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Fibroid & Menstrual Disorders

Washington DC Gynecologists

Whether you've had multiple prior surgeries, are overweight, or have very large fibroids, there is an answer. A hysterectomy may not be your only option. You may qualify for a less invasive procedure to treat your fibroids.

The George Washington University Medical Faculty Associates Fibroid and Menstrual Disorder Center will review your case with you and discuss your options.

Comprised of a team of gynecologic surgeons, high-risk obstetricians, oncologists, and interventional radiologists, doctors at The GW MFA Fibroid and Menstrual Disorder Center are committed to helping you make an informed decision on a treatment plan that is right for you.

Uterine Fibroids

Uterine fibroids—also known as fibroid tumors, leiomyomas, or myomas—are benign, non-cancerous lumps that grow in a woman’s uterus. Fibroids may grow on the inside, outside, in the wall of the uterus, or in the tissue that holds the uterus in place. They can be common in women in their 30s and 40s. Although it is not known what causes the formation of fibroids, the presence of estrogen and progesterone can cause existing fibroids to grow.

It is not uncommon for fibroids to shrink after a woman has experienced menopause and the natural production of these hormones is lessened. In many cases, fibroids will not cause symptoms, or they may only cause mild symptoms. Severe symptoms of fibroids can include:

  • Lower back pain
  • Frequent urination
  • Painful intercourse
  • Pressure in the abdomen
  • Long periods of painful cramping

The presence of fibroids can lead to further complications such as anemia caused by excessive bleeding, or difficulties with pregnancy: achieving pregnancy, early labor, or miscarriage. Because most fibroids cause no or mild symptoms, many women many choose not to do anything to treat them.

In severe cases, there are two surgical options for a woman who would like to remove her fibroids:

  • Myomectomy – If a woman hopes to someday become pregnant or would like to keep her uterus, a surgery known as myomectomy can remove only the fibroids. This procedure does not guarantee that a woman will be able to achieve pregnancy later, and the fibroids may eventually return.
  • Hysterectomy – The second surgical option for removing fibroids is the hysterectomy, in which a woman’s entire uterus is removed. Pregnancy is not possible after a hysterectomy.

Dysmenorrhea

Dysmenorrhea, also known as menstrual cramps, is a condition that includes pain right before and during menstruation that can range from mild to severe. The types of pain that are associated with dysmenorrhea include sharp, burning, throbbing, dull, burning, or shooting in the hips, lower back, or inner thighs. Other symptoms that can accompany dysmenorrhea include vomiting or diarrhea.

The term primary dysmenorrhea is used to describe menstrual cramps that occur without an identifiable cause other than menstruation, while secondary dysmenorrhea is caused by something other than menstruation. Secondary dysmenorrhea can be caused by endometriosis, ovarian cysts, fibroids, cervical or uterine polyps, pelvic infections, or structural problems in a woman’s uterus, cervix, or vagina.

Premenstrual Syndrome (PMS)

PMS is a common condition that most women experience to some degree as their bodies prepare for menstruation. The symptoms of PMS may appear a week or two before menstruation and may include:

  • Cravings for sweet or salty foods
  • Bloating, constipation or diarrhea
  • Loss of appetite
  • Acne
  • Back pain
  • Headaches
  • Sore breasts
  • Clumsiness
  • Nausea
  • Mood swings
  • An inability to concentrate
  • Worsening of symptoms from other conditions such as asthma, depression, or migraines

Some symptoms of PMS can be mitigated through exercise, eating a diet high in B vitamins, and through avoiding foods such as salt, caffeine, sugar, and alcohol. Additionally, many women find relief from the pains associated with menstruation by taking pain relievers such as aspirin, acetaminophen, ibuprofen, or naproxen. For severe PMS symptoms, a doctor may prescribe the usage of birth control pills or other hormones to make periods lighter and reduce symptoms overall.

Premenstrual Dysphoric Disorder (PMDD)

PMDD is a condition very similar to PMS, however in PMDD the symptoms are heightened. An individual suffering from PMDD may experience panic attacks, crying spells, suicidal thoughts, insomnia, disinterest in activities or relationships, fatigue, or feeling out of control. Treatments meant to provide relief from the symptoms of PMS can also be used to minimize the symptoms of PMDD. In addition to exercise and changes in diet, doctors may prescribe hormonal therapies, anti-depressants, or other medications to treat the extreme symptoms of PMDD.

Abnormal Uterine Bleeding (AUB)

Menorrhagia: Menorrhagia is a condition in which a menstrual bleeding is exceptionally heavy or long. In an average menstrual cycle, a woman will lose approximately 70 mL of blood. If a woman bleeds more than approximately 80 mL or for longer than 7 days in a period, she may be experiencing menorrhagia. A woman who has menorrhagia may experience this excessive blood loss during every period to the degree that she is incapacitated and unable to perform usual activities.

Menorrhagia can be caused by:

  • A hormonal imbalance
  • Dysfunction of the ovaries
  • Fibroids
  • Polyps
  • Adenomyosis
  • The use of an IUD
  • Pregnancy complications
  • Medications
  • Cancer

Menorrhagia can cause complications such as anemia and severe pain. Treatment for menorrhagia can include medications such as ibuprofen to minimize pain and bleeding, or hormonal therapies (such as oral contraceptives) to regulate menstrual cycles. In severe cases, surgical options such as the destruction of the lining of the uterus or the removal of the uterus itself can reduce menstrual flow or cease menstruation entirely.

Amenorrhea

Amenorrhea is the absence of menstruation, usually for three or more menstrual cycles (secondary amenorrhea), or the lack of beginning menstruations by age 16 (primary amenorrhea). Amenorrhea can be cause by pregnancy, breast feeding, menopause, certain types of contraceptives, or certain medications. Additional factors that can influence the lack of a menstrual cycle include stress, body weight, excessive exercise, a hormonal imbalance, or a structural abnormality of a woman’s reproductive system. A woman experiencing amenorrhea may have difficulty conceiving. Treatment for amenorrhea varies, depending upon the underlying cause, but may include medication, contraceptives, or surgery.

Clinical Trials

  • SLIPS Study

    This study is looking at the relationship between sleep and perinatal mood disorders such as depression and anxiety. Participants will wear a wrist monitor like a fit bit for 10 days to help researchers gain information into sleep patterns during pregnancy and postpartum and will answer questionnaires about their mood.

  • Vaginal vs Intramuscular Progesterone for the Prevention of Recurrent Preterm Birth
    Preterm birth is one of the leading causes of neonatal morbidity and mortality. One of the most significant risk factors is a history of a prior spontaneous preterm birth. Intramuscular progesterone is the only FDA approved medication for the prevention of recurrent preterm birth. Vaginal progesterone is not FDA approved for the prevention of recurrent preterm birth, but has been found to beneficial. Given the presence of trials demonstrating efficacy for both intramuscular and vaginal progesterone in the prevention of recurrent preterm birth, but limited information one being more superior to the other, we are performing a trial comparing vaginal progesterone and intramuscular progesterone for the prevention of recurrent spontaneous preterm birth in women with a history of prior spontaneous preterm birth.
  • Sonography-Guided Transcervical Ablation of Uterine Fibroids (SONATA)
    [This study is no longer recruiting.] The SONATA Study is an FDA-approved clinical study designed to establish the safety and effectiveness of a new, investigational device to reduce heavy menstrual bleeding caused by uterine fibroids. The device, called the SONATA System, targets fibroids rather than treatment or removing the entire uterus. If effective, this device will provide an alternative to hysterectomy that is: incision-free, preserves the uterus, does not require general anesthesia and is an outpatient procedure.
  • Randomized Controlled Trial: Physical Exam Indicated Cerclage in Twin Gestations
    Women with twin pregnancy who have a dilated (open) cervix detected on physical exam before 24 weeks are at increased risk for delivering their babies preterm (before 37 weeks gestation). Prematurity is associated with many complications for the babies including respiratory (breathing) problems, bleeding inside of the brain (a form of stroke), increased risk of infection, kidney, temperature and feeding problems. The primary objective of this study is to determine if physical exam indicated cerclage use reduces the incidence of spontaneous PTB in asymptomatic women with twin gestations with cervical dilation diagnosed on pelvic exam before 24 weeks of gestation.
  • Prevention of Postpartum Hemorrhage: Pharmacokinetics and Pharmacodynamics of Tranexamic Acid
    Tranexamic acid was shown to significantly reduce risk of mortality when given to women with diagnosed postpartum hemorrhage in the recent Lancet WOMAN Trial.* The purpose of this study is to determine the optimal dose for using tranexamic acid to prevent postpartum hemorrhage during routine cesarean section. Women undergoing cesarean section will be eligible and must not have a history of blood clots or a known clotting condition. *http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31111-X/fulltext
  • Placental Perfusion Imaging Using Arterial Spin Labeled MRI
    In this study, we are developing non-invasive tools to identify early signs of abnormalities of the placental function using arterial spin labeling (ASL) based on fetal MRI. ASL is a particularly attractive method for early and safe monitoring during pregnancy given that ASL is completely non-invasive and does not require contrast agents or exposure to ionizing radiation. Our specific aim is to develop and validate placental perfusion imaging with substantially improved image quality and sensitivity to abnormalities.
  • Fetal Vasoreactivity in normal pregnancy
    This study is being performed at Children's National Health System. We are trying to understand how the normal fetus controls blood flow to the different parts of the body such as the lungs and brain. We will measure your baby’s blood flow using the same ultrasound approach used by your obstetrician. We will test your baby’s control of blood flow by measuring the responses to changes in your (the mom’s), levels of oxygen and carbon dioxide. We will make these changes by asking you to breathe extra oxygen for short periods of time. If your obstetrician determines that your pregnancy is uncomplicated, you and your baby are eligible for this study.