Ep. 85: Uterine Fibroids, with Dr. Ashley Womack
Caitlin:
Welcome to the Woven Well Podcast. I'm your host, Caitlin Estes. I'm a certified fertility care practitioner with a master of divinity degree. Each episode will cover a topic that helps educate and empower you and your fertility while honoring the deep connection your fertility has with your faith. Let's get started.
Caitlin:
Welcome back to the Woven Well Podcast. Here on the podcast we talk about issues related to reproductive health, family planning, fertility, and how faith plays a role in all of it. So we share stories of ladies who are a part of our Woven community so that you can hear their real life experiences, and we provide you with quality restorative health resources like today's guest, Dr. Ashley Womack. So if you value these episodes and the content that we share, we would love for you to just pause this episode and leave a quick review. It really does make a difference and we would love to have maybe 10 more reviews so that more women will see our podcast and have access to the information that we share. Thanks so much for your help. Today's guest is Dr. Ashley Womack. She is a fellowship trained, minimally invasive gynecologic surgeon and NaPro technology medical consultant who practices at Arborvitae Healthcare in Dallas, Texas. She's passionate about helping women optimize their natural fertility and understand their body. So her main areas of focus include fertility, restorative surgeries, endometriosis, fibroids, abnormal bleeding, and infertility. Today I've invited her to share some of her expertise on fibroids, specifically. They can really make a difference when it comes to fertility, but aren't necessarily talked about as much. So I'm excited for you to hear from her today. Dr. Womack, thank you so much for being on the show.
Dr. Ashley Womack:
Thanks so much for having me. I'm excited.
Caitlin:
I'm excited too. And maybe we should start out just sharing a little bit about yourself, your practice, maybe even what led you to the work that you do.
Dr. Ashley Womack:
Sure. So I am born and raised in Dallas, Texas. I went to college kind of knowing I wanted to go into medical school and I was born and raised Catholic as well. And so that kind of influenced how I approached medicine just from the get go. I went to medical school in Dallas and then discerned into going into OBGYN, so, which sounds crazy as a Catholic to try to do that, but I just felt very called to serve women and families in that capacity. So I did what I thought was impossible, to go to OBGYN residency while respecting my conscience. Did that at UT Austin and then completed OBGYN residency and wanted to do, you know, be able to serve women with endometriosis, fertility, restorative surgeries, who did a fellowship in minimally invasive gynecologic surgery out in Phoenix. And now I've been in Dallas serving women and families with infertility for about a year and a half now at Arborvitae. And it's been such a blessing. So thanks for having me. Yeah,
Caitlin:
That is fantastic. I appreciate you sharing that background too because it really shows your heart for this work. This is not just a job that you have, this is a vocation. You discerned this aspect of your life and I really appreciate that. So today we're talking about fibroids, but we may have listeners who aren't even sure what those are. So maybe you can explain to us what are fibroids.
Dr. Ashley Womack:
Sure. So fibroids, they're little tumor. First of all, they're super common. I mean we'll get into how common they are, but they're little tumors of the muscle of your uterus. And when I say tumors, it doesn't necessarily mean cancer. So it's a benign growth in the muscle of the, of the uterus. So, the uterus is made up of smooth muscle. That's the muscle that contracts, like when we have our period or when we're having a baby that contracts. And so those muscles can have these abnormal growths in them that are called fibroids. Like 99.999% of the time they're benign. I mean, it's extremely rare that one of these tumors could be cancer. So usually it's just a benign growth that needs to be managed as far as symptoms go.
Caitlin:
Okay. That's really helpful. And what kind of problems would those fibroids cause? Are there certain symptoms that would point towards the possibility that you have fibroids?
Dr. Ashley Womack:
Yes. So fibroids they can present in so many different ways because it depends on the number and the size of fibroids. So like I mentioned before, fibroids are super common. If you were to ultrasound, you know, 10 random women off the street, I'd probably, I'd say probably seven or eight of them would have fibroids. Wow. You know, it's just a matter of, it's a matter of whether or not they're symptomatic. Okay. So you could scan someone with an ultrasound and find, you know, a couple one centimeter fibroids that she didn't even know what she had because they're not symptomatic at all. They're super small. Or you could scan someone and then they have, you know, several 10 centimeter, five centimeter fibroids that are causing a lot of symptoms and bulk symptoms. So what are the symptoms that someone might have? Usually it's heavy bleeding or if they have large fibroids then that can cause bulk symptoms.
Dr. Ashley Womack:
So by bulk symptoms, I mean pelvic pressure, pelvic pain, if it pushes on your bladder it can cause some urinary frequency or maybe some hesitancy with trying to start to void. It can cause some constipation. If your fibroids are larger, depending on where they are in your uterus, it can cause some pain with intercourse. And of course it can cause issues with fertility so it can cause infertility or recurrent miscarriages. So there's lots of different ways that fibroids present. And so what determines how they bother you, like I mentioned, is the size of the fibroid but also the location. So you can have fibroids and we have a classification system for this so that doctors know how to to explain what they're looking at, but there's different types of fibroids. So it's you know, there fibroids can be submucosal meaning that they're inside the lining of the uterus.
Dr. Ashley Womack:
So the endometrium and a lot of times you'll see that can impact your bleeding pattern and it can impact fertility or it be a cause of recurrent miscarriages. If it's impacting the lining or the endometrium, the inner cavity of the uterus fibroids can then grow in the muscle of the uterus. So they just can be in the middle of the uterus. A lot of times those are the ones that don't really cause too many symptoms unless they're super large. And then the fibroids can then also be on the outside of the meaning towards the outer layer of the uterus. So it's not impacting the endometrium but it's more on the outer edge of the uterus. And those are the ones that can go, I mean they call on go super big, but those are the ones you usually see as going very big. And then you see those pressure pain symptoms from that.
Caitlin:
Okay. Would those in particular cause any issues with infertility or recurrent pregnancy loss?
Dr. Ashley Womack:
Less so associated with fertility than less so obviously associated with fertility than the ones that are submucosal. Okay. The ones that are subserosal, meaning the opposite side of the uterus than the inner cavity, they can cause fertility issues in a sense that it can be inflammatory because it's an abnormal growth. It can be if it's near like for example the tube, it can kind of compress that tube and then make it harder to conceive. And it can also because they require so much blood flow as the bigger they get, they can kind of take some blood flow away from the uterus, then make it hard for implantation hard for the baby to grow. Have I seen women get pregnant and deliver a full term baby with fibroids? Definitely. I mean that definitely happens. I do monitor those patients a little bit more closely, especially if their fibroids are large because like I said, the fibroids can steal that blood flow from the placenta and then cause some issues. So Yeah.
Caitlin:
Well as you're talking about this actually clients are coming to my mind, the different symptoms that you just explained, I thought, ooh, I'm thinking of some specific people who don't have any lab work or anything that's coming up that's showing an issue, but they're describing some of the symptoms that you've just shared. So how would you go about diagnosing a fibroid?
Dr. Ashley Womack:
Yeah, so fibroids are sometimes if the fibroids are very large like I've described, I mean I'll feel it on an exam. You know, like they'll, I've had people come in and lay down on the exam table and it's as if they're pregnant because their fibroids are so large. So in that way it's super easy to diagnose. because I say, oh, you have, I mean I guess it could be other masses like an ovarian mass, but more than likely it's a fibroid uterus. But the, a way to officially diagnose it is with imaging. So an ultrasound will show you if you have fibroids in your uterus. Now occasionally, and we'll get into this with treatment, but I'll sometimes get an MRI depending on the type of treatment that we're planning and that will definitely show you fibroids and it maps them out as to where they are are in your uterus.
Caitlin:
Okay, that's really helpful. Are there certain sizes of fibroids that it's okay to just let them be and see if anything happens? Or do they always need to be treated?
Dr. Ashley Womack:
Yeah, that's a great question because fibroids don't always have to be treated. A lot of it is a what the, because like I said, you know, if you scanned random people, 10 random people, seven or eight will have them. So it's really whether or not you're symptomatic and what your goals are. If your goals are for fertility and you're having issues conceding, obviously you want to be able to take those out. But even then, like if a fibroid is, if I have an infertility patient who has a two centimeter intramural fibroid, it's not impacting her endometrium. It's not, you know, super inflammatory, it's just kind of sitting there. Sometimes it's, it does more damage to go digging and looking for it than it does to just leave it and, you know, work on fertility for other because that's not the cause of infertility is what I'm trying to say. Is there a threshold for what number size, you know, what size fibroid is too big and needs to be taken out? There's not an official number. It's really just based on symptoms and the clinical picture.
Caitlin:
Okay. That's really helpful. So if someone did want to have it treated, what are their options and what do you recommend as far as treatment?
Dr. Ashley Womack:
Sure. So there's tons of options for treating fibroid. Okay. So one of them is, let's say your main symptom is bleeding. You know, a lot of doctors will put you on hormones so that, I mean that controls your symptoms, right? So it'll control your bleeding. Sometimes, but it doesn't, it doesn't get rid of fibroids, right? Okay. Hormone therapy is not going to shrink the fibroids. It's not going to make them go away. I guess I'd say that with a caveat because sometimes if you give, for example, depo Lupron, which is a really, really strong hormone that puts you into menopause. It can shrink your fibroids like, you know, 33% or so. And sometimes we do this as a bridge to surgery. Like if someone is extremely anemic, we can't get their blood counts up safe enough to do surgery, we stop bleeding with this, we shrink fibroids a little bit and then it allows us to do a minimally invasive approach to surgery as opposed to an open surgery.
Dr. Ashley Womack:
So there are very specific circumstances where maybe a, a short course of hormones may be helpful, but overall hormones aren't going to shrink fibroids to the point where you can forever not have fibroids. Okay. So then you talk about, okay, well how do we get rid of fibroids? So that also goes back to, and this should be tailored to the patient. There's not a one size fits all answer. So if someone has submucosal fibroids, like I mentioned, the ones that are in the cavity, then you could do a hysteroscopic removal. So that's a camera through the cervix into the uterus that then you can remove the fibroids that way. That's a great option because there's no incisions, you know, it's minimally invasive, super quick recovery and it gets rid of the fibers that are causing bleeding, perhaps, you know, recurrent miscarriages, infertility. Yeah. That's a great option.
Dr. Ashley Womack:
Now the another option, let's say you have bigger fibroids that are not submucosal, they're more on the inside of the abdomen, you know, on the subserosal side of the uterus. That can be done, those can be taken out laparoscopically. So you could would cut up in the uterus and take them out one by one and then reconstruct the uterus, put it back together. So that's the way to officially get rid of them. Now there are other options where you can decrease the size. It's a small, so two small procedures that decrease the size but don't get rid of fibroids. Okay. So one is uterine artery embolization. So this is a interventional radiology doctors. They can go through your femoral vein and then get to the artery that's, or the vessel that's feeding the fibroid and then block it.
Dr. Ashley Womack:
Okay. And that cuts off the blood flow to the fibroid. And there's only certain patients this would be a good option for, like, if you have 20 fibroids, obviously you can't do that with 20 fibroids, but if you've got one big fibroid that needs to be treated, you can do that. Now this procedure has tons and tons of pain obviously 'cause you're cutting off blood flow to a large part of your uterus. So, and we don't recommend this for someone who's looking for fertility. Right, okay. Because you're cutting out blood flow to parts of the uterus. So that's one option. And then another option is this is a newer therapy radiofrequency ablation where doctors, it's also a surgery where they go in and they can, there's these new, new technology where you put probes in and you can burn the fibroids and it shrinks them.
Dr. Ashley Womack:
I think it shrinks them to like, maybe a third to half of the size, which is a, could be a nice option. And but there's not very many studies yet. They, they're still working on it as far as fertility after doing this mm-hmm, you know, like what are the risks to baby afterwards, what are the risks of preterm delivery what are the risks of having a vaginal delivery? Because when you do, for example, a myomectomy where you take out the fibroid, cut into the uterus and take it out, you know, most of the time you have to have a C-section because now you've placed a scar in the uterus. And so the, it's can be dangerous to have a vaginal delivery. With this RFA the new technology, the thought is, well if we're just burning it, we're not cutting into the uterus. Could you have a vaginal delivery and therefore it's, you know, optimal to do that. But there's, the data's not there yet so I can't recommend it as a treatment if you're looking for fertility yet. Sure. And then of course the last option is hysterectomy. You know, if you are done with fertility, there's tons and tons of fibroids. Hysterectomy has fewer blood loss and it obviously gets rid of the fibroids.
Caitlin:
Oh, I really appreciate you going through all the different options there because one of the things we talk about a lot on the podcast is not every option is right for each individual person. Right. Knowing what all of the options are is what empowers us to make a really well-informed decision. And so the first step is to know what's on the table before we make our choice. And sometimes we're in situations where we get to hear all the options and sometimes we're working with a medical professional that just tells us about one, so I really appreciate that's you giving us the full range there so that people can be better prepared to make those informed decisions. Also, things like you included what recovery time looks like or pain with procedure or whether or not you can have vaginal deliveries afterwards. And I think these are really important things to consider when you're trying to decide what method may be best for you in treating those fibroids. I appreciate all that.
Caitlin:
So I'm really curious if somebody would like to work with you specifically. Because I know we have a lot of listeners in the Dallas-Fort Worth area. What would be the best way for them to go about working with you?
Dr. Ashley Womack:
Sure, yeah. Oh yeah. Happy to have anyone happy to help anyone in the area. I'm at Arbor Vitae Healthcare. Our clinic phone number is, the best way to make an appointment is with calling the clinic. So it's 214-987-1195. My website is ashleywomackmd.com. I'm also on Instagram with the same handle, ashleywomackmd. You can also request an appointment through my website. Any of those ways are ways to contact me, so no problem. Happy to help.
Caitlin:
Okay, perfect. And we will make sure to have all of those things linked in the show notes, anything that can be linked, we'll have it there so that people can have easy access to that as well. So thank you so much for sharing and for educating our community on fibroids and how they may be affecting their fertility. We appreciate it.
Dr. Ashley Womack:
Of course. Thank you for having me.
Caitlin:
I definitely learned some new information today and I hope that you all did as well. Here on the Woven Well Podcast, we bring you resources like this on a regular basis. We provide education and a sense of community that empowers women to make informed fertility decisions while honoring the deep connection between fertility and faith. We'd love for you to be a part of our community. You can join our monthly newsletter or even attend one of our events, and you can find information about both of those in our show notes and also on our website, wovenfertility.com. As always, thanks so much for listening as we continue to explore together what it means to be woven well.