Uterine Fibroids and Fertility: What Women Need to Know (Episode 452)

Full Transcript: Episode 452

Lisa: Today we are delving into the topic of fibroids. I’m sharing my interview with Dr. Camille Hammond, a medical doctor who specializes in fertility and infertility, and we are delving into a lot of the basics. What is fibroids? What are some of the most common symptoms? How does it affect fertility? And what are some of the most common medical treatments related to fibroids? So before we jump in, I’m going to share a little bit about Dr. Hammond. Dr. Hammond is an expert on infertility education, advocacy, and support. She has been published in the peer-reviewed scientific literature and in newspapers and magazines. She is the author of several books, including The Guud Book About Infertility and The Guud Book About Faith and Fertility. She is also the owner of the publishing house, Guud Books About Tough Topics. After an extraordinary medical journey gave Camille and her husband Jason two boys and a girl, the couple decided to give back and help others still going through infertility. They started the Tinina Q. Cade Foundation, which to date has awarded 92 families with grants of up to $10,000. Without further ado, let’s go ahead and jump into today’s episode with Dr. Hammond.

Lisa: Well, I’m so excited to be here today with Dr. Camille Hammond. As we were talking about in the pre-chat, I met Dr. Hammond — we were on a panel together, and it was a really fun experience, and I always like to connect with medical doctors who are amazing, and also women of color in particular, because I know I’ve been doing this podcast for a long time and I’m not always — it just, I think just the way that the field is that I’m in, there’s just not as much representation. So, you know what I mean?

Dr. Hammond: Representation matters.

Lisa: Exactly. And especially today, because we’re going to be talking about fibroids. And so fibroids is something that has affected me personally. It’s something that certainly runs in my family, very, very common in all women, but particularly Black women. So really excited to jump into that. So before we jump into the topic of the day, I’d love to hear just a little bit about your background. What prompted you and inspired you to go into medicine? Tell us a little bit about how that all happened and why you chose to specialize in women’s health and fertility and all those good things.

Dr. Hammond: So I had endometriosis. I was diagnosed when I was 18 years old after I passed out the orientation weekend of my first year of college, undergraduate college. And I was misdiagnosed and ultimately was diagnosed with endometriosis. So I knew that family building may be a challenge for me, but it wasn’t until years later when I met my husband and we decided to get married that it really became something that was the focus of really my career as well as my personal life.

So we married, we immediately started trying to get pregnant and after a year of practicing and, you know, just doing it the old fashioned way, we started having fertility treatment. And that began five years and six unsuccessful rounds of IVF, at which point we had run out of insurance. We were really fortunate that we lived in a state where there was mandated insurance for people who had infertility. But we never got pregnant, and the doctors suggested that we consider adoption or a gestational carrier because they knew we were young and we were both physicians, but we were broke. So we didn’t have a lot of extra cash to have expensive fertility treatment, the same treatment given that it probably would not have been successful.

We were devastated, but at that same time, my mom and dad asked if my mom could carry a baby for us. And they didn’t talk about 55-year-old postmenopausal women carrying their grandkids in medical school. But she certainly felt like they had seen it on 60 Minutes, which is a popular news show in the U.S. And they thought this is something that could happen. I didn’t know anybody who even admitted to having infertility, let alone someone whose postmenopausal mother carried their grandkids. So politely we thanked them, but declined. But my parents were persistent, and after a lot of prayer and a lot of conversation, we moved forward and ended up having fertility treatment. And my 55-year-old mother conceived my triplets and they were delivered and they’re now almost 18 years old.

So infertility is something that impacted me personally. And after a few years, I decided to leave my job as a physician to run the Cade Foundation full time. And I’ve been doing that for the past 15 years at this point. And I’m really privileged to say that I’ve been able to support families that are struggling with infertility caused by many different conditions, including having uterine fibroids, which are a huge issue for Black women in particular. And we have been able to support 160 families at this point with grants of up to $10,000 each. So I get to see it and support it professionally, but it is something that is very near and dear personal to my family building story and our journey to parenthood.

Lisa: That is amazing. I have a couple of questions to delve into your story. Could you tell us again, you said the Cade Foundation?

Dr. Hammond: Cadefoundation.org. The Cade Foundation, yes ma’am.

Lisa: So obviously by your description, you founded it to support other couples who are going through infertility to provide obviously the funding necessary for the various ways. That’s really incredible. What a difference that you’ve made with over a hundred beneficiaries. That’s incredible.

Dr. Hammond: Yeah, 160 families. And so originally we created it to just provide the money, but then we realized that we couldn’t help everyone with money, but we could provide information and help so many more exponentially more people. And so we started doing patient education. And then we realized okay, there’s a missing piece here, because if providers don’t know about these issues, they may not be able to provide the best care that families with infertility need. And so we started partnering with medical schools to co-host multidisciplinary Grand Rounds. Grand Rounds are training opportunities that take place weekly when people are doing their medical residency training. And they include medical students, residents, fellows, and also the senior doctors that work at hospitals, academic hospitals. So we partnered for the past few years with Johns Hopkins, the OB-GYN department and the University of Maryland OB-GYN department when they did their reproductive endocrinology Grand Rounds. And I’m really excited to say this year, in addition to those schools, we’re also going to be partnering with Georgetown University and Howard University for their multidisciplinary Grand Rounds on fertility.

Lisa: And so that’s, you know, like a type of continuing education — that’s what we need. We need more doctors that are in the know about fertility issues. 100%. And I just wanted to touch on your story because I mean it really is incredible. I remember when we were on the panel together and you shared your story with your mother carrying your triplets for you. But I think for me, especially what struck me was that this, like you said, was 18 years ago. So I personally know women who’ve struggled with fertility challenges and perhaps their sister has carried, or they find a different gestational carrier. And although that’s not the main topic that we’re covering today, I just think it’s really incredible not only that that is how you were able to bring your children into the world, that your mother played such a pivotal role, and that was her idea and that she pushed it, but also that it was almost 20 years ago when this wasn’t as — obviously we weren’t talking about it as much and it wasn’t as common at that time. And just briefly, I’m kind of curious what it was like at that time.

Dr. Hammond: You are so right. And we had been in this for about five years, a little over five years when we actually had our kids. So we’re talking 23, 24 years ago when we actually were going through treatment, like late 90s, just to put it into perspective. So it was lonely. Most of my friends were worried about not getting pregnant and were thinking about career. And I was also thinking about career, my husband was also thinking about career, because we were in medical school. We were actively pursuing our careers, but we had been told if you want to try and carry a baby, then you need to get moving. And that’s why we went kind of all out to try and do that for five years before my mom ended up carrying a baby for us, because the goal was really for me to carry my own children. Nobody grows up thinking my mom is going to carry a baby for me one day, but that is what ended up happening. And I’m so grateful that she was willing to do that.

The only other person that I could relate to at that point who had infertility, who was talking about this, was Angela Bassett, because she around the same time ended up having her children by a gestational carrier. So she was a Black woman. She’s older than me, a lot older. She’s fabulous and fierce. Although she looks the same age. But I was in my 20s, and I think she might have been in her late 30s or maybe even 40s when that happened. She was at least a Black woman. I did not know anyone who admitted that they had infertility. So I felt like a purple unicorn, because I at that point thought, hey, Black people were super fertile. Like we were more fertile than everybody else. Isn’t that what they always say? And that is such a lie. I mean, the data, the research that has taken place since that time just do not support that. But I didn’t know that because all I saw was the images of Black women on TV having lots and lots of babies. And so found out that I wasn’t such a purple unicorn, that unfortunately there were so many like me who were struggling.

And what’s unfortunate is we had good friends who were struggling with infertility at the same time that my husband and I were struggling. But we didn’t tell anybody, right? So they found out — these are people that we hung out with, we talked about almost everything under the sun with, but we didn’t share this thing that was so personal and so close to our hearts. They found out on Good Morning America, like everybody else. So they’re calling us in the hospital like, we’re going to this clinic too. We’re at this clinic. And I just felt ashamed because if I had been a little bit stronger and more transparent, we could have been supporting one another. But everything worked out the way that it was supposed to, and most of them have gone on and they built their families. I think maybe having us be so public about it helped other people feel less shame about their own infertility.

Because at one point it was like, and for so many people still, they feel like infertility is punishment. Like God is punishing you, you must have done something wrong. Instead of looking at it as a medical issue, which it is. Purely, it is a medical issue with a diagnosis. And regardless to whether or not you treat it, this isn’t like — by putting it into the purely spiritual realm, what they’re doing is saying somehow it’s like a magical thing that if you do this thing, it can be cured. Well, just like any medical issue, sometimes it can’t be cured. Like everybody with medical disease does not get fixed, right?

Lisa: Yeah, it’s tough because especially in the realm that I’m in, you hear a lot about — and it’s not to say for all the listeners who — like I can just hear — but it’s not to say that we’re discounting the potential emotional issues and stuff like that that are very real, that I wouldn’t completely discount that. But on the other hand, just as an analogy, I struggled with really painful periods when I was younger. And I remember some of these books would have women like, oh, I prayed or I did this cleansing ceremony or whatever and released my emotions and had a good cry and never had pain again. And I’m like, no, that’s not going to work for me. Because I know that this is some sort of medical issue in terms of like — I will never know if I potentially had a touch of endo in certain places. But I certainly had certain symptoms. So I think it’s really important to acknowledge that yes, this is medical. There can be other contributing factors, but we shouldn’t be putting it purely into the realm of spiritual.

Dr. Hammond: I think you get a little too spiritual. We don’t go super spiritual when it comes to erectile dysfunction, okay?

Lisa: No, we don’t. We don’t tell him to go and look in his past for his trauma.

Dr. Hammond: We put him on medication.

Lisa: We put him on medication immediately and tell him go live a happy life. Like stop doing that.

Dr. Hammond: And arguably there could be other health issues. But you’re right, at the medical — so it’s so interesting how we always go there for women’s issues in particular.

Lisa: Yeah, certainly it’s psychological, it’s in your mind.

Dr. Hammond: No, it’s not. It’s endometriosis. And for this topic, it’s fibroids. Fibroids are a huge issue that prevents so many women from building their families. And prayer is important. I love the Lord and I am a Christian, but you still need to talk to a doctor. That fibroid needs to be removed.

Lisa: There is like a saying like pray but move your feet, right?

Dr. Hammond: Well, faith without works is dead, okay?

Lisa: Yeah. So for all the Christians listening, yes. I mean, this is — we’re just kind of talking a little bit about it, but my belief has always been that we should be doing what we can as well. So let’s jump into it. I think a good place to start would be, let’s talk about fibroids. Like what are they? Maybe share a little bit about the overview, prevalence, because I don’t think women realize how prevalent they are in general. And I’m not sure if you have any of that data of general prevalence and also particularly for Black women.

Dr. Hammond: Right. So I have to admit that I did not look up the data about fibroids but I will have it for you in two seconds because Google is right here. But fibroids are non-cancerous growths in the uterus and often they grow using the same hormones that allow a pregnancy to grow, right? Estrogen makes them get bigger. So there are times when a woman has a fibroid on the inside of her uterus that is growing at the same time a pregnancy is growing, and it grows using blood vessels. It needs the same kind of nutrition that a growing baby needs. And so what can happen is fibroids can prevent pregnancy, but they can also cause a miscarriage, because they take up a lot of the nutrients that the baby would need to grow. And so it’s important to know if you have fibroids, and they can mimic — I mean, as far as the way women look, it can look like a pregnancy.

I know my grandmother, when she was — after my grandfather passed, she ended up having a grapefruit-sized fibroid removed, and she was in her 70s. So these — and there are women who have not one or two, but they can have upwards of 20, 30, I mean, depending on her genetics and her background. Fibroids are very prevalent among Black women, and I’ve seen a lot in the research as well as the kind of pop culture about causes of fibroids, you know, the question being why is it so prevalent in Black women. And I know that I’ve seen people talk about things about like diet, and also some of the things that Black women are exposed to as far as their hair — you know, relaxers and some of the types of hair products that we use.

But they’re devastating. In addition to impacting pregnancy, and I see the prevalence — and this is according to the National Institute of Health — ranges from about 4.5 to 68.6% of the study population, depending on the diagnostic methodology. Much higher in Black women than in other groups of women. And in addition to impacting pregnancy, it just impacts quality of life, ranging from lengthy menstrual periods, which can result for some people in having anemia, to just pain, extreme pain associated with the fibroids. And then of course physically, you look different because this is a non-cancerous tumor in your womb, the same place where a pregnancy would be. So your belly may be distended and you don’t look the same as you would if that weren’t present.

And fibroids shrink — because I just mentioned that they grow with estrogen — so often they shrink during menopause, and they are very connected with family history. So for women whose mothers and grandmothers and other relatives have struggled with fibroids, they are more likely also to have fibroids.

Lisa: Well, I have a stat here that’s interesting. I could put the study in the show notes. It says the incidence of uterine fibroids by age 35 in this particular study was 60% among African American women, increasing to over 80% by age 50. And then whereas Caucasian women showed an incidence of 40% by age 35 and almost 70% by age 50. The only reason I brought that up is I remember reading that and thinking it’s so interesting because basically this is an issue that all women deal with on some level. And I think that would indicate that there’s kind of a spectrum — like not everybody has a grapefruit-sized fibroid. Many of these women have smaller ones that are not necessarily causing as much problems. But that’s crazy if you think about it — by age 50, 70 to 80% of the study population had some evidence of this.

So I think what I often think of — because fibroids affected me personally. So I do have fibroids. They were identified in my early 20s and I just asked for an ultrasound because they were in my family and I kind of wanted to know, but if I hadn’t, nobody would have offered it to me, right? So, and then I just did what I could to try to improve my cycles, try to reduce my xenoestrogen exposure, some of the things that you talked about. So maybe if you could share some of the most common symptoms, and also, I just feel like with fibroids, many, many women are not even getting diagnosed likely until they’re very bad because they’re coming in for these — like, you know what I mean? I feel like many women who have fibroids maybe at a smaller scale or earlier stage wouldn’t necessarily be seeking that confirmation diagnosis.

Dr. Hammond: Yes. So some of the symptoms, the common symptoms are heavy menstrual bleeding, vaginal bleeding at times other than during menstruation, and we talked a little bit about having low blood or, people call it low blood, but it’s anemia. Low hemoglobin levels and a symptom of that might just be being really tired or lethargic. Heavy periods, bleeding and bleeding through pads, bleeding through tampons, having to wear multiple pad and tampon together. And as you mentioned, they do vary in type and severity.

And I want to also talk about — I mentioned the fibroids that are on the inside of the uterine cavity, but they can occur in other places. They can occur in the actual muscle, in the wall. So they can occur on the inside, kind of where the blood is shed during menstrual periods, but if they occur in the wall, in the actual muscle, they’re not going anywhere. And they can sometimes occur connected with the fallopian tubes. So they occur at different places, but they’re always connected with the uterus.

Lisa: Well yeah, I think that’s so important. I mean, one of the things that I find really interesting — so with the work I do as a fertility awareness educator, we’re tracking the menstrual cycles, we’re looking at the period, we’re looking at the mucus, prior ovulation, et cetera. And what I found is that there’s a couple of things I always have to make sure I ask about because I think as women, we’re used to our periods. We deal with it. Depending on how we think about it, our culture is very much like, oh, it’s that time of month. And really negative about it. And the expectation is actually that it’s going to be a pain, sometimes literally, but like a pain in the butt. And also we’re kind of expected to have not a good time with it. So I feel like because of that expectation, I often have to ask specifically, you know, if you do experience pain. And that’s — maybe you could talk a little bit about how fibroids could relate to pain because I think it depends on where they are.

Also, even in terms of the heaviness — so for me personally, because I did have fibroids, they were small, but I had really heavy periods. And so to put it into perspective, when I was using tampons, I would use a super plus — I called them torpedo tampons — and I would go through them every two hours for the first day or two of my period. And so I always had to have the tampon and something else just in case, and I was always every two hours. And then when I switched to the cup, I would fill a cup every four hours. So the cup was brilliant because now I could go for four hours instead of two.

So just to put that out there, because during that time, I knew it was heavy. I feel like I didn’t actually think it wasn’t heavy — I really was going to the bathroom every two hours — but I didn’t realize what normal bleeding was or that there are women who use one or two or three tampons a day during their first day. So I didn’t really have that point of comparison. So maybe share some of the things that you’ve seen or talked to with your patients over the years — like big flags that we should be really paying attention to.

Dr. Hammond: Well, I’ll also add constipation. So the uterus doesn’t just kind of exist by itself in the belly. The rectum, your colon, your GI tract is right next to it. And so if you’ve got this big non-cancerous mass that is kind of projecting into that area or causing the uterus to — the uterus is like a balloon, but if it’s kind of projecting, not growing into, but it is pushing the colon, that’s going to make it harder for stool to pass. So you might end up having constipation. Frequent urination, because if that non-cancerous mass is pushing against your ureter or against your bladder. The bladder doesn’t like it when things touch it. It kind of tends to get a little spastic. And so that results in you having to go to the bathroom more often. And then just pelvic pressure or pain. And again, that’s something that many women who are pregnant experience because you have extra weight. And that causes pressure. Well, the fibroid is extra weight. It’s something additional that’s not normally there and that can cause the pelvic pressure. That can cause you to feel some pressure in your pelvic floor.

So fibroids are a big issue. And I think that you made a huge point. We just kind of associate periods with pain. And so this is one thing I want people listening to understand: periods shouldn’t be painful. And also, sex shouldn’t be painful. So if you’re having pain with either of those, regardless to whether it’s fibroids or endometriosis or some other issue, you need to talk with your healthcare provider. Because periods inherently are not painful. Everybody doesn’t have excruciating cramps where they’re laid up in the bed for a whole day and unable to function. So I think that’s an important takeaway.

Lisa: Well, so along those lines, I have a question about that. One of the most common things that I hear from my clients, and one of the common themes on the podcast when women are coming on the podcast to share their personal experiences, is having to go to several doctors, having doctors not believe them, having doctors tell them it’s normal, and you know, oh, just go on the pill if you have heavy periods, or, oh, it’s painful, whatever. So this is a very, very common unfortunately experience for women. And I don’t have data to say if it’s even harder for Black women to receive proper care. I don’t know because just the — I recently recorded two very powerful interviews with two women who had endometriosis. And in both cases, it was very severe. The one woman was having the vomiting and not being able to — yes. And I’ll link those episodes to this episode. And the other woman, she had endometriosis — I don’t know the medical term, but it wasn’t localized. So she had lesions on her diaphragm and all throughout her body. So it was kind of atypical in terms of the presentation. But both of them struggled with this severe kind of pain around the time of their period, and they both just had such a difficult time getting diagnosed, also getting the proper care.

So in terms of fibroids, what are some — I guess from the perspective of a medical doctor — what would you say to that woman who might even have tried to get care, who did recognize her periods were really heavy and went to the doctor, and potentially still hasn’t got that diagnosis? Like, what does she do?

Dr. Hammond: So you have got to be your own best advocate, okay? Unfortunately, the data do bear out the fact that Black women are not referred appropriately. They’re not referred at the same levels. And there’s a history of Black women not being believed, our pain being perceived differently.

Lisa: One of my clients said — she was on the podcast — she mentioned that they’re more likely to be thought to have a venereal disease as opposed to potentially like a diagnosis like endometriosis. I’ve never really heard that particular take before, but as you were saying that, I just thought I’d mention it.

Dr. Hammond: No, I mean, it’s an issue. It’s a huge issue. Medical bias, bias in referring, bias in clinical practice is an issue. And it’s such an important issue that all of the major governing credentialing organizations — American College of Obstetrics and Gynecology, American Society for Reproductive Medicine, American Academy — there were 17 of them that signed on in a joint statement saying that racism has negatively impacted clinical practice and that it needs to be fixed.

When you have all of these groups that together come and say that this is an issue, they’re not saying it because they just decided it was a good thing to say. They’re saying it because clinical outcomes are impacted. And if you want to just talk about issues for Black women, you can go throughout the entire reproductive health cycle — from pre-pregnancy and just being diagnosed with different medical diseases and being treated appropriately, to pregnancy and receiving prenatal care and receiving the support that we need. We’re less likely to conceive, less likely to be referred appropriately for fertility treatment when that is needed, less likely to have IVF. And when we do have IVF, we’re less likely to get pregnant, more likely to deliver early, and more likely to die during or around childbirth. And those statistics have been going in the wrong direction for two decades. So at a time where we have the best technology that has ever existed, Black women are still dying faster and more frequently than every other group on the planet. So provider bias is absolutely a part of that.

I’m sorry, I got distracted. What was your original question?

Lisa: Well, yes, but I mean, everything you said was relevant to the question because then the question becomes what do you do. And what you said was you have to be your own best advocate. I always just like to highlight that it’s not easy. It’s such a tall order. It’s not fair. It’s not fun. And we shouldn’t have to. I mean, that’s why doctors go to medical school and get these fancy degrees, right, so that we can go and be taken care of. But that’s not how it works. So from my perspective, what I’ve seen is that it’s a good idea to find someone who specializes. When you have a specific health problem, I feel that we can’t go to a general practitioner. You can’t expect the same level of care, even if you think about it from an educational standpoint. As you were saying, you’re offering specialized training on fertility issues. So if you’re working with a fertility specialist, someone who’s taken an interest in that, they’ve done extra training, they have extra experience, their clients are primarily this issue. And so they have a lot more nuance in terms of their approaches, generally speaking, than someone who’s a generalist.

So in addition to that, what are some of those practical tips for all women who have fertility-related issues, suspected fibroids, some of these symptoms that we’re talking about that aren’t normal? How do we get to the bottom of it? How do we know if we’ve got that good practitioner?

Dr. Hammond: So part of being your own best advocate means relying on your own common sense and not just thinking this person has a degree, they know more than me. So maybe my pain is real. It’s not real. Maybe I imagined it. It means also acknowledging the fact that doctors are people and doctors have biases as well.

So one thing that I would recommend is that you treat your healthcare like you treat your car, okay? If your car was — if you heard a rattle, you heard something going on in your car, you would maybe try and troubleshoot on your own, but if you couldn’t figure that out, you would go to a dealer. And if that dealer couldn’t figure out what was going on, but you kept hearing the same rattle, you would find somebody else who could fix that car, right? You wouldn’t just say, okay, well, they didn’t find anything, so I’ll just keep driving it, and then you end up on the side of the road with a smoking hood. You gotta use that same due diligence when you’re looking at your healthcare provider. If your doctor is not believing you, then maybe you need to find another doctor. And not to say that that is a bad doctor. Maybe they’re just not a good doctor for you because you deserve to be believed by the person who’s providing care for you. And if they for whatever reason are not able to provide the support that you need, then look elsewhere.

There are a lot of support organizations and online platforms where people talk about these things. So don’t be afraid to — and I’m not saying that everything that’s shared on these platforms is accurate because sometimes it’s just garbage — but you can say, hey, I live in this city and I’m struggling with fibroids and I have tried to talk to my doctor and my doctor is not giving me the support I need. Does anybody else have any experience with a doctor who is providing support for them with fibroids? That’s a great way to crowdsource knowledge. And I know Facebook has a ton of these groups. Instagram, I also believe has a ton of these groups. You can learn a lot from other people on social media.

Also, if you go to some of the national credentialing organizations, they may identify doctors who have special training and special experience working with specific diseases. So it may be that some of the people in your area who are most experienced with fibroids are not the fertility specialist. They may be OB-GYNs, but they may be OB-GYNs who really have an interest in fibroids. And so you may be able to go to the American College of Obstetrics and Gynecology, for instance, if you’re in the U.S., or the American Society for Reproductive Medicine, and say, hey, I’m looking for someone who really has expertise with fibroids. And they may be able to direct you to some of those people who have that as a focus.

Lisa: I think that’s also helpful. And I think again what you said is really helpful — about the doctor and maybe it’s just not being the right doctor for you. Because I don’t think it’s about bashing doctors. I always say that. I just think that you have to find the person who specializes. So that doctor might be really great at XYZ, but this might be something that this doctor comes across once every blue moon, so they don’t necessarily know all the things that are needed to really support you to get over that hump.

From a practical standpoint, of course, one of the challenges about fibroids is that from my knowledge, there’s no cure. So there’s no magical pill you can take and they just disappear, is where I’m going with this. And also there are — I think there is an argument for certain natural ways to deal with hormones and all those kinds of things, but I think that the level to which it could help depends on how far it has gone. So there’s a point where if you have a grapefruit-sized fibroid, even if you wanted to do other things, there’s a point at which, is it going to really reverse? So share with us a little bit about how fibroids are diagnosed — so what’s necessary to get that positive diagnosis — and then how they tend to be treated within the medical realm.

Dr. Hammond: So there’s something called an ultrasound. It often for women, it might be a transvaginal where they have a little probe and they stick it into the vaginal canal and they can see what’s going on inside your uterus. It can also be transabdominal where they kind of squirt the jelly on your belly and they use the ultrasound device to see what’s going on in your belly. But those are the ways that it’s diagnosed.

And it’s treated by removal. So they can actually go in and just kind of carve out the fibroid. They can cut it out or cut them out if you have multiple. And I mentioned before that the fibroids grow — they have a blood supply. They need a blood supply to grow. And so they can clot that blood supply. It’s called uterine artery embolization, UAE, and they would just put little small particles into the artery that would clot it, that would fill it up so that blood couldn’t pass.

They can also use radiofrequency to destroy the fibroid. Again, I mentioned removal — they can do that through something called hysteroscopy where they actually go in and look inside of the uterus and they use a little tool to actually remove the fibroids. And then another thing that can be done is called endometrial ablation, where they go in and they heat the inside of the uterus and they almost cauterize it so that the fibroid can’t grow roots and continue to receive blood supply.

And then, you know, also menopause, and that is just getting to a stage in life where you just don’t have the same level of estrogen naturally, and they tend to shrink with that as well.

Lisa: So when I was young and they determined that I had fibroids — after my ultrasound, the internal one, I call it the magic wand — I was offered the birth control pill. Yeah, because they say that it shrinks it. And I know that they use, I think at times, ulipristal acetate — Ella — as a way to shrink it a little bit or — so basically then from the medical perspective, there’s a variety of surgical techniques. And then sometimes they might offer a medical hormonal type suppressing treatment or something like that.

And so this is more than we have time for today, but I feel like that comes with a lot of questions. So in terms of, does everybody need to do that? Obviously, at what point would that be necessary? Do these things improve fertility? So if someone is trying to conceive and they have a giant fibroid and this is inhibiting their ability, does the surgery improve that? So in terms of endometrial receptivity, because there’s all these conversations around how fibroids can interfere with endometrial receptivity, making it more difficult for conception. But then there’s also the issue of surgery, surgery potentially doing that as well. So it’s a big conversation, but I’m not sure if you want to speak to some of those challenges, because the last thing you would want is to get this fibroid removed only to find out that the surgical scarring and et cetera, kind of make it difficult.

Dr. Hammond: Well, so there’s — okay, for surgeons, the theory is to cut is to cure. And surgery can be used very successfully. Birth control pills do not make fibroids go away. They control your symptoms. So they control heavy bleeding and they can control the growth of the fibroids. But I don’t know that birth control pills are going to make it get smaller, okay? So you still have the issues that we talked about earlier. It’s just, it’s kind of like making you feel like, okay, I don’t have the symptoms, so it’s gone away. It has not gone away.

And so I think that each person is going to need to make decisions based on their own belief system and also in counsel with their provider. I wouldn’t tell someone to do something or another thing, but I would advise that you be informed about the options and then make a decision based on what seems to be best for you. But in my mind, if you want to get pregnant, you need to have the fibroid removed. And I know that for some people, everybody is not told that they need to be removed. When I was actually trying to get pregnant, that was kind of the universal advice, because they felt like fibroids acted almost like a little bit of an IUD and it made it more difficult for implantation, for the embryo to implant.

Lisa: Interesting. In my case, I was told that because they were small, because of their size —

Dr. Hammond: They were small. So that’s something to explore.

Lisa: I feel like what I always think is, maybe before you have the surgery, have more than one medical opinion, just so that you can, like you said, get all the information and then you make the best choice for yourself.

Dr. Hammond: Make the best choice that you can in consultation with your provider so that if things don’t turn out the way that you hope — because obviously the goal right here, if we’re talking about fertility, is to get pregnant. But everybody doesn’t get pregnant. So you don’t want to feel like if things don’t work out that there was something that you could have done, that if you had known better, you would have done. You want to feel like regardless to what the outcome is, I’ve done everything in my power to get myself in the best position to be able to have a healthy pregnancy. To do that, you do need to be informed about all of the different options and then go with the provider and whatever recommendation that makes the best sense to you.

Lisa: Yeah. We could — I mean, there’s so much more we could delve into today. As we’re wrapping up, I’m thinking of all these different things, but I feel like our conversation today has given a really good basis for what fibroids are, what some of the most common symptoms are, how to get that diagnosis, what some of the medical options are. And I think it’s challenging — a lot of the listeners to my podcast want natural solutions. And again, I think it’s really helpful to have — I always think of a team approach where you have your medical doctor, potentially your surgeon, potentially naturopathic doctor to help you sort out hormonal issues and have that kind of team approach, not necessarily favoring one over the other, but having the support you need to deal with things in the way that you want to deal with, maybe a nutritionist to help you with some of the dietary concerns or things like that.

But at the same time, I think fibroids presents a challenge because many women, if it gets to a certain point, you really do have to seriously consider the surgical option. I’ve certainly experienced that in my own life with friends and family and clients. And I know in my book, I share the story of my mom needing a full hysterectomy. I mean, it was years ago — they do less hysterectomies for fibroids now — but hers were big enough that she did look like she was a few months pregnant. So like you had said at the beginning of the call, it’s so specialized to each person, their experience, the size, the severity, the symptoms, what’s going on in their life, their goals. So with that said, maybe share some final words to kind of end on based on your experience there.

Dr. Hammond: Well, I wanted to add — because you made me think — surgery is not just one thing, right? There are different kinds of surgery and there are different surgical approaches. So my recommendation is if you decide that you’re going to have surgery, that you find a doctor who can do the procedure in the least possible invasive way, in the least invasive way. And if you don’t have to be opened up so that your surfaces are exposed to the air, which will increase the likelihood that you’re going to have some scarring — which cause issues, those cause issues in and of themselves, right? If you can have someone who does the procedure laparoscopically, where they’re not actually opening your whole belly up, that’s going to decrease the amount of time it takes to heal and decrease the likelihood of scarring.

So you’re going to have to continue to navigate these decision trees and just continue to advocate for yourself and to remember what your focus is. Sometimes you may get to the point where you have to make hard decisions. Like these are all hard decisions, but hard decisions like, what do I need most — to be pregnant or to be a mom? And that’s part of the whole fertility discussion. And I know for myself, I had to make the decision — I wanted to be a mom more than I wanted to be pregnant. But none of this is easy. And I salute everyone who’s on this journey and just encourage you to be kind to one another and not judge other people who make decisions that you would not have made. And just to continue to advocate and support and be a good member of this community.

Lisa: Amazing, amazing words to end on. Well, Dr. Hammond, thank you so much for being here. I feel like we scratched the surface. We could have talked about this all day, but I really appreciate you for being on the show. And share with us one more time where the listeners can go to learn more about you.

Dr. Hammond: So you can learn more about the work of the Cade Foundation at cadefoundation.org. And we have social media presence on Facebook, Instagram, Twitter, and TikTok. And we always post about the grant. The grant is limited to those who live in the U.S. We do have a family building grant that provides up to $10,000 for fertility treatment or adoption. And the application is online and available 24/7, 365 — so you can apply. And if you do decide to apply, make sure that you make a note that you heard about it on this podcast, because we are always looking to go back and thank the people who shared about the resource. The foundation is based just outside of Baltimore, Maryland. We’re in a little bedroom community called Owings Mills, which is maybe 10 minutes outside of the city, but we’re Baltimore Metro. But we operate nationally. We have events nationally and support families all over the country.

Lisa: Amazing. Well, I’ll make sure to put all the links in the show notes page for today’s episode, and thank you so much for being here.

Dr. Hammond: Thank you for having me. I truly appreciate it.

Lisa: Thank you for listening.