Finding a treatment for fibroids

When Patricia Caudle first began noticing that her menstrual periods were abnormal, she “just dealt with it.” But after they began substantially interfering with her quality of life, she knew she needed help.

The severe pain, irregularity of her monthly cycles and the unexpected and prolonged bleeding she experienced were causing difficulties at work -- she sometimes had to dash out of meetings or go home early. And her social life was suffering. She was bailing out on engagements with friends and missing church and community theater activities.

During an exam, Caudle, a human resources manager at a Los Angeles law firm, says her gynecologist noticed that her abdomen was unusually hard. MRI and ultrasound scans revealed that she had several large fibroids, masses that were equivalent in size to two big grapefruits.

Fibroids are benign tumors that develop in the walls of the uterus.

It’s not clear how many women in the United States have fibroids, though it’s estimated they may occur in up to three-fourths of American women, most of whom do not need treatment. But many women with severe symptoms do seek treatment, such as Secretary of State nominee Condoleezza Rice, who on Nov. 19 underwent a procedure known as uterine fibroid embolization, a relatively new minor surgery.

Studies suggest that 20% to 40% of women of reproductive age have fibroids that cause symptoms such as heavy bleeding, pelvic and back pain, fertility problems, frequent urination and constipation.

Doctors don’t know exactly why fibroids develop, although estrogen appears to promote the growth of these noncancerous tumors. Fibroids generally shrink after menopause, when estrogen production declines.

In preparation for a procedure to treat the fibroids, Caudle received several months of hormone injections to send her body into a menopausal state in an effort to reduce the size of her fibroids. But the tumors didn’t seem to budge, and Caudle suffered hot flashes and night sweats, common menopausal symptoms that only added to her misery.

At the time, she was also taking iron supplements to treat her anemia.

Caudle had considered having a hysterectomy, the removal of the uterus and the only guaranteed cure. She had also weighed a more conservative choice known as myomectomy, a procedure in which fibroids are surgically cut out of the uterus.

But concerned about undergoing major surgery, Caudle decided on uterine fibroid embolization, also known as uterine artery embolization, a newer, less invasive approach.

During the procedure, a radiologist makes an incision in the groin and, using a special dye and X-ray imaging for guidance, threads a catheter into the main uterine artery. Beads the size of grains of sand are then released to block the blood vessels that nourish the fibroids.

“The fibroids shrink and die over time,” says Dr. Victoria Marx, an interventional radiologist at USC’s Keck School of Medicine in Los Angeles, who treated Caudle in October 2002.

During the procedure, Caudle received intravenous sedation, which made her sleepy but allowed her to remain conscious.

She stayed in the hospital two days and didn’t feel completely recovered until about seven weeks later.

Many patients, however, are back to normal within a couple of weeks, Marx says.

Until recently, Caudle’s periods remained erratic. “If I did bleed, it would be unannounced,” she says. “Then I didn’t have periods for a while. It got to the point that I didn’t think I’d ever have one again. It’s been within the last few months that I think things are back to normal.”

Caudle’s periods now last about five days, as before, and the bleeding on the first couple of days is still quite heavy. The cramps she experiences are less severe than before she underwent treatment for fibroids. “Now it’s just your normal cramping,” she says. “I can manage it.” And her menstrual cycle is back on track; her periods arrive pretty much every 28 days.

She’s happily regained an active social life. Her energy is back and she’s able to plan activities without worrying that she’ll have to cancel at the last minute because of debilitating bleeding and pain.

She knows that uterine fibroid embolization isn’t always a permanent cure.

About 20% to 25% of patients will experience a recurrence at some point, says Marx, who underwent the embolization procedure for fibroids in 2001. But Caudle is hoping the effects of the procedure will carry her through to menopause.

“They can always come back, but right now I’m comfortable,” she says. “I’m not a nervous wreck at work anymore.”