Dearest:  My guest tonight, Michael S. Broder, M.D., M.S.H.S., is an assistant professor 
of obstetrics and gynecology at the UCLA School of Medicine. He has extensive research 
training and has served as a consultant to the RAND Corporation (a research think tank
in Santa Monica, CA) since 1996.

Dr. Broder has earned a listing in Who's Who in America, 2001. He is a frequent public 
speaker on women's health issues. Dr. Broder has also studied the overuse of hysterectomy 
to treat gynecologic problems.

Dr. Broder is on the board of the National Uterine Fibroids Foundation, a group dedicated 
to helping women with uterine fibroids. Dr. Broder and Dr. Scott Goodwin co-authored the 
book, What Your Doctor May Not Tell You About Fibroids:
New Techniques and Therapies--Including Breakthrough Alternatives to Hysterectomy 

It's a pleasure to welcome you to Power Surge, Dr. Broder. 


Michael Broder, M.D.:  Thank you, I'm happy to be here.


Dearest:  Could you please give us a brief description of uterine fibroids and what
causes them? 


Michael Broder, M.D.:  I wish that there was a brief description. Uterine fibroids are 
benign tumors, meaning that they aren't cancer. They usually grow in the uterus but can 
grow in other places, as well.  No one really knows what causes them, but they are very 
common. By age 40, about half of all women will have a fibroid that can be identified
by ultrasound.


Dearest:  Are certain age and/or ethnic groups more prone to develop fibroids? 


Michael Broder, M.D.:  Yes, fibroids begin to develop in women in the late teens or
early 20s, but it's more common to see women in their 40s with problems.  They often
grow slowly, and don't cause problems for many years. 

As far as ethnic groups, African American women are more likely to develop fibroids
than Asian or Caucasian women. No one knows exactly why that is. 


Dearest:  I read that 77% of women have fibroids. Does one always experience symptoms
with fibroids? 


Michael Broder, M.D.:  I think that the 77% figure might be a little high, but certainly 
they're very common.  They most commonly don't cause symptoms, so it's more
common to have fibroids and not know it, than to have problems. 


Dearest:  I understand that fibroid tumors are benign, but do they ever have the
potential to become malignant?


Michael Broder, M.D.:  They cannot become malignant. A fibroid is benign by definition
and will always remain that way.  A leiomyosarcoma is a uterine tumor which is a very
rare cancer. At one time it was thought that fibroids could turn in to this kind of
tumor. Sometimes this kind of tumor (leiomyosarcoma) can be confused with a fibroid
at an examination. 


CKrafft:  Do fibroid tumors go away after menopause? 


Michael Broder, M.D.:  Probably not. But the symptoms that they cause tend to go away 
after menopause.  They do shrink somewhat and it's possible that the smallest of them
will go away, but unlikely that most go away completely.  Once the cells are there,
they don't usually go away, but the overall size decreases. If the symptoms go away,
and that's what really matters. The shrinkage is due to the loss of estrogen and 
progesterone. 


PatC:  I really don't know very much about uterine fibroids. What problems do they cause?


Michael Broder, M.D.:  The most common problem is irregular or very heavy periods. 
Sometimes when fibroids get very big, they can cause a protruding belly or pain.
They can also cause infertility.  The most common problem, though, is changes in
the bleeding pattern. 


Dearest:  What questions do you recommend a woman ask a doctor who has told her she
needs to have a hysterectomy to relive her fibroid problem?


Michael Broder, M.D.:  That's an excellent question!  I have lots of women who have been 
told that they need a hysterectomy, but at least 2/3 don't really need that.  The most 
common mistake that I see doctors making is not to try safer, non-invasive things first. 
For example, if a woman is having bleeding troubles, there are medications to try first. 


Dearest:  Of the 35-45 percent of hysterectomies performed because of fibroids, why
wasn't a myomectomy or the newer, UFE (uterine fibroid embolization) performed instead? 


Michael Broder, M.D.:  That's a very hard question to answer since no one has studied
what is happening in the doctors offices.  Traditional training for gynecologists is
that hysterectomy is the "right" treatment for women who don't want more children.
Because fibroids can recur after myomectomy, many gynecologists want to avoid more 
possible surgery. That completely ignores the fact that many women don't want to part
with their uterus.

As for UAE, it's not performed widely around the country. 


Dearest:  When was UFE developed and how successful has this treatment been?


Michael Broder, M.D.:  Many women don't have access to someone who can perform the UFE.  
Most gynecologists don't refer their patients for UFE, even if there are people close
by who could perform it. 

UFE and UAE are 2 names for the same thing.  In UAE, the uterine arteries are blocked
or "embolized". UAE is probably the more correct term. 

UFE is more descriptive and has become a more common way of referring to this procedure. 

The first use of this technique was in the 1990s.  It started gradually and has increased 
over time.  There have now been more than 10,000 women who have been treated with UAE
for fibroids.  In the first few years, it is very successful, particularly in controlling 
bleeding.  As many as 90% of the women see a dramatic reduction in the bleeding.


Dearest:  I was surprised to read that this procedure is performed by an interventional 
radiologists, rather than a surgeon? 


Michael Broder, M.D.:  An interventional radiologist has had training in this technique
as well as radiology and knows about injecting a dye or particles into the veins as well 
as observing where they go or seeing how they react with the body.  Interventional 
radiologist often treat aneurysms in the brain.  This is a natural outgrowth of what
they do. 

Surgeons, on the other hand, are trained in procedures actually cutting into the body 
cavities one way or another.  Radiologists are more used to working in blood vessels, 
rather than cutting. 


Sadie Joy:  What happens to the polyvinyl particles in a UAE procedure? Do they remain
in the body or are they flushed out?


Michael Broder, M.D.:  The particles that are used to block the uterine arteries are made 
of polyvinyl alcohol (PVA).  PVA is a non-reactive substance and doesn't cause irritation 
to the body. PVA stays in the body forever, like surgical staples. 


Dearest:  What tests are done to discover if a woman has fibroids?


Michael Broder, M.D.:  Often they can be felt on a physical exam, and that's the first 
clue. Two of the best ways to confirm are ultrasound or MRI scans.


MartieMapp:  I just had a sonogram and it showed multiple small fibroids with one large, 
approximately 5cm.  I have had breakthrough bleeding and I'm on hormones. The nurse 
mentioned the UAE but what do I need to ask the doc about this? How many he has done? 


Michael Broder, M.D.:  You should definitely ask how many procedures the radiologist has 
done.  How the radiologist and the gynecologist work together, who will take care of you 
afterwards. 


Dearest:  How soon after the procedure, assuming it's successful, will a woman feel 
relief? 


Michael Broder, M.D.:  Usually, if a woman is having bleeding, it will stop or slow down 
within the first few days.  If there are only periodic problems, it may take several 
months to see if the procedure is successful.  The success is in whether the symptoms
have subsided. 


Sadie Joy:  In your expert opinion, is there a down side to a UAE? 


Michael Broder, M.D.:  Absolutely - there is a downside to any intervention.  Any 
treatment for fibroids has risks. For UAE, one of the main risks is that it won't work. 
Even if it does work, there are other cases where the PVA pellets block the arteries to 
the ovaries, too.  That can cause premature menopause.  That seems to happen in 10% of
the cases.  There are also minor problems like bruising at the site where the catheter
is inserted near the groin or infections. 


MrsUnderstood:  Are the medications used to shrink the fibroids or for symptom relief? 


Michael Broder, M.D.:  There are medications that can do either.  Generally, when I 
mentioned treating fibroids with medications, I was thinking of the symptoms.  The 
symptoms are the most important problem.


Dearest:  In your book, you talk about various alternatives methods of treating or 
preventing fibroids. Could you share some of the natural/alternative options,  i.e, 
nutrition, exercise and other alternative remedies? 


Michael Broder, M.D.:  The two things that aren't medications that I recommend are
changes in lifestyle, like exercise and diet.  There is no hard evidence that these
things directly affect the fibroids, but they have so many beneficial effects that
many women have found them to help their fibroid symptoms too, so I recommend them
as a first line treatment.  Specifically, there are a number of studies suggesting
that women on vegetarian diets have fewer problems so it seems logical to try a
vegetarian diet.  Also women who don't exercise, who are overweight, are more prone
to develop fibroids, so exercise seems important.  So, diet and increase exercise
can't hurt and may help. 

Progesterone releasing IUD is another option. One of the best and little used options
is the progesterone releasing IUD.  This IUD was developed to prevent pregnancy but
was discovered to have excellent "side effects".  First, women using the progesterone
IUD have fewer fibroids. Even more importantly, they have dramatically less bleeding.

This is very different from the earlier IUDs.  First, the IUD that most people think
of is the Dalkon Shield which was associated with high risk of infection.  The newer
IUDs don't have that same risk.  Older IUDs were just a piece of copper or plastic that 
sat in the uterus. The newer ones actually release small amounts of progesterone into
the uterus and it's this hormone that is thought to reduce the bleeding and the risk
of fibroids. 


SturdyWoman:  Does a really large fibroid always need to be removed?  Like the size
of a grapefruit? 


Michael Broder, M.D.:  No, it doesn't. The size has very little to do with how it's 
treated.  First, and most important question is "am I having some kind of problem?"
If the answer is no, no matter what size you have, you should do nothing and watch
and wait. 


Schwing41:  I had a severely prolapsed uterus and had a hysterectomy but in the process
my doctor found a fibroid the size of a grapefruit. They sent it to a lab and found it
was mostly filled with cancer (leiomyosarcoma). I see you are speaking about it now. My 
point is, if my uterus hadn't become prolapsed then I would have never known I had a 
cancerous fibroid, and then where would I be?


Michael Broder, M.D.:  It's true that sometimes cancers are found in the course of taking 
out what's thought to be a non-cancerous tumor (like a fibroid) but this isn't a good 
argument for women to have hysterectomies.  It's a little like being afraid to wear a 
seatbelt for fear of being thrown clear in an accident.  In general, though, fibroids 
should be left alone unless they're causing problems.

I'm very glad that they found your tumor.


MartieMapp:  What is a good number of procedures for the radiologist to have performed
to be competent?  Thank you. 


Michael Broder, M.D.:  It's a good question, but one without a good answer.  Certainly
in the first 20 procedures, I'd want them to be doing it with someone with more 
experience.  There are probably some people who have done 25 and done a better job
than someone who has done 250. 


Dearest:  Dr. Broder, thank you for a very informative chat about fibroids and the newest 
methods of treatment. Seeing as how 77% of all women have fibroids, I strongly recommend 
everyone reading a copy of Dr. Michael Broder and his co-author, Scott Goodwin's book, 
WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT FIBROIDS. 


Michael Broder, M.D.:  Thank you. It was my pleasure. 

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