Dr. Whitney Dunham is a Board certified OBGYN, with concentration in routine and high risk obstetrics, adolescent gynecology and Robotic surgery. A native of Philadelphia, she obtained her undergraduate degree with honors, from Howard University and Medical Degree from Meharry Medical College, graduating at the top of her class.
After completing her training in OB/GYN, Dr Dunham moved to Huntsville in 2001 where she started and successfully ran her own practice for nearly a decade. Currently, Dr. Dunham holds a Medical Director position for the North Alabama Hospitalist program at Huntsville Hospital while continuing her clinical duties. Dr Dunham is also a proud mom, spending most of her free time with her two very active daughters.
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WHAT ARE FIBROIDS AND WHAT CAUSES THEM?
Fibroids are benign (non-cancerous) growths in the uterus (womb). They are made of up the muscle fibers of the uterus. Fibroids grow in different areas of the uterus; within the lining, within the wall, close to the surface and sometimes attached by a stalk. At this point, there are no definitive causes. There is research to show that fibroids are stimulated by hormonal production. They are more common in women of African descent, but are seen in most races and nationalities. Fibroids are common in families. More research is necessary.
\WHAT ARE THE MOST COMMON SYMPTOMS OF UTERINE FIBROIDS?
Most common symptoms include: heavy bleeding, severe cramping with menses, pain – with urination and with intercourse, pelvic pressure sensation due to uterine enlargement, changes in bowel habits, complications with pregnancy (pain, bleeding, miscarriage, preterm labor, preterm delivery), infertility
WHY DO FIBROIDS CONTINUE TO RETURN IN SOME WOMEN FOLLOWING TREATMENT?
Every woman should be counseled prior to any type of management decision that fibroids will return as long as there is continued stimulation by hormones and the uterus is present. The only way to insure that they will not return is to remove the uterus.
HOW ARE BIRTH CONTROL PILLS USED TO TREAT FIBROIDS?
Birth control pills can be taken daily to control bleeding and regulate menstrual patterns.
WHAT IS THE FIBROID EMBOLIZATION PROCEDURE USED FOR TREATMENT?
Uterine fibroid embolization (UFE) is a procedure used to treat fibroid in an outpatient setting. It is performed by an interventional radiologist in the radiology department. This procedure is not performed by a gynecologist in the operating room. During this procedure, under x-ray, a catheter is introduced through their groin and travels to the blood vessels that supply the targeted fibroids.
Particles are then injected into those blood vessels to block that blood supply. This then causes the fibroids to be without nutrition for further growth and they recede. Prior to this procedure the patient has had a consultation with the radiologist and has had an MRI performed which will delineate the fibroids. The patient then stays overnight for observation for any potential side effects like pain and fever. The patient then has a follow ultrasound in 6 to 9 months. Patients have to be counseled that they may not be able to get pregnant following this procedure.
UNDER WHAT CIRCUMSTANCES SHOULD A HYSTERECTOMY BE CONSIDERED?
A hysterectomy can be considered in patients who have completed childbearing or do not desire the ability to bear children. The decision to have a hysterectomy should be made following a discussion of all options available based on that woman’s individual situation. A hysterectomy is not necessary in every situation. There are other methods to manage and treat fibroids that do not require complete removal of the uterus.
WHAT’S THE DIFFERENCE BETWEEN A MYOMECTOMY AND A HYSTERECTOMY?
A myomectomy is the removal of the fibroid from their uterus. A total hysterectomy is the removal of the uterus and cervix. (this can occur while leaving the ovaries intact). (Misnomer: Many people have been told that a partial hysterectomy means the ovaries are left behind. It actually refers to the retention of the cervix following the removal of the uterus.)There are multiple ways to do both of those procedures including laparoscopically, with or without the assistance of robotic technology, open incision (abdominally), vaginally. The methods for each depends on the woman’s individual situation regarding the size of her uterus and number of fibroids in the skill level of the surgeon.
CAN DIET AND EXERCISE AFFECT FIBROIDS?
Yes. If you research or speak with a naturopath or nutritionist, they will suggest you avoid certain types of unhealthy food including high fat, processed meat, certain types of dairy, refined sugar, refined carbohydrates, alcohol, caffeine, food preservatives, food dyes, foods treated with pesticides and herbicides, bleach, and many others. There is also the suggestion to add certain essential oils and nutritional supplements. And although these will definitely improve your overall health and well-being, one cannot say that absolutely these will target fibroids specifically.
ARE THERE NATUROPATHIC TREATMENT OPTIONS THAT WORK?
To my knowledge there are no naturopathic treatment options that have been proven scientifically to work. But there are many women who have had some relief and will attribute a decrease in their symptoms and in the size of their fibroids to various methods that day personally utilized. But as with any type of treatment method, medication, supplement, each person may have a different outcome.
WHAT’S THE BEST WAY TO FIND AN AFRICAN-AMERICAN FEMALE GYN WHO SPECIALIZES IN THE TREATMENT OF FIBROIDS? CAN YOU RECOMMEND A DIRECTORY OR SITE TO FIND A PHYSICIAN?
To my knowledge there are no specific sites or lists of African-American female gynecologist exclusively. But if you do an Internet search and put in the parameters you’re looking for in your area you should be able to find us. In addition contacting your local medical society or ACOG.org (the American College of Obstetricians and Gynecologists), may be helpful. One website that I found with good information: Hystersisters.com. Many women find that they are more comfortable with referrals from family, friends, and/or coworkers.
Your “Text Tom” Answers on the next page:
I had a myomectomy at age 40 – 6 mos ago. I have no children and want them. I want to avoid fibroids reoccurring again. What can I do?
There really isn’t a way to avoid their return. The typical recommendation following myomectomy, if pregnancy is desired, is to start trying to conceive after 3 month recovery from surgery.
Should I be worried an abnormal Pap?
It depends on the actual result. It is important to follow up with the doctor so he/she can discuss possible biopsy, if that is necessary.
Are polyps and fibroids similar?
They are different. Polyps are soft, fleshy like over growths of the lining of the uterus(endometrium). Fibroids are firm, roundish growths made of the muscle fibers of the uterus.
Is it true when you’ve had a hysterectomy that fibroids come back?
No. Fibroids start in the uterus. Once the uterus is removed, they cannot grow back.
What happens to fibroids after menopause? Do they disintegrate? Or do they continue to grow?
During menopause, the fibroids typically stop growing and calcify (get old and hard. If there is continued bleeding or growth of the fibroids, there may be another more serious condition that needs to be evaluated promptly. So it is important to see a doctor right away if that happens.
Is it true you can pass the fibroids without surgery?
Rarely. If the fibroids are located within the lining of the uterus and they lose blood supply, they may pass through the cervix if they are small.
My daughter has had over 6 iron transfusions in 2 years because of a fibroid. Why doesn’t her doctor just remove it?
I can’t answer to the management of that doctor, but I think it is important for you and your daughter to get another opinion. Management is based on your daughter’s particular situation.
What if your fibroids are between 8 to 10 cm which is like the size of a baseball? Do you still have an option to get them removed or are they too big ? I asked that question because my doctor informed me that my fibroids are too big that’s why I have to have a hysterectomy.
If your desire is to retain your uterus, then I would suggest you get a second opinion. The decision for the type of management from the doctor side is comfort level for that particular procedure. If that is not what you want, then find someone who can better assist you. And don’t be afraid to speak up and ask questions.
I bleed during ovulation every month. Me and my husband I trying to make have a baby but the bleeding is preventing that I have no pain, just the ovulation bleeding. Could this be fibroids?
It is important to have an evaluation from your doctor. It is difficult to determine what it could be without knowing your complete history.
So, at what point should a woman have a hysterectomy? What if fibroids are inside and outside the uterus? How invasive is fibroid removal surgery?
Having a hysterectomy is truly a personal decision. You should have a detailed discussion about all the options that are available. If you feel you have exhausted ALL of your options and there are no other options and your quality of life is extremely compromised, then make the decision with which you are most comfortable.
I heard that the chemicals that are found in hair relaxers lead to fibroids. Is this true?
That statement was mentioned during the segment. Last year, TJMS had on another physician that discussed that topic specifically. There is information that chemicals, including those in hair care products, can cause negative effects of various kinds to people that use them. It is my recommendation to avoid all (whenever possible) harsh chemicals, preservatives and additives in products we use and foods we eat.
I’m almost 44. I have had 6 children, 2 are twins (I’ve been pregnant 6 times with 1 abortion). My OB/GYN of 19 years hasn’t suggested anything but birth control or wait until menopause for my fibroids. I tried the patch and they caused me severe depression. My fibroids cause me heavy menses & fatigue, and I’m on iron pills. I’m interested in myomectomy. Should I suggest it to my doctor and ask her to refer me to a specialist if she can’t do it? What other options would you suggest?
It is important to discuss your concerns with your doctor. You need to ask about your options for management. If he/she does not respond, then seek out another physician for another opinion.
I have fibroids and was told by my doctor that they are deep in my tissue and he didn’t want to touch them. l have had polyps removed but how dangerous is it to keep those in there? I now have pain in my left pelvic area.
If your symptoms have changed and/or worsened, it is time to ask about different management options. If your doctor does not discuss other options and you are uncomfortable or unsatisfied with the response, then seek out another physician for another opinion.
Dr. Dunham, I live in Huntsville. Are you accepting new patients?
Yes. But we are making some changes in the office. We will be accepting new patients after July 1. You can reach out to us at that time.
I am 57 and getting my third fibroid removal next week. I have been told that dairy, which I love, is the cause of so many fibroids. Also, does having fibroids cause weight gain? Thank you!
Fibroids do not necessarily cause weight gain, it is possibly a combination of a several things that could include metabolic changes that come with menopause, dietary habits, and minimal activity. There are nutritionists who believe that dairy does contribute to fibroid development. But the questions at hand are why are you having another fibroid removal at 57? Are they still growing? Have you been evaluated for more serious issues?
Is there a direct affect of having a hysterectomy and experiencing problems losing weight?
Not necessarily. Without having all of your information, it is difficult to answer. But if you are menopausal or have gone through surgical menopause (because of the removal of ovaries at the time of the hysterectomy), then your metabolism and hormonal situation has changed, which can affect your ability to lose weight.
I’m 50 years old with 600 g fibroid and a few smaller ones. I have no menopause symptoms but I have heavy bleeding.
It is extremely important to have open dialogue with your doctor regarding your situation. Your continued bleeding at 50 could be due to the fibroids.
I had my tubes tied almost 13 years ago and I’m looking to get them reversed but I just recently found out I have cysts on my ovaries. I’m wondering will it still be possible for me to do the reversal and have another baby or will the cysts cause me to have to have a hysterectomy? I’m 35 years old.
Benign cysts on ovaries is not cause for hysterectomy, per se. You and your GYN should discuss the tubal reversal. They may suggest lab work to determine your hormonal situation and may suggest a referral to infertility specialist. The recommendations have changed regarding management of tubal reversal.
Are the other removal methods costly and are there any free treatments?
Unfortunately, there are no free treatment options. The other removal options are both surgical and non-surgical. There are some insurance companies that consider some of the options ‘experimental’ and will not cover them.
If you’re having extreme pain (at its best really bad cramps at its worst contraction type pain) is it worth taking a chance with the UFE procedure or should you consider a partial hysterectomy? I’ve already had endometrial ablation 5 years ago.
If your desire is to retain your uterus and you don’t want hysterectomy, then you might ask for consultation for the UFE. There is testing and criteria that are required before the procedure can be performed. You will need consultation with the Interventional radiologist who performs the procedure to determine if you are a good candidate for the procedure and if your insurance will cover it.
I have a fibroid size 11 by 14 equal to 5 months pregnant. 1) is there a prescription for the pain during menstrual cycle? 2) I’ve gotten two opinions one says hysterectomy, the other myomectomy but he has malpractice lawsuit that he lost…any advice?
A prescription for birth control pills can possibly be used to manage the bleeding during the menstrual cycle but may or may not work. If you desire to retain your uterus and prefer the myomectomy and are uncomfortable with that doctor, then you will need to seek out another doctor.
I would suggest you speak with that doctor regarding the lawsuit, if you have concerns. Many times doctors are sued and lose, not because they did something wrong but because the insurance company wanted to settle or there was a complication, which can happen. Give him/her the opportunity to explain before you decide to switch doctors.
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