**If you have questions or need a physician referral, please contact HERS at 888.750.

HERS (4377) or
610.667.7757.**

Uterine Fibroids
More than half of all women have fibroids. They are a common, benign, uterine growth.

Fibroids are not a disease. Much like the genetic blueprint that determines the color of your eyes and hair, if fibroids are
common in your family, you are more likely to develop them.

Fibroids often do not cause symptoms. Most women are unaware that they have them until a doctor mentions it during a
routine pelvic exam.

Composed of smooth muscle cells and connective tissue, fibroids grow slowly until you reach menopause. They have two,
predictable, rapid growth spurts that are natural and not a cause for concern. After menopause, fibroids shrink and
become small and calcified.

The first rapid growth spurt usually occurs in the late 30's to early 40's, followed by a few years of slower growth. The
second (and last) rapid growth spurt occurs just before menopause-- when women experience the hormonal changes
associated with the beginning of menopause. About a year after menopause, fibroids begin to slowly and gradually shrink
to a negligible size.

Some women have large fibroids, while others have smaller fibroids. But for women in their late 30's to early 40's who
have fibroids, the size of the uterus including the fibroids is, on average, about the size of a 10-12 week pregnancy--about
13cm in the largest dimension. In the middle 40's, the uterus including fibroids is, on average, about the size of a 14-16
week pregnancy--about 17cm in the largest dimension. And for women in their late 40's to early 50's, the uterus including
fibroids is, on average, the size of an 18-20 week pregnancy--about 21cm in the largest dimension.

By about age 40, women have all the fibroids they are ever going to have. Rarely will a new fibroid develop after about the
age 40.

Both estrogen and progesterone stimulate fibroid growth. Some foods, such as eating large amounts of soy, can also
stimulate excess estrogen production, which in turn makes fibroids grow. There is an abundance of advertising for
vitamins and other products that promise to reduce the size of fibroids or eliminate them entirely, but many are ineffective,
and others actually stimulate fibroid growth. For example, so-called "natural" progesterone yam creams are promoted as a
way to shrink fibroids, but in fact they make them grow.

If you have symptoms such as extremely heavy menstrual bleeding with large blood clots or pressure on the bladder
causing urinary frequency, it may be more of a nuisance than a true health problem. If you can live with the symptoms, you
will avoid needless intervention of any kind. If you have symptoms that you cannot live with there are conservative
treatment options.

The location of fibroids that cause heavy menstrual bleeding is submucosal. "Submucosal" fibroids are located in the
inside layer of the uterus--in the endometrium. Even tiny submucosal fibroids can cause extremely heavy menstruation
with large blood clots. Submucosal fibroids that are 4cm or smaller may cause heavy bleeding and large blood clots. They
can by shelled out in a procedure called a hysteroscopic resection of the fibroid, which should not be confused with a
hysteroscopic resection of the endometrium. You can avoid having a doctor think you want a hysteroscopic resection of
the endometrium, which would make the bleeding worse, by referring to the procedure as the hysteroscopic shelling out of
a submucosal fibroid.

Hysteroscopic resection is usually an outpatient surgery in which a long endoscope called a hysteroscope is inserted into
the vagina, through the cervix, and into the uterus. A tool is attached to the scope, and the surgeon chips away at the
fibroid until nothing remains but the shell. This may sound like a simple surgery, but shelling out the fibroid without
perforating the uterus requires skill and experience.

Submucosal fibroids that are larger than 4cm cannot be shelled out hysteroscopically, but they can be removed with a
myomectomy. Myomectomy is a conservative surgery to remove fibroids that leaves the uterus intact. Fibroids in other
locations, such as intramural fibroids (in the middle wall of the uterus) and subserosal fibroids (in the outside wall of the
uterus) and pedunculated fibroids (outside the uterus attached to a long stalk, which is the blood supply from the uterus to
the fibroid) can also be removed with myomectomy.
Fibroids of any size, number, or location can be removed by a skilled surgeon. If a doctor tells you that a myomectomy
cannot be performed because of the size, number, or location of your fibroids, you need another doctor. It is unlikely that a
doctor will tell you that a myomectomy could be performed by a more skilled surgeon.

It is a major operation, but unlike hysterectomy, endometrial ablation, focused ultrasound, UAE (uterine fibroid
embolization) and other destructive surgeries, myomectomy is a constructive surgery that preserves the uterus and its
many lifelong functions.

Uterine Artery Embolization (UAE) is sometimes referred to as uterine fibroid embolization (UFE). It involves occluding
(blocking) the blood flow in the uterine arteries. It is performed by an Interventional Radiologist who inserts an embolic
material--such as tiny plastic polyvinyl alcohol particles, microspheres, embospheres, gel foam, or metal coils--into the
femoral artery, and then into the uterine artery that supplies blood to the fibroid. UAE is considered successful if the
fibroids shrink, even when there are serious complications.

One of the serious complications from UAE is misembolization. Misembolization occurs when the embolic material travels
to distant parts of the vascular system. The reason this happens is that the blood supply to the fibroids is shared with other
organs--such as the labia, vagina, clitoris, ovaries, bladder, and kidneys. In fact, the blood flowing through the uterine
artery, where the embolic material is injected, is part of the same blood supply that provides blood flow to your legs and
feet and back up through your vascular system to your heart and lungs. Adverse effects ranging from chronic pain and
loss of ovarian function to a loss of sexual feeling have been reported as a result of misembolization, as well as several
deaths.

The goal of UAE is to block the flow of blood. But when the blood supply to any part of your body is blocked, the tissue
that depends on that blood supply may become necrotic--it might die. Necrosis of tissue as a result of impaired blood flow
is common and may be lifethreatening.

The Food and Drug Administration (FDA) maintains an Adverse Events database with hundreds of reported complications
of UAE. Although it receives only a small percentage of the actual number of adverse events that occur (reporting is
voluntary, and the only complication that must be reported is death), it is a significant number. The Adverse Events
database can be accessed online by going to "FDA Maude" on the FDA website, clicking on "Simple Search," and entering
the search term "uterine artery embolization." A second search entering the term "uterine fibroid embolization" will provide
additional adverse event reports.

The HERS Foundation has counseled many women with permanent, disabling problems from UAE. Some women
experience necrosis of the uterus (leading to a hysterectomy that was not necessary before the UAE), as well as necrosis
of the vagina, labia, buttocks, bladder, bowel, and kidney. And many women experience impairment, or even the total loss,
of ovarian function. The medical term for the removal of ovaries is castration, and for the loss of ovarian function in intact
ovaries, the term is de facto castration.

Although UAE does sometimes diminish heavy bleeding and shrink fibroids, the relief may be temporary. Fibroids often
begin to grow again a few months after embolization and cause a recurrence or worsening of previous symptoms. The
embolic material remains in a woman's body the rest of her life, often causing future health problems. There is no remedy
for these complications because the embolic material cannot be removed or flushed out of the vascular system once it is
injected into it.

We will not know just how dangerous UAE is until the effects of longterm exposure to radiation (from fluoroscopy, which
allows the doctor to see inside the artery during the procedure) and the effects of injecting plastic balls and metal coils into
the human bloodstream plays itself out in the lives of millions of women.

Another destructive "alternative" treatment for heavy bleeding from fibroids is called endometrial ablation. Endometrial
ablation is a surgery where the endometrium, the inside, endometrial layer of the uterus, is burned by heat or freezing.
Whatever method of ablation is used, the purpose is to permanently scar the inside of the uterus so that the endometrium
(the layer of the uterus that sheds during menstruation) cannot build up. The hypothesis is that if the endometrium is
prevented from proliferating (building-up), there will be nothing to shed as it naturally does during menstruation.

Endometrial ablation is considered successful if menstrual bleeding stops. But the uterus continues to attempt to perform
its natural functions as if it were not scarred. In preparation for menstruation, the natural engorgement of blood still occurs
in the uterus and pelvis, but due to the scarring caused by ablation, there is no endometrial tissue to build up. With no
endometrial lining to shed, there is no way for the blood to exit the uterus, so the uterus remains engorged with blood. This
may initially only cause a feeling of fullness in the pelvis, but after a few months of the uterus being engorged with blood
by a blockage of natural menstrual flow, many women experience constant, debilitating pelvic and vaginal pressure and
pain.
Other risks of heat and freezing ablation include thermal perforation of the uterus, bowel, or bladder and infection and
hemorrhage. Additional risks of heat ablation are fluid overload and death.

Intravenous fluid is given to replace the fluid lost during heat ablation. The amount of fluid must be closely monitored, and
every woman is unique in terms of how much fluid her body will tolerate. The surgeon then applies heat or cryo (freezing)
to the endometrium. This procedure causes an unknown quantity of the fluid to evaporate. Some of the fluid is absorbed
into the woman's body, but the amount of evaporation and absorption cannot be measured precisely. It is far from an exact
science. Women have experienced serious complications, even death, as a result of fluid overload in the heart and lungs.

Damage to the uterus as a result of endometrial ablation often leads to a hysterectomy that was not necessary before the
ablation. Although the exact number is not known, it is important to note that the incidence of hysterectomy after
undergoing endometrial ablation or uterine artery embolization to treat fibroids is probably significant, because these
procedures themselves often do irreparable damage to the uterus, ovaries, external genitalia and other internal organs.

If a doctor tells you that you need a hysterectomy for fibroids, you need a better doctor. You never need a hysterectomy for
fibroids unless you have the wrong doctor. If you have symptoms that you feel you need to do something about, there are
conservative treatment options.

Hysterectomy causes many well-documented, permanent, irreversible, and life-altering problems. For more information,
visit http://hersfoundation.com/anatomy/ to watch the short video Female Anatomy: the Functions of the Female Organs.

Questions? Fill out the HERS contact form.

HERS Foundation
www.hersfoundation.org
www.uterinearteryembolization.org
610.667.7757
HERS@hersfoundation.org