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Learning from city councilor’s fibroid condition

City Councilor Ayanna Pressley

Jim Davis/Globe staff/File 2011

City Councilor Ayanna Pressley

Boston City Councilor Ayanna Pressley had surgery at Massachusetts General Hospital earlier this month to remove benign uterine fibroids.

“Having lived with these fibroids for almost two years and having them impact the quality of my life, I decided after consultation with my doctors to take care of this situation, which like most women, I had been putting off for far too long,” Pressley (inset) told me in an interview last Tuesday evening.

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Fibroids — benign balls of muscle that grow within or on top of the uterus — occur in the vast majority of women, often unnoticed, but about half of black women and one-third of white women develop troublesome symptoms such as prolonged heavy periods, frequent urination, and pelvic pressure.

“It is so intimate, so private, so uncomfortable for women to talk about,” said Pressley.

Some women have periods that last for a month, or get asked if they’re pregnant because a large two pound fibroid is causing their uterus to bulge; others feel constantly fatigued due to anemia from excessive monthly blood loss.

“Sometimes, fibroids can cause fertility problems by mechanically blocking off the fallopian tubes or more commonly preventing implantation or increasing the risk of miscarriage,” said Dr. Trevin Lau, a gynecologic surgeon at Massachusetts General Hospital who treated Pressley.

Determining the best course of treatment for fibroids — which almost never develop into cancer — depends on a woman’s age, her childbearing preferences, and the size and location of the growths. Pressley, 38, isn’t married and told me she wants to have children in the future, which factored into her decision to have surgery to remove just the fibroid, called a myomectomy. Women who aren’t planning future pregnancies often opt for a hysterectomy, to remove the entire uterus.

The trouble with myomectomy, said Lau, is that fibroids may return. One study found that about half of women had a recurrence of fibroids within five years of having the procedure, and 10 to 20 percent were plagued with symptoms again.

Pressley opted to have a myomectomy with a full abdominal incision rather than having her fibroids removed through a small belly button incision via a laparoscope. The less invasive laparoscopy has a shorter recuperation time — four weeks instead of six weeks, according to Lau — but it’s not often the best choice for those with a large fibroid or with multiple small growths scattered throughout the uterus that are tough to spot with the scope.

Surgical removal of fibroids isn’t necessary for every woman who has symptoms. Birth control pills, progesterone shots, and progesterone-secreting intrauterine devices can all help reduce the flow of heavy periods. Nearly half of women with fibroid problems find these measures work to manage their symptoms. Menopause also tends to drastically shrink fibroids — which grow in the presence of estrogen — though Tau said it won’t cause large fibroids to vanish completely.

A newer technique called uterine artery embolization can cut off the blood supply to a fibroid by injecting tiny beads via a catheter into the artery; it’s often a good option for women who don’t want to have a hysterectomy, said Tau, but it’s associated with infertility and not offered to those who want future children.

As for Pressley, she’s planning to work at home until she gets the green light to return to her neighborhood rounds.

“I will do everything to make sure that my recovery is one that is swift and thorough, she said, “so I can continue doing what I’ve been doing for the past two years, which is the job that I love.”

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2
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