What to Know Down Below™
Welcome to What to Know Down Below™ by Tina’s Wish! We’re here to empower you with the knowledge and tools you need to advocate for your own gynecologic health.
Knowledge is power, and we encourage everyone to join us in learning more about what you need to know, down below!
What to Know Down Below™
All About Fibroids, Featuring Dr. Shieva Ghofrany
Featuring Dr. Shieva Ghofrany, OBGYN & Co-founder of Tribe Called V, and moderated by Meaghan Repko DeShong, Tina's Wish Board Member & Partner at Joele Frank, Wilkinson Brimmer Katcher.
Learn more about Dr. Ghofrany at:
https://www.instagram.com/drshievag/
https://telleveryamazinglady.org/
https://www.tribecalledv.com/
Welcome to What To Know Down Below by Tina's Wish. We're here to empower you with the knowledge and tools you need to advocate for your own gynecologic health. Knowledge is power and we encourage everyone to join us in learning more about what you need to know down below.
Speaker 2:Hi everyone. My name is Megan Repko and I am so excited to be hosting today's episode of What To Know Down Below. I am one of Tina's wishes board members , um, but I've been passionate about Tina's Wish and finding early detection of ovarian cancer , um, because I personally went through a situation where it, it impacted me personally. Um, and today's topic actually is how we found out that , um, there was some growths and other things that were very concerning to my ob GYN I'm so thrilled to be here with our subject matter expert today for today's episode. She's a board certified OB GYN, Dr. Shiva. Welcome Dr . Go . Thank you,
Speaker 3:Megan . I'm so excited to be here.
Speaker 2:So today we are going to be talking about uterine Fibroids. I'll tell you a little bit, this is how my whole thing started with Tina's wish actually is. Um, I , I wanted to freeze my eggs , um, and I was in my mid thirties, which is probably too late to really never too late, but I wish I'd done it earlier. Um, and I went to my OB GYN and she said to me, no joke. Um, has anybody told you you have a bulky uterus? And I was like, no , no one's ever told me . And it
Speaker 3:Doesn't sound like a compliment at the time. Right? You're
Speaker 2:Like, really? Exactly. Um, but that, but she, you know, started the whole process and I went and I got an ultrasound and then that's when kind of all this stuff kind of came to fruition where I had 13 fibroids mm-hmm <affirmative> . And, and I had a tumor on my ovary mm-hmm <affirmative> . Um, that was connected to my ovary and my fallopian tube. And so I then obviously immediately went to an oncologist specialist, all this stuff had the surgery to get things removed . Um, and the thing is, is that I feel like it's a topic that people don't talk about, right? And like, people don't know they have them, but they don't know how to even go. Like what? Like what are the symptoms? So I'm excited to talk to you today because I hope we can educate someone so they don't go through the length of time I did , um, of having a bulky uterus. <laugh> .
Speaker 3:Yes. I think that's wise. Good.
Speaker 2:So I guess to start, can you explain to our audience what fibroids are?
Speaker 3:Yes. So I'll give you a quick background about myself just so it makes sense in the context also, because I always joke, I am like not only the doctor but also the patient because I am now almost 55. I've been a doctor for 25 years in OB GYN in private practice. But I myself had endometriosis. I had six miscarriages. I've had HPV, like 80 to 90% of us. Um, multiple other things culminating I hope culminating I say in ovarian cancer eight years ago when I was 46. So it's really given me a different lens because of course I understood everything medically speaking. But I also, very early in my career and even before my career when I had endometriosis, had a lot of insight into our mindset and our psyche as women with all of these issues. And the single biggest thing I've not only learned early on, but it's been consistently reiterated to me every day , is that no matter how educated a woman is, regardless of age, socioeconomic status, you know, race, it doesn't matter. Women don't have an opportunity to learn about their OBGYN issues. Mostly because the teachers don't know it, the moms don't know it. And the OBGYNs don't have time to preemptively teach everyone about all these issues. So then when they come up, they sound scary, right? And they sound jarring and they sound shocking. And most women will say things like, no one ever told me. I never knew. And so like, I always joke with my patients and they joke back like I told you, I'm telling you. 'cause I try to talk about all these things frequently and kind of casually so that when they come up they don't sound as scary. So the statistics on fibroids are in a way shocking when you don't know them, but not at all shocking to OB GYNs because, and you might know this now, Megan , 70% of all women and 80% of black women have fibroids. And just to go back, fibroids are benign. Meaning they're not malignant, they're not cancer. We'll touch upon the cancerous analogy to a fibroid in a little bit. But they are benign growths of the muscle of the uterus. And the word growth is the same as tumor. So that makes it really confusing, right? So first and foremost, when people hear the word tumor, they think it's cancer. It's not always cancer. Tumor just means growth. Fibroids are benign. Growths, again, of the muscle of the uterus. 'cause the uterus is made of muscle. I was , I have like my handy uterus here all the time. So if this is the inside lining of the uterus, the fibroid can be in the muscle, it can be growing off the top, it can be within the uterine lining. And then this is the tube and the ovary. And I suspect, 'cause you had so many, you probably had in all different places, some within the lining, some within the muscle , some outside. And as you know, they can hide because even someone with a bulky uterus, even if someone is lean , they, I think that as women what we tend to do is we then reflect back and go, you know, I did have x , y , Z symptom . Maybe like in my case, I had a 17 centimeter , um, cyst in my ovary, 17 centimeters, which is the size of like a big grapefruit in medical school. And of course I looked back once they told me and I was like, you know, I have been peeing more frequently or I did like, I was lying in fetal position during my period. So I suspect you probably look back and go, you know, I did have some pressure, some bloating, maybe some bleeding. I dunno if you had pain, right? You're nodding your head. So you had some of these, right? Yeah. Yeah.
Speaker 2:I, I mean very heavy periods, all that stuff. And I just thought it was normal. Yeah . Right. Because I, I think I've had them for, I had had them for so long that, and by the way to touch on your point, like, and, and my mother is a amazing mom, right ? But when I told her about this, she was like, oh, that makes sense. I had those and I was like, mom , you didn't think of telling me .
Speaker 3:And I bet , and I'm sure your mother was amazing , but you probably also at some point said to your mom, mom, my period's really heavy and your mom or your doctor or your friends or anyone probably innocently said, oh, periods are terrible, periods are heavy. You know, we are really, yeah , we are really used to and expected as women to just withstand right. Pain, pressure, bloating, bleeding. This is just part of the female experience. And while it is part of the female experience, we need to do better at learning and teaching that there is something outside of the norm that might be part of the experience. Shouldn't be scary, but we can actually identify it, teach you about it, sometimes fix it, right. And at least not be scared and blindsided. Right?
Speaker 2:Yeah. I mean, you answered a lot of my questions right there, so I appreciate that. Um, but I guess, I guess 'cause see for me it was a little bit different, right? Like I was going to prepare my body to do something right in egg retrieval, but like typically how would a fibroid be diagnosed? Right?
Speaker 3:Well, so, and, and this is where it's important to recognize that fibroids in general for millions of women are totally asymptomatic. Meaning they don't have appreciable pain, pressure, bloating, bleeding. When I say appreciable, that word is really subjective. So when, when someone says to me like, how much is too much, the answer is objectively with bleeding. We say as gynecologists, if it's longer than seven days, more frequent than every 21 to 25 days, or you're bleeding heavier than you're used to , that is objectively what we think is too much. But the truth is there are people who bleed less than that and it's still uncomfortable for them. So I say to patients all the time, if it's anything other than what you feel like you should have, please tell me. And I have a very low threshold to then send a patient for an ultrasound, which is the best way for us to diagnose it. The truth is that there are millions of women who really, even when I kind of probe them, they're like, I mean, I didn't think they were that bad. It really didn't bother me. And we discover them only again during a fertility workup or when they're pregnant or sometimes they're done, done with their pregnancy and I'm doing a C-section. And during the C-section we'll find a fairly good sized one that if it's hanging off the top or the back of the uterus might not have even shown up during the ultrasounds during pregnancy. So again, I'm glad that I can say it's so incredibly common. It's so incredibly common. Please don't freak out if anyone's listening and they, in the future here they have them or they just found out they had them that said, if you have bloating, pain, pressure on your bladder, pressure on your rectum, dis difficulty with sex or any kind of heavy or irregular bleeding and any kind means whatever you consider having irregular, please go see your doctor. I always joke and you feel free to say, I heard a doctor on a podcast say, ask for an ultrasound because you should have an ultrasound done. And that's the best way they can look at it and then decide with you what to do. What often happens is you go to your gynecologist, you have a regular pelvic exam where we put our hand inside, right? And we touch on the outside of your pelvis and we don't do enough to say to you, okay, I don't feel anything. But that does not mean that there can't be something growing in there that we might not feel. So, because we don't say anything. You tacitly believe as a patient that like, everything's fine, we for forget that you don't realize that fine still could mean fibroids. Right? Right . And so that happens a lot. And that also happens with things like ovarian cysts. Um, so again, the best way to diagnose it is with an ultrasound. And the most likely time to diagnose it would be pain, pressure, bloating, bleeding.
Speaker 2:Okay. So then if I , if , if your patient then goes and gets this ultrasound mm-hmm <affirmative> . Comes back, yes. They've got some fibroids. Yes . What is the treatment? What's the best, like, and I, I assume it might vary. Yes . Yeah . Right. But so I , I know that's like kind of a big question but Well, and
Speaker 3:My answer is gonna be almost every time someone says what's the best, my answer is almost always for almost everything OB GYN related . It depends, right? So let's say someone literally just came in to me and I said to them, huh , I feel like your uterus feels a little bit bulky, a little bit bigger than usual. I think it's likely nothing. Tell me about your periods. And when I say I think it's likely nothing, what I mean is it's likely nothing dangerous. But I often say to patients, it's likely nothing but let's check it out. So I will say to them, tell me about your symptoms. Let's assume they still have no symptoms. I would then send them still for a pelvic ultrasound because I don't know, is it fibroids, is it a cyst, is it something else? Now we found fibroids and they really say to me, I don't have heavy periods that bother me. I don't have pain, I don't have pressure or bloating. And to the degree that we can tell the fibroids are not in the uterine lining, like meaning not in here, but let's say they're only in here in the muscle or outside, then a patient might not do anything. I say if they're not in here. Because if they're in here, they tend to almost always cause heavier bleeding 'cause they increase the surface area of the line . So let's say no pain, pressure, bloating, they're fine. And let's say they even say, but I wanna get pregnant. The answer is if they're in the muscle or outside, they're most likely not gonna cause harm or fertility issues. I say most likely because there's a little bit of emerging data that multiple fibroids, even not within the lining of the uterus, might decrease fertility. But it's also hard to say that because our patient population's getting older and everything. So one option is do nothing. Second option is resect them either through the uterine lining, something called an operative hysteroscopy where we scrape them out or shade them out. They can also actually be frozen or burned through the uterine lining. Not as ideal. If you're planning on getting pregnant, they can be surgically operated on meaning laparoscopically or robotically through those little holes where we then remove them and have to sew up that part of the uterus. There's also medication, as you probably know, for example, you could take the birth control pill, which won't shrink them, but will at least hopefully control the bleeding. You can take medication like injections of a medication called Lupron, and there's oral versions now of it. And that literally is an anti hormone . It basically antagonizes your own body's hormones that are stimulating the fibroid and it shrinks them, but it temporarily makes you feel like you're menopausal. Um, but the good news is there are ways to treat it and the better news is you don't always have to treat it. It just depends.
Speaker 2:Yeah. Okay. Um, if someone has fibroids, are they all , like, would they be more susceptible to other gynecological issues? You know, because I feel like right,
Speaker 3:You had like, you had both,
Speaker 2:I don't wanna use like when they're s smokers fire kind of thing. Like, you know ,
Speaker 3:Well, great question. And the answer is no. Meaning fibroids themselves don't predispose you, for example, to, to cyst in your ovaries. Okay? Mm-hmm <affirmative> . And people often misconstrue that. Meaning I have patients all the time who say, oh, I had a cyst in my uterus. Or they'll say I had a fibroid in my ovary. And just to clarify, fibroids are muscular growth. So they're in the uterus, which is made . Muscle cysts are typically either fluid, fluid-filled or blood filled or some other solid components. But they're in the ovary, so they're unrelated. But the truth is, 70% of women have fibroids and probably more will have cysts in their lifetime. But many of the cysts are undetected. So they just are again, part of the female experience that we can address. There are other features of fibroids, like we think that maybe, for example, vitamin D deficiency can increase the chance of fibroids, but that's also very funny data because most of us are vitamin D deficient because we're not laying naked in the sun. And so vitamin D deficiency can also increase the risk of other things. So there's a lot we don't know because again, a lot of these issues just kind of run together. One thing that is definitively true is that fibroids do not become cancer. And it's really important for people to know that again, they get very anxious and think, well, if I leave them alone, will they turn into cancer? Regular fibroids will not turn into cancer. There's a big but though if someone has just discovered they have fibroids every now and then, what the doctor might think is a fibroid could theoretically be a malignant counterpart that is, that will look initially like a fibroid, something called a Lao myo sarcoma, which is a cancerous tumor in the uterine lining. And initially, again, every now and then it can look like a fibroid. So when you hear people say, I had a fibroid that became cancer, what really likely happened is it was misdiagnosed from the beginning as a fibroid. They think it turned into cancer when it was from the very beginning cancers. And the differentiating factor is if you see something rapidly growing, then you really have to make sure that it's just a fibroid. So those ones are not ones that most of us as doctors would just sit on and say, oh, let's just wait. If you're not, if it's not bothering me , if I see a new fibroid, then I usually will say to patients, okay, let's just have a short interval where we'll look again maybe in anywhere from like two to six months, assuming no other SI and no other symptoms. And then if it's rapidly growing, we would absolutely consider intervention surgically to make sure it's not cancer. But again, that type of cancer very rare, thankfully.
Speaker 2:Right. And because I think that's a myth then that we can sort of debunk right there, right? Is that they're they're different things . They're
Speaker 3:Different things. Yeah . Right . They , they , they are similar but very different. And that's why there's a little confusion. Mm-hmm <affirmative> . Yeah .
Speaker 2:Okay . That makes a lot of sense. Um, is there anything that someone could do to lower their risk or prevent the pro , like developing a fibroid? Or is it, are , are they hereditary? Like how do I , I
Speaker 3:Mean, again, here's what's interesting. When you think about hereditary things, it wouldn't, it , they could be hereditary and yet we don't necessarily think they are because 70% of women have them. Right? So things like ovarian cyst and fibroids, again, are just so common that it's hard to say if there's a heredi true hereditary component. Now, all that said, like I said, vitamin D deficiency, things like they think maybe dietary changes like eating diets that are, that are high in trans fat or processed food might increase the risk of fibroids. But again, that data is, it's more causation. I mean, it's more correlation probably than causation. There are large groups of people who are more at risk for fibroids, like black women. And unfortunately their vitamin D levels tend to be lower because of the , their skin's ability to absorb and tr and create the vitamin D three. And we know that unfortunately because of different resources, their diets might be different. Right. So is it causation or correlation? We don't know. So could I say right now to any person, here's what you could do. The honest answer is I can, I can say that I think most of us should have our vitamin D three levels checked, which is a controversial thing to say because there's pros and cons in all of the data and literature. I can say that we should try to limit our alcohol, limit, our trans fat increase leafy green vegetables and our really good quality fats and protein. But can I say directly it's gonna prevent it? No, I see some of my healthiest patients and they still have fibroids, which is in keeping with the data, which is why I , I mean I say this a lot, I all at once want to be casual and calm about it, while also very clear and give information that yes, you might have it. Yes, it's very common. No, it's not likely to cause harm. But yes, you might have symptoms and also, yes, you can get treated right, all of it at once. But if we approach it by giving you preemptive information, like how much better would it have been had you known from the beginning as you have embarked on being a woman <laugh> , that these are the things that might happen to you, then you wouldn't have had to go through the freakout period. It would've still been annoying and frustrating, but it wouldn't have been as anxiety provoking. Right?
Speaker 2:Yeah. Yeah, I can, I can attest to that. Yeah , for sure. Um, all right . Rapid fire. Yes . What are the top three takeaways you hope our listeners remember from this conversation? Because you've given so much good information. I think like if we could pick three. Okay . What do you, what would you say?
Speaker 3:Okay, so two with fibroids and one in general, one fibroids, very, very common. If you find out you have , so one is that they're very, very common. Two is if you find you have them, don't be scared at all because the odds are you either will need no treatment or you'll need some treatment that will help you either feel better or be safer and healthier because we know that you can bleed heavily, have anemia, things like that. And the third correlates to it, but is in general try to learn more about your body. And I say that cautiously 'cause it's very hard, right? Again, your OBGYNs, we're seeing patients every 15 minutes because insurance is not because we don't love you and wanna see you more, but it's hard to preemptively teach you these things. So this is where the internet and Dr . Google could actually teach you good things and instead people are Googling the wrong things. But learn about your body and advocate for yourself. If someone says to you, oh yeah, you told me that you bleed X, Y , z and you told me that it's heavy and annoying, but you're fine. I hate to say like, don't believe them, but it's your body. So if you don't feel like it's fine, then say to them, I think I need a pelvic ultrasound. Or find a doctor who will really, really listen to you. In the end, you might still be fine, quote unquote , meaning you're safe, you're healthy and everything, but maybe you're fine with fibroids. Maybe you don't have fibroids, but you deserve the discovery of what is going on.
Speaker 2:Yeah, I love that. I think advocating for oneself, and I think sometimes women don't do it. Yeah . That well, and that applies medical, it applies at work, it applies to so many things. And so for me, I think that is something, and I think from a Tina's wish perspective, you know, as a whole it's, you know, advocating for oneself with medical, you know, kind of developments or concerns or anything else. It's just so important .
Speaker 3:Well, and to that point, since Tina's wish is really about ovarian cancer, and since I love to talk about ovarian cancer, my other little tidbit would be this. Let's just say for the sake of argument that your doctorate said, oh, you have a bulky uterus, but you don't have any symptoms. End of sentence. I would personally say to every woman out there, if you hear anything other than your pelvic exam feels perfect, you don't have pain, pressure, bloating, bleeding, anything other than that. Please, please, please ask for a pelvic ultrasound. As you probably know, Megan , it is not a standard screening tool. We can't screen everyone with it, but we should have a very low threshold to ask for it. And we should have a high index of suspicion to look for the things that we are worried about. Fibroids, I'm not as worried about as we know ovarian cancer , we do worry about and we have no screening tool for it .
Speaker 2:So I think to your point, advocating is, is really, I I asked you for three, but I think that fourth one is also great. So I appreciate you for, for throwing that in there. Yeah .
Speaker 3:Thank you.
Speaker 2:Well, thank you so much Dr . Gorani . I, it really has been a pleasure. And I think these are topics that people just don't talk about enough. Yeah . And I get, this is what I try to tell people that I work with is like, when you're uncomfortable, it's actually when you learn the most. Yeah . And so, like understanding a little bit more about these things and if you're going to your doctor and asking these questions and kind of feeling more empowered to advocate for yourself, but also to your point, is not going in a state of stress or worry. Um, but it's, but it's also better to just be educated and understand kind of these different gynecological things that we've got going we could have going on. Yeah .
Speaker 3:I mean, it's a difference. I always say between preemptive versus reactive. Like that's why I like to try to give my patients preemptive knowledge knowing that they're only gonna actually listen to this much. Because as you said, we tend to be like on high . We're like, yeah, yeah, yeah. Not gonna happen to me. And then it happens and we have reactive knowledge, but at least if we've laid the groundwork with a little bit of preemptive knowledge, then it's in the back of your mind and you can decrease your anxiety. Yeah,
Speaker 2:I agree. Well, hopefully for all of our listeners , um, you're feeling a little bit more empowered in your own health and you've learned something. And I'd also invite you, 'cause we are going to do another podcast , um, where we discuss everything you need . Well, hopefully it'll be everything you need to know about ovarian cysts, which as Dr. Gorani mentioned, are also very common. Mm-hmm
Speaker 3:<affirmative> . Yes .
Speaker 2:So thank you all for joining. Thank you .
Speaker 4:For
Speaker 1:More information about gynecologic health, visit tina's wish.org/what to know . That's tina's wish.org/w H-A-T-T-O-K-N-O-W . And like, follow or subscribe wherever you listen to your favorite podcasts.