrogen is removed from the body as the ovaries stop functioning, women will experience several months to years of estrogen-dominated menstrual cycles. Since fibroids are known to be estrogen-sensitive, this period in a woman’s life, which is essentially an “estrogen bath,” can be a time of fibroid growth.

“Waiting it out” until menopause for fibroids to shrink may result in years of growth and worsening symptoms of pain and bleeding. If you’re suffering from fibroids and approaching menopause, the best time to treat your fibroids may be now.

There is a minimally invasive, 90% effective option: Uterine Fibroid Embolization (UFE). This minimally invasive procedure shrinks the fibroids to provide relief and is 90 percent effective in reducing symptoms caused by fibroids. The interventional radiologists at Indiana Fibroid Center are dedicated to helping you find relief from your fibroid pain.

Fibroid Types and Symptoms

Fibroids are non-cancerous (benign) tumors that grow from the muscle layers of the uterus and affect at least 20 percent of women sometime during their lifetime. Depending on their size and location, fibroids may cause no symptoms at all or a variety of complications.

There are four primary types of uterine fibroids, classified by location:

Intramural

The most common type of fibroids, intramural fibroid tumors develop within the muscles of the uterine wall and often expand from there. When an intramural fibroid expands, it tends to make the uterus feel larger than normal and can cause excessive menstrual bleeding, prolonged menstrual cycles and clot passing, frequent urination, and back and pelvic pain caused by the additional pressure placed on surrounding organs.

Submucosal

The least common type of fibroids, submucosal, are located in the muscle under the uterine lining (endometrium) and may protrude into the uterine cavity. Submucosal fibroids can cause heavy bleeding, prolonged menstrual cycles, and the passing of clots. Left untreated, prolonged or excessive bleeding can cause more complicated problems, such as anemia and fatigue. Submucosal fibroids are also most closely linked to fertility problems, as large tumors can block the fallopian tubes.

Subserosal

Subserosal fibroids grow on the outer wall of the uterus. They can become quite large, continuing to grow outward and putting increased pressure on surrounding organs. This type of fibroid does not usually interfere with a woman’s menstrual flow or cause excessive bleeding but can cause pelvic pain and pressure.

Subserosal, as well as submucosal, fibroids can sometimes develop into pedunculated fibroids, meaning they grow on a stalk. Pedunculated fibroids can twist on the stalk, causing additional pain and pressure.

Cervical

Cervical fibroids are located in the wall of the cervix, the neck of the uterus. The most common symptom is irregular or heavy bleeding. Cervical fibroids can also cause painful sexual intercourse, vaginal discharge, or trouble with urination.

Women generally have multiple fibroids, and it is possible to have more than one type, making it difficult to determine which fibroid is causing symptoms.

If you are experiencing any of the following symptoms, you may have uterine fibroids:

  • painful, heavy periods
  • pelvic or back pain
  • frequent or difficult urination
  • swelling in the abdomen
  • painful intercourse

Fibroids and Infertility: Is There a Connection?

While uterine fibroids are more common as a woman ages, approximately 20-30 percent of women of childbearing age are affected. These noncancerous tumors of muscle tissue in the uterus can cause back pain, abdominal pressure, urinary frequency, and heavy, painful, prolonged periods. Reproductive problems, such as infertility, can also be caused by uterine fibroids.

Are Fibroids The Cause of My Infertility?
Fibroids are the cause of infertility in some cases, so it is possible. Approximately 5-10 percent of infertile women have fibroids; however, when all other causes of infertility are eliminated, fibroids may only account for 2-3 percent of infertility cases.

Fibroids can cause the uterus to change shape, which can decrease fertility. The size, number, and location of the fibroids determine whether or not they affect a woman’s fertility. Fibroids located in the wall of the uterus (intramural) or on the inside of the uterus, bulging inward (submucosal) may affect fertility. The large majority of fibroids, though, are very small or located in an area of the uterus such that they will have no impact on reproductive function.

How Do Fibroids Affect Fertility?
The following are ways uterine fibroids can decrease fertility:
♀ Fibroids can distort the shape of the cervix and can affect the number of sperm that can enter the uterus.
♀ Fibroids can create an abnormal uterine cavity, which can also affect sperm transport and can affect embryo implantation.
♀ Fallopian tubes can be obstructed or distorted by fibroids, preventing the egg from passing through.
♀ The lining of the uterus can be affected by fibroids, which can impact implantation.
♀ Blood flow to the uterine cavity can be affected, decreasing the ability of the embryo to implant or develop.

Should I Attempt to Get Pregnant If I Have Fibroids?
If you already have fibroids and get pregnant, it may be difficult to carry to term, as fibroids can lead to preterm birth or miscarriage. Fibroids rarely affect the baby, although they can change the baby’s position in the uterus, increasing the likelihood of the woman needing a cesarean section. Fibroids are found in up to approximately 10 percent of pregnant women, but not all fibroids get larger or cause problems in pregnancy; however, it is not advisable to attempt to get pregnant until after you deal with your fibroid problem.

What If I’m Already Pregnant?
Talk to your doctor, so that your fibroid condition may be monitored, and be sure to let him or her know if you experience any pain or contractions. It is recommended that you delay treatment for your fibroids until after you give birth. While increased hormones can cause fibroids to grow, no procedure should be performed while you are pregnant.

What Can I Do If I Think Fibroids Are Affecting My Fertility?
First of all, talk to your doctor. If he or she thinks that fibroids are the cause of your fertility, there are treatment options that can help. Uterine Fibroid Embolization (UFE) is a minimally invasive, nonsurgical procedure that blocks off the blood supply to the fibroids and is a good option for young women who want to conceive. Removal of fibroids through embolization may increase your fertility afterwards; however, each case is different. How your fibroids are managed depends on your unique situation and your doctor’s recommendations.

Questions to Ask Your Specialist About UFE

You’ve talked to your OB-GYN about your uterine fibroid diagnosis and possible treatment options. So…what’s the next step?

If you and your OB-GYN have determined that a treatment option such as Uterine Fibroid Embolization (UFE) might be right for you, it’s time to see a specialist, particularly an interventional radiologist, who can evaluate whether or not you are indeed a good candidate for the procedure.

Once referred to a specialist, you should take a copy of your medical records and any imaging that has confirmed your fibroid tumors to your consultation. A copy of your most recent gynecologic evaluation is also helpful, as an OB-GYN exam is recommended to rule out non-fibroid causes of symptoms.

To help you understand UFE as a procedure, and also to help you understand how the physician will manage your case, it is important to ask lots of questions. Below is a list of questions you may want to ask your specialist so that you can be prepared to make the best decision about your fibroid treatment.

  • How would you coordinate my care with my OB-GYN?
  • Which OB-GYNs refer patients to you for UFE?
  • How often is the procedure successful in treating uterine fibroids?
  • Are your patients happy with the procedure?
  • What are typical complications, and how often do complications occur?
  • How will I feel during and after the UFE procedure?
  • How long should I expect to be away from work?
  • What is the length of the procedure? What is the normal recovery time?
  • How long should I expect to stay in the hospital?
  • What kind of follow-up care is typical, and who manages it?
  • What typically happens to the fibroids after the blood supply is cut off? Should I expect them to be expelled vaginally, or will the procedure simply result in my fibroids shrinking?
  • Will my fibroids, or the symptoms of my fibroids, come back?
  • Will I still get my periods after having UFE, and what will they be like?
  • Will my insurance cover Uterine Fibroid Embolization?
  • Can you help me determine if I am a candidate for UFE, and when can we schedule the procedure?

Questions to Ask Your OB-GYN About UFE

If you’ve been diagnosed with uterine fibroids and are tired of the pain and heavy bleeding you’re experiencing, it’s time to take action.

With many treatment options available, it’s important to find the right one for you. Uterine Fibroid Embolization (UFE), a minimally invasive, nonsurgical procedure that blocks off the blood supply to the fibroids, is one option. While UFE may be right for you, it is first a good idea to talk with your OB-GYN. He or she can be a very useful resource in diagnosing your fibroids and guiding you to the best course of treatment.

Make an appointment with your OB-GYN to discuss whether you might be a candidate for UFE. The questions below will help you better understand the fibroid treatment options available.

Questions about fibroid treatments:
• How do you typically treat symptomatic fibroids? What are the risks and benefits of each of these treatments?
• What are the surgical, and less-invasive, options for treating my fibroids?
• What are the advantages, risks, and benefits of each of the fibroid treatments?
• Have all of the necessary diagnostic tests been performed? Trans-vaginal ultrasound or MRI? Endometrial biopsy? Blood tests? Why or why not?
• If I want to retain my uterus, what alternatives to hysterectomy are available?

Questions about more invasive surgical options:
• Do I need to have surgery? Will my ovaries be removed? If so, why? Will my cervix be removed? If so, why?
• What are the risks associated with surgery?
• Will I experience earlier menopause? Can the symptoms of menopause be treated?
• What are the risks and benefits of treatment for the symptoms of menopause?
• What are the limitations of surgery?
• Will surgery cure my uterine fibroid tumors?

Questions about UFE:
• Do you refer patients for UFE? If not, why?
• How many patients have you referred for UFE, and how many have chosen UFE to treat their fibroids?
• Will you refer me to an interventional radiologist for a consultation?

If your OB-GYN determines that you are a good candidate for UFE, ask for a referral to a specialist. The interventional radiologists at Indiana Fibroid Center are some of the most experienced in the Midwest at UFE, and we would be happy to speak with you about your specific symptoms and treatment plan.

Is Uterine Fibroid Embolization Covered By Insurance?

If you’re considering Uterine Fibroid Embolization (UFE) to treat your fibroid symptoms, you most certainly have many questions. “Will I have to stay overnight in the hospital?” “Is the procedure painful?” “How long will my recovery be?”

One question that may also be on your mind—“Will my insurance cover UFE?”

Although all insurance companies and policies differ, the answer is most likely yes. You may be responsible for a portion of the cost—depending on your individual plan, your deductible amount, and what percentage of the cost will be paid by the insurance company—but UFE is covered by most insurance providers.

Before having any procedure, of course, you should do your homework and check with your insurance provider to verify your plan and benefit coverage. Know ahead of time what your financial responsibility will be and if you’ll need any specific referrals or preauthorizations before undergoing UFE.

Be sure to ask your health insurance provider the following:

  • Is a referral by my primary care physician required for consultation with a radiologist?
  • Is my interventional radiologist considered in-network?
  • Is pre-certification required for UFE’s pre-procedural pelvic MRI?
  • Is pre-certification required for my UFE procedure?

At Interventional Physicians of Indiana, we are here to help with all aspects of your fibroid treatment—including the financial part. We will work with you to submit your health insurance claim and will try to answer any questions you may have about your coverage. We participate with many medical groups to provide healthcare service to their HMO members and PPO healthcare plans.

We are in-network with a number of health insurance providers. You can find a general list of insurance providers we work with here. However, be sure to check with your provider directly to verify your specific plan and benefit coverage.

You May Be Able to Treat Your Fibroids for Little Out-of-Pocket Cost

The year is winding down, and although it’s likely a very busy time of the year for you, it’s also a good time to think about your health and do something about that pelvic pain that’s been keeping you from enjoying everyday activities.

The end of the year is the time to make sure you are getting the most out of your health insurance plan. If you have met your deductibles or have funds remaining in your Health Flexible Spending Account (FSA), you may be able to treat your pelvic pain for little out-of-pocket cost to you.

Deductibles, Maximum Out-of-Pocket Expenses and FSA Funds
Most insurance policies calculate deductibles and maximum out-of-pocket expenses based on the calendar year. Medical expenses incurred during the year are applied to your deductible and are paid out-of-pocket until that deductible is met.

Once your deductible is met, you incur little or no out-of-pocket for covered medical expenses.

So if you’ve met or nearly met your 2105 medical deductible, now is the perfect time to take care of any medical procedures you may have been putting off. But don’t wait, copays, deductibles, and out-of-pocket expenses are reset on January 1, 2016.

As the end of the year approaches, it’s also a good time to check your policy and balances. If you’ve already met your deductible or if you have funds left in your FSA, and you’ve been putting off treating your pelvic pain, now is the time.

Schedule now to get your procedure before the end of the year. Don’t wait because medical facilities typically experience a heavy demand for procedures towards the end of the year as patients try to maximize their benefits.

Stop suffering, Uterine Fibroid Embolization (UFE) is a non-surgical, minimally invasive treatment performed by an Interventional Radiologist that shrinks the fibroids to provide relief. UFE is 90 percent effective in reducing symptoms caused by fibroids.

Chronic Pelvic Pain? Make The Most of Your FSA Balance

Start off 2016 pain-free by using your remaining 2015 FSA savings to schedule that chronic pelvic pain treatment you’ve been putting off.

The new year is just around the corner. If you have a health Flexible Spending Account (FSA), it’s time to check your balance and start thinking about how you can use, not lose, the money you’ve put into your account.

Uterine Fibroid Embolization (UFE) is a non-surgical, minimally invasive treatment performed by an Interventional Radiologist that shrinks the fibroids to provide relief. UFE is 90 percent effective in reducing symptoms caused by fibroids. The Interventional Radiologists at IPI perform this procedure at Community Hospitals North and East.

Medical facilities typically experience a heavy demand for procedures toward the end of the year as patients try to maximize their benefits, so the sooner you schedule your appointment, the better.

The fact that your procedure may be of little or no cost to you could be just the motivation you need to take care of those nagging aches and pains.

Take action now. Make the most of your benefits and make the most of the funds that are just waiting to relieve your pelvic pain this year. Start off 2016 without pelvic pain.

Steps to Take to Treat Your Fibroids

Most uterine fibroids are harmless and do not cause symptoms; however, some may be painful, press on internal organs, cause heavy bleeding and possible anemia, or cause infertility problems.

If you have a fibroid problem, there are several treatments to consider, including uterine fibroid embolization (UFE). Doing your research and talking with specialists will help inform and educate you so that you can make the right decision for your treatment.

Below are five steps to get you on the path to treatment:

1. Get Informed

Do your homework. Conduct research on which uterine fibroid treatment options are appropriate for you. Visit websites for such organizations as the National Uterine Fibroid Foundation (www.nuff.org), the American Congress of Obstetricians and Gynecologists (www.acog.org), and the Society of Interventional Radiology (www.sirweb.org). Also, check out your hospital’s website for information on treatment options.

Seek a second (or third or fourth) opinion. Obtain a copy of your medical records from your OB-GYN, and don’t hesitate to discuss treatment options with other doctors. Make sure you are comfortable and satisfied with the information you hear and the treatment plan you and your doctor decide on. Talking with an Interventional Radiologist (IR), who is familiar with UFE, will help determine if you are a candidate for that treatment option. If you are not, your OB-GYN can provide you with alternative options.

Talk to other women with uterine fibroids. Many hospitals have women’s health seminars that feature fibroids discussions. Hearing about others’ individual experiences, especially those who have undergone UFE, can help you determine if it is a possibility for you.

2. Talk to Your OB-GYN

Make an appointment with your OB-GYN to discuss whether you might be a candidate for UFE.

3. Get Referred to a Specialist

Your OB-GYN is accustomed to referring patients to different types of medical specialists, so he or she will be a great resource for where to go to seek further treatment options. Ask your OB-GYN about UFE and if a specialist, such as those at Indiana Fibroid Center, would be appropriate for treating your symptomatic uterine fibroids and managing your post-procedure care.

4. Find a Specialist

The physicians at Indiana Fibroid Center are some of the most experienced in the Midwest at performing UFE. We are happy to speak with you about your specific symptoms and options for treatment.

5. Talk to a Specialist

Prepare for consultation. If your OB-GYN has diagnosed you with uterine fibroids, you should take a copy of your medical records and any imaging that has confirmed your fibroid tumors, to the consultation with the specialist you have been referred to. A copy of your most recent gynecologic evaluation is also helpful, as an OB-GYN exam is recommended to rule out non-fibroid causes of symptoms.

You don’t have to continue suffering from the discomfort of uterine fibroids. The physicians at Indiana Fibroid Center are dedicated to creating treatment plans that will improve our patients’ comfort and lifestyle. We offer state-of-the-art, minimally invasive, nonsurgical procedures to treat your fibroids, and our experienced staff is committed to providing you with the best care available.

Uterine Fibroids – The Facts

Uterine fibroids, which are also known as leiomyomas, are non-cancerous tumors, or growths that can grow on the outer wall of the uterus, within the muscle wall of the uterus, or on the inside wall of the uterus. They can change the shape of the uterus as they grow. If not taken care of, the size, shape, location, and symptoms of fibroids can change.

Fibroids do not grow before the start of menstrual periods (puberty). As women age, they are more likely to have uterine fibroids, especially from their 30s and 40s through menopause (typically around age 50). Uterine fibroids can stay the same for years with few or no symptoms, or you can have a sudden, rapid growth of fibroids.

During pregnancy fibroids sometimes grow larger in the first trimester, and they usually shrink for the rest of a pregnancy. After menopause, when a woman’s hormone levels drop, fibroids usually shrink and don’t come back.

Complications of uterine fibroids aren’t common. They can include:

  • Anemia from heavy bleeding.
  • Blockage of the urinary tract or bowels, if a fibroid presses on them.
  • Ongoing low back pain or a feeling of pressure in the lower abdomen (pelvic pressure).
  • Infection or a breakdown of uterine fibroid tissue.