FIBROIDS: TARGETING THE MOST COMMON PELVIC TUMOR IN WOMEN

On August 7th, 2014, posted in: Latest News by

By Dr. Ronald Portadin and Dr. Jonathan D. Gewirtz Vineland Gynecology Associates

The uterus is the female organ located in the lower abdomen(pelvis) behind the urinary bladder and in front of the rectum.

Until the time of puberty, the uterus remains about the size and shape ofaninverted pear.With puberty, under the influence of the female hormones estrogen and progesterone, the uterus begins to change. With the onset of the reproductive phase of a woman’s life, the uterus changes and grows. Normal levels of estrogen and progesterone in a woman’s body help prevent excess or abnormalgrowthin tissues sensitive to the effects of estrogen. Problems can develop without the right balance of estrogen and progesterone in a woman’s body. For example, fibroids may grow in the uterus, cystsmay grow in the breasts or ovaries and even cancer of the uterus, breasts or ovaries may develop.

What are fibroids?

Uterine fibroids are benign or nonmalignant tumors of the uterus. Fibroids, also called leimyoma, are the most common pelvic tumor of women of reproductive age. Almost half of Caucasian women and more than 80 percent of African-American women will have uterine fibroids by age 50. The cause of uterine fibroids is still unknown. However, recent studies have identified a genetic change in as many as 70 percent of these cases. There are other factors that can raise a woman’s risk of developing fibroids as well.

African-American women experience more severe disease and tend to develop symptoms four to six years younger than Caucasian women. There is an increased risk in developing fibroids if the onset of puberty is less than 10 years of age or if a woman never becomes pregnant. An increase in consumption of beef and other red meat also is associated with increased risk of fibroids, as is vitamin D deficiency. Dairy products may be protective, however. High blood pressure and uterine infection also appear to be associated with increased risk.

How are fibroids diagnosed and treated?

Although the majority of fibroids are small and cause no symptoms, many women with fibroids have significant problems that interfere with quality of life and warrant therapy. These symptoms are primarily related to the number, size and location of these tumors. Heavy or irregular abnormal uterine bleeding is the most common, followed by pelvic pressure or pain and bladder problems. Discomfort during sexual intercourse also is a problem. Even fertility can be affected if the fibroids distort the uterine cavity.

Miscarriage and preterm labor can occur, and anemia is possible for women with heavy bleeding. The finding of an enlarged uterus at the time of pelvic examination with the gynecologist often leads to the diagnosis of fibroids. Usually an ultrasound image is obtained to confirm the diagnosis and to exclude the possibility of an ovarian disease. There are more treatment options today than ever before. If future fertility is desired, a myomectomy is recommended:

Laparoscopic myomectomy: A minimally invasive procedure where the fibroid is removed using a laparoscope, a slender telescope that is inserted through the navel to view the pelvic and abdominal organs. For this type of surgery, the instruments are passed through two or three small, 1⁄2 inch incisions to remove the fibroid.

Hysteroscopic myomectomy (Myosure): The Myosure procedure represents a type of hysteroscopic myomectomy, an out-patient procedure where the doctor removes fibroids through the uterus via the vagina and cervix with a resectoscope.

For heavy bleeding, uterine artery immobilization can be successful, but may be temporary. Medical therapies include hormonal treatment, an IUD, oral contraceptives or progestin implants. Low-dose oral contraceptives do not cause fibroids. Anti-estrogen agents are a newer treatment method, but they are still early in the evaluation of their effectiveness. Innovations in technology, new medications and future research can provide effective, minimally invasive alternatives to hysterectomy.

For women who do not respond to medical therapy or minimally invasive surgery, or who have completed childbearing, hysterectomy remains the treatment of choice.

Vineland Gynecology Associates offers an exemplary tradition of women’s care based on years of medical experience supported by a caring and knowledgeable staff in a modern office setting. The board-certified physicians of VGA are Dr. Ronald Portadin and Dr. Jonathan Gewirtz.Together with Nurse Practitioners Cindy Nevara, RitaVastano, Karen Duncan and Sharie Hiller, they bring outstanding women’s health care to 1318 S. Main Road, Building 3, in Vineland, and to 3980 Black Horse Pike, The Festival at Hamilton, in Mays Landing Formoreinformation, or to schedule an appointment, visit http://www.VGAVineland.com or call (856) 462-6350.

About Dr. Ronald Portadin For decades,Dr. Portadin has served the Vineland community as one of the premier professionals in the field of women’s health. After earning a Bachelor of Arts from New York University and a Doctor of Medicine from Georgetown University, Portadin served a rotating internship followed by a fouryear residency at St.Vincent’s Hospital in New York City. From 1967-69, Portadin served as a Major in the United States Army Medical Corps. After his service, he obtained Certification from the American Board of Obstetrics and Gynecology and relocated to Vineland, where he became an associate atVineland Obstetrical & Gynecological Professional Association. Portadin is a member of the American College of Surgeons and the American Gynecological and Obstetrical Society. He specializes in non-invasive gynecologic surgery, including laser surgery, and cancer screenings.

About Dr. Jonathan D. Gewirtz Dr. Gewirtz received a Bachelor of the Arts in Chemistry from the State University of New York, Stony Brook. He then obtained two Doctors of Medicine; one from Autonomous University of Guadalajara, Jalisco, Mexico, and one from the State University of New York in Buffalo. After his graduate education, Gewirtz served an internship and residency in Obstetrics and Gynecology at Emory University Affiliated Hospitals in Atlanta, Georgia. He then completed two fellowships; one in maternal-fetal medicine at Pennsylvania Hospital in Philadelphia, and a second in integrative medicine at Beth-Israel Hospital in New York. In 1991, he was certified by the American Board of Obstetrics and Gynecology. Since his certification, Gewirtz has offered complete obstetrical and gynecological care to the women of South Jersey, with practices in Cherry Hill, Atlantic City, Manahawkin and Vineland. Gewirtz is a clinical instructor of bioethics at Drexel University,andheis amemberof theNewJersey Medial Society and the American College of Obstetricians and Gynecologists. Gewirtz remains active in his community, and he has been published in the medical journals Findings and The Journal of American Medical Association.

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