Uterine Fibroids Blog — An Expert Speaks Out

Those who have been following this blog know that accurate diagnosis is the most important aspect of planning treatment.

I have explained the importance of hysteroscopy for seeing directly into the uterus, but fewer than 10% of OB/GYN’s in the US are equipped to do hysteroscopy in an office setting. I’m hoping to change that. Last year I was approached by an engineer with a video camera the size of a pinhead, asking how we could use it in gynecology. Together, we developed a small portable hysteroscope. It consists of a small reusable handle with a screen the size of a smartphone, coupled to a sterile single-use hysteroscope utilizing a built-in high resolution camera integrated with light source.

Current hysteroscopes require an investment in thousands of dollars of equipment, including a light source, video camera, and video monitor. Care and sterilization of instruments, and setting up for hysteroscopy are time consuming and often do not fit into the schedule of a busy office. As a result, most women who need hysteroscopy are taken to the operating room, at much greater expense and inconvenience. My goal is to enable every gynecologist to do office hysteroscopy. It is important to note that this instrument currently has investigational status and has not been cleared by the FDA for commercial use.

I have been using this hysteroscope as part of an investigational study. If you would like to learn more about this, I was recently interviewed by Hope Waltman, at OBGYN.net. The following link to the interview also has a link to a video of using the hysteroscope during a clinical trial in my office. Interview at

Note: Full disclosure: I am a co-founder and shareholder in the EndoSee Corporation, which is developing the hysteroscope. — Paul Indman, M.D.

Medical Journal Article

Tranexamic Acid Treatment for Heavy  Menstrual Bleeding

Andrea Lukes et al.: Obstet Gynecol. 2010 Oct;116(4):865-75.

Tranexamic acid has been used around the world for over 20 years to treat heavy menstrual bleeding. It was recently approved by the FDA in the U.S., and is sold under the trade name LYSTEDA™. In this study 196 women were randomized to receive either LYSTEDA™ or a placebo (sugar pill).  36% of women in each group had fibroids. Menstrual blood loss was measured before any medication and after taking either LYSTEDA™ or the placebo.   Read the rest of this entry »

Medical Journal Article

Levonorgestrel-releasing intrauterine device insertion ameliorates leiomyoma-dependent menorrhagia among women of reproductive age without a significant regression in the uterine and leiomyoma volumes.

A progesterone containing IUD (or “Lng-IUS”), marketed in the USA as Mirena®, has be shown to decrease or eliminate menorrhagia (heavy menstrual bleeding) in many women, and is proving for some to be a viable alternative to surgery.  Read the rest of this entry »

Medical Journal Article Review

This is a study in which human uterine fibroid tissue was implanted into mice, and the effects of progesterone, estrogen, and anti-progesterone compounds were observed.  The authors found that estrogen plus progesterone stimulated growth of fibroid cells, and this growth was blocked with anti-progesterones. Withdrawal of progestrone caused fibroid tissue to shrink.  Interestingly, estradiol (estrogen) without progesterone had no effect in this study.

Comment: This study confirms others in showing that progesterone is needed for fibroid growth. For those tempted to use over-the-counter progesterone creams to treat fibroids, this study shows that extra progesterone may cause more harm than good. Do not interpret this study to mean that you shouldn’t take birth control pills if you have fibroids.  Certain low dose birth controls do not cause fibroid growth, and may actually slow growth! — Paul Indman, M.D.

Medical Journal Article Review

Tulandi, T and Salamah K.  Obstetrics & Gynecology. 2010, 115:857

This is an article that presents a case of premature ovarian failure in a 37 year old infertility patient after a uterine artery embolization (UAE).  It goes on to discuss the current literature about UAE and fertility.

In reviewing evidenced based studies (versus “opinion” articles) the authors make the following points:

1. Women with fibroids in or partially in the cavity (submucous fibroids) undergoing IVF were less likely to conceive and more likely to miscarry than women without fibroids.
2. Women in whom fibroids distort the uterine cavity are more likely to conceive if these fibroids are removed.
3. Women with fibroids that do not distort the cavity and do not have symptoms do not require intervention before pregnancy.

The authors looked at studies on pregnancy after UAE and after myomectomy and found:

1. By measuring FSH (follicle stimulating hormone) levels one study showed UAE decreases ovarian reserve in all women.  This may not result in menopause but may impair fertility.
2. The safety of pregnancy after UAE is unclear.  They cited studies showing that the risks of miscarriage and premature delivery are higher after UAE than after myomectomy.

Comment: There are very few studies comparing pregnancy with and without treatment of fibroids.  Most studies are retrospective, meaning that records of women treated by different methods are reviewed.  The best type of study would require taking women planning treatment and randomly assigning them to a no-treatment group, a UAE group, and a myomectomy group.  One study by Mara et al, and cited in the above article, did in fact randomize women to have either myomectomy or UAE, with the finding of more pregnancies in the myomectomy group.  I will be watching for further research in this area and posting the results of any new studies.