Women with uterine fibroids
wait more than three years on average before seeking treatment, even though
symptoms often interfere with their everyday lives, a new survey finds.
These benign tumours affect
up to 80% of women before the age of 50, and are the leading cause of
hysterectomy – surgical removal of the uterus – in the United States.
Nearly 1000 women with
fibroids responded to the Harris Interactive survey, and close to one-third of
those with jobs said they missed work because of symptoms, including heavy or
prolonged menstrual bleeding, cramping and fatigue.
Many of the women expressed
concern about fibroid treatment. More than three-quarters said they would
prefer non-invasive approaches, more than half wanted to preserve their uterus,
and younger women were often focused on preserving their fertility.
"I was impressed by
how strongly women felt about uterine preservation," said study author Dr.
Elizabeth Stewart, a professor of obstetrics and gynaecology at the Mayo Clinic
in Rochester, Minn. "For many women, even if they don't want fertility,
preservation of their uterus is an important goal."
Hysterectomy not always required
Fortunately, fibroids won't
necessarily require a hysterectomy, especially if women get medical care early,
The 968 women surveyed were
aged 29 to 59 and had reported fibroid symptoms. Fibroids often present no
symptoms, but one-quarter of women with fibroids say their day-to-day life is
affected by the growths.
Among the other findings:
24% of the working women said fibroid symptoms kept them from reaching
their career potential, and 41% of women saw two or more health care
providers before getting a diagnosis.
A sub-study found that
black women are more likely than whites to have severe symptoms, and 32%
of black women waited more than five years before seeking medical treatment
compared to 17% of whites.
Quality of life
"Fibroids affect the
quality of your life," said N Edward Dourron, a reproductive
endocrinologist at Hoag Memorial Hospital Presbyterian in Newport Beach, California.
The survey results mirror what he sees and hears in real life, he said.
It's no surprise that women
often see more than one doctor, said Dr William Parker, a gynaecologist at the
University of California Los Angeles Medical Centre, Santa Monica.
"Patients get told they need a hysterectomy, and they see another
doctor," he said. "And they see another doctor."
The national survey was
funded by Fibroid Relief, a program of the Focused Ultrasound Foundation in
Charlottesville, Virginia. The foundation, which promotes ultrasound treatment for
fibroids, is funded by ultrasound device manufacturers such as InSightec and
others, as well as private donations.
Stewart has been a clinical
trial investigator for InSightec and a consultant for Abbott, which also
contributes to the foundation, and to Gynaesonics, which makes a fibroid
The exact cause of fibroids
is unknown, Stewart said. Multiple hormonal and genetic factors are believed to
play a role.
"I believe treatment
needs to be individualized," Stewart said. Women need to assess where they
are in their reproductive lifespan. "Most women get some shrinkage [of
their fibroids] at menopause," she said.
If waiting isn't an option,
treatment choices include medications such as birth control pills, surgery to
remove just the fibroids or hysterectomy.
Ablation, a technique that
destroys the lining of the uterus, and embolisation, which cuts off blood flow
to the fibroid to make it shrink, are also options. Focused ultrasound, which
uses ultrasound waves to destroy the fibroids, is yet another treatment.
According to Parker,
"ultrasound is the least invasive approach, but it has the least amount of
data." It was approved by the US Food and Drug Administration in 2004.
Information on the
long-term safety of focused ultrasound, including pregnancy after the
ultrasound treatment, is still being collected, Stewart said.
The American College of
Obstetricians and Gynaecologists has more on fibroids.