Author: Nicole

Categories
Fibroids

Treatment Options for Uterine Fibroids

It's important to discuss the various treatment options for your fibroids.

Over the next few weeks, we’re going to take a deeper look at all of the treatment options available for women with uterine fibroids.

We will look at what those options are and how they work. As well as discuss the advantages and disadvantages of each treatment.
Some of the treatment methods we will cover are:

Medications:

  • Gonadotropin-releasing hormone (GnRH) agonists. These medications can be taken via a nasal spray or injection and they work by shrinking your fibroids.
  • Birth control: Birth control can also be used to help with symptoms of fibroids — specifically heavy bleeding during and between periods and menstrual cramps.
  • Progesterone-containing agents — pills, implants, injections, or an intrauterine device (IUD) — may also control bleeding.

Oral therapies:

  • Elagolix is a new oral therapy indicated for the management of heavy uterine bleeding in premenopausal women with symptomatic uterine fibroids.
  • Tranexamic acid is an antifibrinolytic oral drug that’s indicated for the treatment of cyclic heavy menstrual bleeding in women with uterine fibroids.

Non-Uterine Sparing Surgical Treatment:

  • Hysterectomy- During this surgery, your uterus is removed. By removing your uterus completely, the fibroids can’t come back and your symptoms should go away.

Uterine-Sparing Surgery and Non-invasive outpatient procedures:

  • Abdominal Myomectomy: Open abdominal surgery to resect symptomatic uterine fibroids
  • Laparoscopic myomectomy: Laparoscopic removal of uterine fibroids
  • Laparoscopic myolysis: Uses a laser probe to heat coagulate uterine fibroid
  • Uterine Fibroid Embolization: Small particles are injected into the arteries supplying the uterus, cutting off blood flow to fibroids, causing them to shrink and die.

Ultimately your treatment plan will depend on a few factors, including:

  • The number of fibroids you have.
  • The size of your fibroids.
  • Where your fibroids are located.
  • What symptoms you are experiencing related to fibroids.
  • Your desire for pregnancy.
  • Your desire for uterine preservation.

Another deciding factor regarding the best treatment option for you will also depend on your future fertility goals. If you want to have children in the future, some treatment options are better than others. We will cover this in future articles as well.

In the meantime, talk to your healthcare provider about your thoughts, feelings, and concerns when discussing treatment options. And check back next week, as we dive deeper into the first of many treatment options, medication.

Categories
Fibroids

The Four Types of Fibroids

Fibroids are diagnosed by type, based on their position within the uterine wall.

Fibroids are diagnosed by type, based on their position within the uterine wall, and are typically divided into four categories. These categories are:

  • Subserosal fibroids
  • Submucous fibroids
  • Intramural fibroids
  • Pedunculated fibroids

Though these names may be somewhat challenging to pronounce, they are fortunately fairly easy to explain.

Let’s start with Subserosal Fibroids.

  • Subserosal Fibroids are located near the outer layer of the uterus, known as the serosa. This particular type of fibroid grows toward the outside of the uterus. When they are small, they are unlikely to cause symptoms, and usually do not require treatment. However, they should be monitored in case they become larger and therefore symptomatic.

The next fibroid type is Submucosal Fibroids.

  • Submucosal Fibroids are also located near the outer layer of the uterus, however, they grow toward the internal layer of the uterus, called the mucosa, causing them to protrude into the uterine cavity. These fibroids tend to be symptomatic even at smaller sizes, and can even impact fertility. However, when caught early, these fibroids can be removed, thus preventing fibroid-related issues regarding pregnancy.

Another fibroid type is Intramural Fibroids.

  • Intramural FIbroids are located primarily within the width of the uterus. Because they grow toward the outside of the uterus, these fibroids usually cause symptoms similar to that of subserosal fibroids. And, just like with submucosal fibroids, if they are too large, they can also cause fertility issues and pregnancy complications.

The last type of fibroids is Pedunculated Fibroids.

  • Pedunculated Fibroids are a variation of the aforementioned fibroid types. They grow on a stalk on the outside or inside of the uterus. When small and subserosal ( growing on the outside of the uterine walls ), these fibroids are often asymptomatic. However, pedunculated submucosal fibroids, which grow inside the uterus, can cause various significant symptoms.

The classification of fibroids is somewhat limited, in that most fibroids are big enough or numerable enough to fall into several categories. However, identifying the type of fibroids can help in the diagnosis and treatment of them. If these fibroids are significant, like in the case of a large intramural fibroid with a significant part of it being submucosal, sometimes the solution is a hysterectomy. For women of childbearing age that want to conceive, an option for them is a myomectomy. This surgical operation can remove fibroids while preserving the uterus.

One of the best options out there for fibroid removal is Uterine Fibroid Embolization. Unlike the other treatment options available, UFE targets all of the fibroids in the uterus, making it effective for women with multiple fibroids, regardless of the fibroid’s size.

The bottom line is if you are experiencing symptoms that could be related to having uterine fibroids, help is available.

The first step is to make an appointment with your doctor. Your doctor can then order an ultrasound to find out where the fibroid or fibroids are located, and what type of fibroid it is. 

Categories
Fibroids

Acid Reflux and Fibroids

Americans are gobbling up antiacids at a record pace, and amongst them are many women experiencing acid reflux due, in part, to uterine fibroids.

Americans are gobbling up antiacids at a record pace, and amongst them are many women experiencing acid reflux due, in part, to uterine fibroids.

Whether it’s Tums, Pepcid AC, or powerful acid-reducing drugs such as esomeprazole (Nexium 24HR), lansoprazole (Prevacid 24HR), and omeprazole (Prilosec OTC). 

So what exactly is acid reflux?

Acid reflux, also known as Gastroesophageal reflux disease (GERD), is a digestive disorder that causes uncomfortable symptoms such as:

  • Heartburn – A burning sensation that can run from your throat to the center of your chest.
  • Regurgitation of food or sour liquid.
  • Chronic, dry cough.
  • Difficulty swallowing.
  • A sensation of a lump in your throat.
  • Horse or sore throat.

Acid reflux is caused by gastric acid from the stomach flowing back up into the esophagus. This typically happens when the lower esophageal sphincter, which is a muscle that briefly opens to let food into the stomach and closes to take food inside, relaxes too often or for too long. Not only can this cause the uncomfortable symptoms listed above, but when it occurs frequently and goes untreated, it can lead to serious health issues such as esophagitis, ulcers, strictures, aspiration pneumonia, and more.

Fortunately, acid reflux, when experienced infrequently, is normal. And, when experienced more frequently, is treatable. In fact, some estimates suggest that 95% of acid reflux issues can be resolved by making appropriate dietary changes.

So this is all very informative, but what does this have to do with women with uterine fibroids?

Well, in some cases, quite a lot.

Just like pregnancy can increase the experience of acid reflux due to the uterus becoming significantly enlarged above the belly button, this can also happen due to the same occurrence- but from uterine fibroids. The expanded uterus from the fibroids, especially in the case of large fibroids-  can cause pressure on the upper abdomen which can lead to abdominal pain, pressure, bloating, and yes, acid reflux.

Large fibroids in the uterus exacerbate issues with heartburn and acid reflux by making it more difficult for the lower esophageal sphincter to close properly. And, of course, when the sphincter is unable to work correctly, it leads to acid reflux.

One way to manage these acid reflux symptoms is to avoid alcohol and carbonated beverages. As well as steer clear of acidic foods such as citrus and tomatoes. Furthermore, researchers at the Cleveland Medical Center compiled a gastroenterologist-approved and research-backed list of the best and worst foods for acid reflux.

Best Foods for Acid Reflux

  • Chicken breast – Be sure to remove the fatty skin. Skip fried and instead choose baked, broiled or grilled.
  • Lettuce, celery and sweet peppers – These mild green veggies are easy on the stomach – and won’t cause painful gas.
  • Brown rice – This complex carbohydrate is mild and filling – just don’t serve it fried.
  • Melons – Watermelon, cantaloupe, and honeydew are all low-acid fruits that are among the best foods for acid reflux.
  • Oatmeal – Filling, hearty and healthy, this comforting breakfast standard also works for lunch.
  • Fennel – This low-acid crunchy vegetable has a mild licorice flavor and a natural soothing effect.
  • Ginger – Steep caffeine-free ginger tea or chew on low-sugar dried ginger for a natural tummy tamer.

Worst Foods for Reflux

  • Coffee and tea – Caffeinated beverages aggravate acid reflux. Opt for teas without caffeine.
  • Carbonated beverages – The bubbles expand in your stomach, creating more pressure and pain. Choose plain water or decaf iced tea.
  • Chocolate – This treat has a trifecta of acid reflux problems: caffeine, fat, and cocoa.
  • Peppermint –Don’t be fooled by its reputation for soothing the tummy; peppermint is an acid reflux trigger.
  • Grapefruit and orange – The high acidity of citrus fruits relaxes the esophagus sphincter and worsens symptoms.
  • Tomatoes – Also avoid marinara sauce, ketchup, and tomato soup – they’re all naturally high in acid.
  • Alcohol –This has a double whammy effect. Alcohol relaxes the sphincter valve but it also stimulates acid production in the stomach.
  • Fried foods – These are some of the worst foods for reflux. Skip the french fries, onion rings, and fried chicken — cook on the grill or in the oven at home.
  • Late-night snacks – Avoid eating anything in the two hours before you go to bed. Also, you can try eating four to five smaller meals throughout the day instead of two to three large meals.

Though this list of best and worst foods is a great resource and changing your diet can definitely help- When it comes to acid reflux caused by uterine fibroids, the most effective way to alleviate the symptoms is to treat the fibroids. This can be done by removing them or shrinking them through UFE.

Bottom line, if you are experiencing acid reflux as a result of your fibroids, there are solutions. In the short term, changing your diet can be very helpful. However, for long-term relief, it’s important to speak with your doctor and find the best fibroid treatment for your particular situation.

So call your doctor and set up an appointment today- and in the meantime, maybe pass on the McDonalds, and opt for some good ole’ chicken and rice instead.

Categories
Fibroids

Uterine Fibroid Embolization

Uterine Fibroid Embolization is the only non-surgical procedure to date, that can be done to remove fibroids.

Uterine Fibroid Embolization is the only non-surgical procedure to date, that can be done to remove fibroids.

So what exactly is UFE? How does it work? Does it work? And…is it painful?

UFE is an outpatient procedure that begins with the use of conscious sedation ( an IV of a light sedative) to help you to relax and remain pain-free during the UFE procedure.

Once the sedating medicine has been administered, an expert radiologist will make a teeny tiny nick in the skin ( about the size of the tip of a pencil).

They will then thread a tiny 2mm catheter through the groin or wrist. Using moving X-ray technology (fluoroscopy), the interventional radiologist guides the catheter through the artery to the uterus.

Once it reaches the artery that supplies blood to the fibroids, the catheter is used to release tiny gelatin beads into the blood vessels, creating a blockage. This blockage cuts off the blood supply to the fibroids. And, without the fibroids being able to receive vital nutrients through the blood, they can not survive. Therefore, the fibroids shrink until they are altogether eliminated.

You might be thinking, that’s interesting and makes sense, but does it work? And what does it feel like afterward?

Immediately following the procedure, it is normal to experience some pelvic pain and pressure from the procedure. Sometimes this is accompanied by an overall feeling of malaise and decreased energy levels. Basically, you might feel like you have a cold or the flu. Fortunately, these symptoms do not last long and can be easily treated with pain medicine and anti-nausea medication, which the doctor will provide.

Though there are no restrictions after the procedure, most studies have found that it takes on average, between 9 and 12 days to fully recover. Of course, the exact recovery time varies from person to person based on numerous factors such as the size of the fibroids, the number of fibroids, and the severity of pre-UFE symptoms. In general, women who undergo UFE should plan for roughly 1 to 2 weeks of recovery before returning to all of their normal activities.

Post-procedure, the fibroids targeted during UFE commonly continue to shrink for 6-9 months or longer. As the fibroids continue to shrink, it is normal to experience some bleeding in-between cycles for the first few weeks. And, the first period following the procedure is likely to be heavier and more uncomfortable than usual- but this is temporary.

In fact, research has shown that approximately 85-90% of women achieve relief from their symptoms after UFE. In fact, UFE is so effective, that less than 2% of patients will require repeated treatment.

The bottom line, is if you are suffering from the painful and life-interrupting symptoms of fibroids, it’s worthwhile to look into UFE.

UFE is a very effective treatment and is performed by our expert radiologist here at MidAtlantic Fibroid Care.

So call us today and see if UFE is right for you.

Categories
Fibroids

Fibroids and Constipation

Some women with fibroids also experience problems involving their bowels, such as bloating and constipation.

Fibroids have many symptoms such as heavy bleeding, bleeding between cycles, pain during intercourse, fatigue from anemia, severe pelvic pain, and abdominal swelling. As if those symptoms aren’t annoying enough, some women with fibroids also experience problems involving their bowels, such as bloating and constipation.

So why is this?

For starters, it has to do with the location of the uterus and the fibroids. The uterus rests directly in front of the colon, which is the part of the bowels that controls bowel movements. When fibroids develop in the back of the uterus, they can press on the colon from the outside, which can lead to significant constipation and bloating.  In order to deal with this, many women will resort to taking laxatives. However, this does not resolve the underlying issue, and when taken too often, it can actually make things worse.

In addition to this, some women with fibroids need to take iron supplements to combat blood loss from heavy periods to help prevent and treat anemia. Unfortunately, iron supplements can also cause constipation.

Another issue that can result from having fibroid-related constipation, is the development of hemorrhoids.  Hemorrhoids are swollen veins in the anus and lower rectum that are caused by straining in order to have a bowel movement. These can be quite uncomfortable, and sometimes painful.

If left untreated, fibroid-related constipation can create additional stress and negatively impact a woman’s quality of life. It can also lead to other significant complications. Some of which are:

anal fissures

rectal bleeding

rectal prolapse

fecal impaction.

These issues, if left untreated, can begin to impact a woman’s social life, career, and relationships, as well as overall health. Therefore, if you or someone you know is experiencing any of these symptoms, it’s important to talk to your doctor about the situation- because fortunately, there are treatment options available.

One of the most successful treatments is Uterine Fibroid Embolization ( UFE), which we offer here at MidAtlantic Fibroid Care. UFE is a minimally invasive, outpatient treatment that can shrink fibroids, alleviate symptoms, and improve the overall quality of life. In fact, most women return to normal daily activities within one to two weeks.

When dealing with fibroid symptoms, it’s important, to be honest, and upfront with your doctor. Oftentimes women will avoid treatment for numerous reasons, one being that they feel embarrassed to discuss symptoms that have to do with going to the bathroom. It is not uncommon for women to be taught from a young age that they shouldn’t talk about bodily functions, which is a lesson that needs to change.

Discussing and sharing any and all information with your doctor regarding fibroid symptoms, big or small, is a necessary form of self-care. And taking that action to speak with your physician is nothing to be ashamed of. In fact, it’s something to be proud of because that action can lead to a happier, healthier, more comfortable life for you, and in turn, for those around you as well.

Categories
Fibroids

Fibroids: Does Size Matter?

Fibroids can be as small as a pea and as large as a grapefruit. Fibroids can also occur as single entities, as a group, or as a cluster.

Fibroids can range in size, from as small as a pea to as large as a grapefruit. Fibroids can also occur as single entities, as a group, or as a cluster which can also vary in size.

In fact, the largest fibroid ever removed from a surviving human weighed over 100 pounds. Yikes.

While a fibroid of any size can cause potential complications, larger fibroids are more likely to cause more severe symptoms, and can even lead to hospitalization.

In fact, one study shows that in 2017, fibroids sent over 65,000 women to the emergency room. This is a big jump from another study in 2006, which showed that just over 23,000 women visited the ER because of fibroid symptoms.

Though women dealing with fibroids of any size can end up having to take a trip to the ER, larger fibroids are more likely to cause serious complications. These include, but are not limited to:

  • Impacting the uterine lining: fibroids found on the inside of your uterus may change the shape of your uterine lining. If not removed, they can impact your ability to become or stay pregnant.
  • Uterine damage: Fibroids that are larger than a three-month-old fetus can cause damage to your uterus during surgical removal, and should be treated before reaching that size.
  • Ruptures: Very large fibroids may burst inside you, causing sudden, extreme pain.
  • Blood clots: Though it is extremely uncommon, very large fibroids can cause you to develop a pulmonary embolism (blood clot in your lung), a potentially fatal complication.

Fibroid size can also cause painful bloating, and weight gain that can contribute to a series of other health issues.

Fibroids may not be entirely preventable, but they are treatable. And the earlier the detection, the better. By getting screened for fibroids and catching them early, most women can avoid developing larger fibroids, and can do so with a non-invasive procedure like Uterine Fibroid Embolization (UFE).

So the bottom line is to stay on top of your uterine health. If you think you may be experiencing symptoms from uterine fibroids, please make an appointment as soon as possible. The sooner they are found and treated, the better.

For more information on UFE, please call our office today at 301-622-536

Categories
Fibroids

Diet and Fibroids

If you are diagnosed with uterine fibroids, one way to help reduce fibroid symptoms is to make changes to your diet.

If you are diagnosed with uterine fibroids, one way to help reduce fibroid symptoms is to make changes to your diet. This means cutting back on high-fat and processed foods. As well as foods high in salt, refined carbohydrates, and sugar. 

At the first read-through, that might leave you thinking, that’s a lot of stuff to avoid. However, it really isn’t when you compare it to all the wonderfully beneficial and nutritious foods that women with fibroids can and should eat.

The recommended diet for women that want to reduce their fibroid symptoms most closely resembles the Mediterranean Diet.

The Mediterranean Diet is a primarily plant-based plan of eating that includes a daily intake of fruits, vegetables, whole grains, olive oil, beans, legumes, nuts, herbs, and spices. As for protein, this particular diet suggests that the main form of it should come from fish and seafood- which isn’t always the most affordable or accessible choice. Therefore adding lean meat and poultry is fine as well.

Here’s a look at some of the many foods that you can enjoy and benefit from:

Fresh Vegetables In particular, broccoli, asparagus, spinach, and kale. These four veggies are rich in iron that can help those suffering from the heavy bleeding that fibroids can cause- which can lead to anemia. Kale in particular has also been shown to aid in the prevention and further development of estrogen-fueled fibroid production.

Fruits Make sure to eat fruits such as pears, apples, grapes, tomatoes, figs, melons, peaches, and avocado– as all of these can help to lower the risk of fibroids. In fact, pears and apples, in particular, contain phloretin- which is a flavonoid that blocks estrogen- which has been found to decrease fibroid growth.

Nuts and Seeds Start adding nuts and seeds to your diet, like almonds, flaxseeds, and cashews- which are all rich in omega-3 fatty acids and can help not only decrease fibroid growth but can also help prevent uterine cancer. Flax seeds, in particular, can inhibit estrogen sensitivity in the uterus, and can even help prevent uterine cancer. Nuts and seeds are also excellent sources of fiber.

Oily Fish We’re talking about sardines, mackerel, salmon, and tuna– all of which contain essential fatty acids which have anti-inflammatory properties. They’re also rich in the beloved Vitamin D. Even better- B12-rich foods like seafood like shrimp, clams, and mussels can help to alleviate the symptoms of anemia.

Olive Oil When it comes to talking about the Mediterranean diet- we probably should have mentioned this must-have first- Olive oil. Olive oil ( in particular extra virgin olive oil), contains polyphenols that can potentially inhibit the production of prostaglandin, which is an inflammatory molecule. This, in turn, can help decrease or even prevent fibroid inflammation.

Though some of the following is not part of a Mediterranean diet, they can be part of a diet to reduce fibroid symptoms, and even inhibit their growth. These include: Fiber-Rich Whole Foods: cooked and raw vegetables cooked, raw, and dried fruit whole-grain bread and pasta cruciferous vegetables oats lentils barley beans

Potassium Rich Foods: avocado bananas citrus cantaloupe collard greens dates lentils oat bran potatoes tomatoes

Cruciferous vegetables: Arugula Bok choy Broccoli Brussels sprouts Cabbage Cauliflower Collard greens Horseradish Radishes Rutabagas Turnips Watercress Wasabi

The list goes on and on.

Though we can not entirely prevent fibroids, adhering to a healthy diet can not only improve other health conditions and overall quality of life, it can reduce and even alleviate painful and disruptive fibroid symptoms.

For more information about the Mediterranean diet, and some great recipes check out the following website.

Categories
Fibroids

Foods That Can Increase Fibroid Growth

There is evidence to suggest that certain foods can exacerbate fibroid symptoms and even contribute to fibroid growth.

There is evidence to suggest that certain foods can exacerbate fibroid symptoms and even contribute to fibroid growth.

So let’s take a look at the foods to avoid, and why.

High-Fat Processed Meats: Some examples of high-fat meats are- Filet mignon, also known as Chateaubriand or tenderloin, T-bone, New York Strip, porterhouse, flap or skirt steak, and rib-eye steaks. And high-fat processed meats, like sausages, hot dogs, salami, Ham, cured bacon, salted and cured meat, and corned beef.

Red processed meat in particular is known to be high in added hormones, particularly estrogen, which can be troublesome for women with fibroids.

High-Fat Dairy Products Such as butter, cheese, heavy cream, ice cream, and some milk, can all contain high levels of hormones, steroids, and other chemicals that can cause inflammation and exacerbate symptoms.

Food High in Salt Examples of these is smoked, cured, salted, or canned meat, fish, or poultry including bacon, cold cuts, ham, frankfurters, sausage, sardines, caviar, and anchovies. Frozen breaded meats and dinners, such as burritos and pizza. Canned entrees, such as ravioli, spam, and chili. Salted nuts. Chips and other salty snack foods.

Foods with excessive amounts of salt are hard on the liver, which is the organ that is most responsible for removing toxins and balancing hormones- Which is important for uterine and overall health.

And of course, you guessed it…

Refined Carbohydrates We’re talking about pasta, white bread, white rice, cookies, cakes, and all the other high-carb foods that pretty much every diet excludes. These foods aren’t inherently bad, but for women with fibroids, refined carbohydrates can be extra troublesome, as they can alter estrogen levels and cause an increase in fibroid growth.

Though none of these foods are inherently bad, for women with fibroids, it’s in their best interest to eliminate or at least limit the amount consumed. 

Categories
Fibroids

Low Impact Exercises for Women with Fibroids

When it comes to exercising with uterine fibroids, the right exercises can actually reduce symptoms and decrease pain.

When it comes to exercising with uterine fibroids, the right exercises can actually reduce symptoms and decrease pain. This is the result of the body producing feel-good neurotransmitters including endorphins, endocannabinoids, and dopamine.

The chemicals that are produced as a result of exercise, create a natural pain reliever and a positive feeling in the body- similar to that of morphine.

In fact, many people describe the feeling that follows a workout as being almost euphoric- resulting in decreased pain and increased pleasure.

So what effect does exercise have on fibroid pain?

Research has shown that the best way to use exercise in order to decrease the painful symptoms associated with uterine fibroids is through low-impact cardio.

Low-impact cardio includes activities like walking, light jogging, or swimming. Each of these low-impact exercises will increase your heart rate, and as a result, release those feel-good chemicals.

Even better, low-impact exercise will also help in the maintenance of a healthy weight, or even weight loss, as being overweight has been linked to increased fibroid symptoms.

When it comes to exercising, it’s important to find a workout that you enjoy.

If swimming isn’t your forte, try taking a daily walk with a furry friend, or do some light jogging around the track at your local high school. You can even practice light stretching and gentle yoga. Or take yoga classes that can be found online, or at your local studio.

So start exercising to help decrease fibroid pain, and make you look better, feel better, and live a healthier, happier life.

Categories
Fibroids

African American Women and Fibroids

For African American women, their chances of developing fibroids in their lifetime are higher than for white women.

Though it is estimated that 70 to 80 percent of all women will develop fibroids in their lifetime, for African American women, their chances are even higher.

Multiple studies have found that African and African American women are 2 to 3 times more likely to develop fibroids than white women.

In fact, some estimates state that at least 25% of African-American women will suffer from fibroids by the age of 25, and 80% of them will have them by age 50. 

Furthermore, as a result of the prevalence of fibroids in African-American women, they are also 2 to 3 times more likely to undergo surgery such as a hysterectomy.

Although research has not been able to pinpoint a singular cause of this disparity, they have found several elements that could contribute to it.

Some studies have shown that, just like with all women diagnosed with fibroids, there could be a genetic component that increases the likelihood of fibroids in African-American women.

While another study found that environmental factors can increase the prevalence of fibroids in African-American women such as an increase in stress, a history of abuse, dietary issues, and lifestyle.

Unfortunately, many women suffer from the symptoms of fibroids for a long time before getting treatment, which means many who live with a chronic fibroid condition are undiagnosed.

No one deserves to experience the painful symptoms of fibroids, and the sooner they are diagnosed, the easier and less invasive is the treatment.

For more information on the racial disparity that exists in the development of fibroids, please check out the following link.