Fibroids affect millions of women

Secretary of State-designate Condoleezza Rice took a day off from work recently to be treated at Georgetown University Hospital for what news organizations described as minor surgery.

In fact, Rice, 50, President Bush’s national security adviser, underwent a surgical procedure to treat noncancerous tumors of the uterus. These tumors, called fibroids, are one of the largest health issues facing American women today, with nearly half of all women older than 35 afflicted.

While the tumors are almost always noncancerous, they range in severity from hardly noticeable to very painful. In some cases, they cause serious problems, including infertility.

In Rice’s case, Jim Wilkinson, deputy national security adviser, reported that “the surgery was successful.”

Years ago, the only treatment for fibroids was the removal of the uterus, a serious operation that requires a six-week recovery. But medical advances have created new options, and research holds out the hope for even less invasive treatments.

A recent study provides clues about the structure of fibroids and could clear a path for the development of drugs, rather than surgery, to treat the condition.

The study, published in the October issue of the journal Fertility and Sterility, reiterates the widely held opinion that conventional hormone therapy will only temporarily relieve symptoms or shrink noncancerous fibroids but will never cure them.

What’s more, researchers at the National Institute of Child Health and Human Development of the National Institutes of Health, using electron microscopic analysis, found that fibroids were made up of large tangles of collagen threads.

“We have to find a way to get rid of this abnormal collagen if we are ever going to find a medication to treat fibroids,” says Phyllis Leppert, chief of NICHD’s Reproductive Science Branch, and lead author of the study.

Leppert and James Segars, of NICHD’s Pediatric and Reproductive Endocrinology Branch, plan to launch in January a study of two drugs aimed at collagen growth. The drugs, to be used together, will be tested to determine whether they can block collagen formation or break collagen apart.

“It’s my hope that eventually we will have a medicine to treat uterine fibroids,” Leppert says, “rather than having to treat them surgically.”

That would be welcome news to millions of American women.

Studies show that roughly 40 percent of American women age 35 or older have uterine fibroids. Black women are afflicted at higher rates, with studies showing as many as 50 percent to 80 percent of these women of child-bearing ages suffering from fibroids.

Dr. Chandra Graham, a faculty member at the University of Maryland Medical Center, recently admitted two patients to a hospital for blood transfusions as a result of fibroids.

“It can be very serious,” Graham says. “The fibroids cause excessive bleeding. And when the blood level is decreased, it can cause chest pains, shortness of breath and other complications.”

At Mercy Medical Center’s Weinberg Center for Women’s Health and Medicine, Dr. Fermin F. Barrueto, chief of endoscopy and pelvic reconstruction, says hardly a week goes by when he doesn’t have a fibroid surgery. Depending on the case, the surgery is either minimally invasive or more extensive. In one patient, for example, Barrueto had to remove 75 individual fibroids.

Uterine fibroids account for one-third of the hysterectomies in the United States, a statistic that has researchers pushing for less invasive treatments.

For younger women, doctors often recommend a myomectomy, a surgical procedure that removes fibroids but retains the integrity of the uterus.

In the last decade, radiologists have pioneered a technique called uterine fibroid embolization. Rice had this procedure, which shrinks fibroids by injecting small particles into the blood vessels that feed fibroids.

And earlier this fall, the Food and Drug Administration approved the use of ultrasound beams to treat fibroids. At Johns Hopkins Hospital, one of three locations nationwide to offer the ultrasound-beam treatment, doctors are establishing a fibroid center that will offer many treatments.

Dr. Hyun S. “Kevin” Kim, who has worked on the embolization and ultrasound technologies, says patients will be able to choose their treatment depending on the severity of the fibroids.

Still, many researchers hope to one day find a medicine that will cure fibroids.

Barrueto cautions women to be patient, though. “We are very encouraged that there is a breakthrough in knowledge,” he says. “And that will lead to the next step of finding drugs… . But we are not there yet.”