Uterine fibroids are a huge, underappreciated issue. They are the most common gynecological disorder, affecting nearly half of women younger than 40 years old, and far more (~80%) for those older. Frankly, I don’t think we are doing enough to help these patients. Fibroids are the leading indication for hysterectomy in the US, accounting for 39% of all hysterectomies each year, and while some are asymptomatic, symptoms include heavy and prolonged periods, difficulty with intercourse, bowel dysfunction, non-cyclic pelvic pain, low back pain, urinary frequency and urgency, and constipation. Because not all fibroids cause heavy bleeding, their impact can be missed, think: refractory constipation or incontinence. Conventional treatments include pharmacotherapy, surgical interventions, and uterine artery embolization, however, these treatments leave much to be desired. Oral contraceptives are used to manage bleeding, and even after myomectomy, fibroids often recur and 10% of women will undergo hysterectomy within 5 – 10 years.
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