Uterine Fibroids: The Complete Guide »

Elizabeth A. Stewart, M.D., is a professor of obstetrics and gynecology at the Mayo Clinic College of Medicine in Rochester, Minnesota.

You've called in sick today. Your back and legs hurt. Your abdomen is bloated and more than a little uncomfortable. You are having your period, and the bleeding is so heavy you can't even think about leaving the house. You have uterine fibroids.

One in every four women see their lives affected by uterine fibroids, which can cause heavy bleeding, abdominal bloating, pain, and infertility. The symptoms can be mildly annoying or life altering in severity. Until recently, hysterectomy was the only way to cure fibroids, and each year more than 200,000 hysterectomies are performed in the United States to treat these noncancerous growths.

But hysterectomy isn't always the best solution. The procedure can be devastating for women who were planning to get pregnant, and it is a significant surgery for anyone. In this comprehensive and compassionate guide, Dr. Elizabeth A. Stewart helps women understand the treatment options now available.

An internationally recognized expert on fibroids, Dr. Stewart describes all the available medical and surgical treatments as well as alternative and complementary therapies. In addition to hysterectomy, she explains uterine artery embolization (UAE), noninvasive focused ultrasound (FUS), and innovative hormone treatments. Simple diagrams and photographs illustrate the condition — and its treatment.

Dr. Stewart encourages women with fibroids to learn as much as they can before choosing a treatment plan. Providing the most reliable and up-to-date information on this very common and difficult disorder, she helps women understand uterine fibroids and make the best possible choices about their care.

Doody Review Services

Reviewer:Jacqueline Ogutha, MD(Washington University School of Medicine)
Description:This is a well written resource on uterine fibroids, full of scientific data, hypotheses about their etiology, and available treatment options. Figures and pictures help readers understand some of the more complicated concepts.
Purpose:According to the author, the purpose is to educate women about fibroids and enable them to become more active participants in the decision-making process regarding treatment options. These objectives are certainly worthy given that upwards of 20 million women have fibroids.
Audience:As the introduction states, this book is written for the woman with uterine fibroids who would like to be better informed about her diagnosis and treatment options. However, the first several chapters read like a gynecology text book. Chapter 4, on the endocrinology of the uterus, contains a fairly detailed discussion of receptors, growth factors, and second messenger systems that may be challenging for readers with no previous exposure to biochemistry. The author has published articles on fibroids and has years of clinical experience.
Features:After an overview of the biology of fibroids and surgical and medical management, the book makes a case for more rigorous scientific inquiry into the genetics of fibroids. The chapters on surgical treatment are especially well written and clearly describe all the available options. The appendix, "Hints for Surgical Recovery," is a thoughtful addition to the book and will be appreciated by any patient contemplating surgery.
Assessment:This book is a comprehensive account of uterine fibroids for the motivated patient. Although the amount of scientific detail may be overwhelming for those without a background in the sciences, it is balanced by illustrations, photographs, and a clear writing style that make the book easy to read overall.

Introduction     ix
About Fibroids
Who Gets Fibroids, and What Are the Symptoms?     3
What Are Uterine Fibroids?     10
Why We Are So Far Behind in Understanding and Treating Fibroids     20
The Endocrinology of the Uterus     26
Why Do Fibroids Form?     37
Diagnosis: How Do I Know That I Have Fibroids?     42
When Fibroids Come Back     56
Surgical Treatment
Surgery Inside the Uterus: Hysteroscopic Myomectomy, Endometrial Ablation, and Vaginal Myomectomy     63
Laparoscopic Myomectomy and Myolysis     70
Abdominal Myomectomy     75
Uterine Artery Embolization     83
Focused Ultrasound Surgery and Other Thermoablative Therapies     95
Hysterectomy     104
Medical Treatment
Traditional Hormonal Therapies: Birth Control Pills and Progestin     117
GnRH Agonists, Add-Back Therapies, and GnRH Antagonists     121
Innovative Medical Strategies for Treating Uterine Fibroids     126
Other Factors, Other Conditions
The Genetics of Fibroids     133
Pregnancy, Infertility, and Miscarriage     144
Adenomyosis and Endometrial Polyps     153
Uterine Cancers     159
Fibroid-like Conditions     165
Alternative and Complementary Therapies     172
What Can We Do about Fibroids?     175
Hints for Surgical Recovery     179
References     191
Index     215