Managing Uterine Fibroids: Understanding Symptoms & Treatments

# Understanding Estrogen Dominance in Fibroids, With Dr. Soyini Hawkins, MD | The DUTCH Test
# https://www.youtube.com/watch/YfdQ83gKrpA

00:00:04.080 Welcome to the Dutch podcast, where we
00:00:06.240 dive deep into the science of hormones,
00:00:08.240 wellness, and personalized healthcare.
00:00:10.719 I’m Dr. Jacqueline Smeen, chief medical
00:00:12.800 officer at Dutch. Join us every Tuesday
00:00:15.280 as we bring you expert insights, cutting
00:00:17.760 edge research, and practical tips to
00:00:19.920 help you take control of your health
00:00:21.199 from the inside out. Whether you’re a
00:00:23.279 health care professional or simply
00:00:24.880 looking to optimize your own well-being,
00:00:26.640 we’ve got you covered. The contents of
00:00:28.800 this podcast are for educational
00:00:30.480 andformational purposes only. The
00:00:32.719 information is not to be interpreted as
00:00:34.559 or mistaken for medical advice. Consult
00:00:37.280 your healthcare provider for medical
00:00:38.719 advice, diagnosis, or treatment. I’m so
00:00:41.280 glad you’re joining me for this week’s
00:00:42.800 episode of the Dutch Podcast. This week,
00:00:45.360 we’re talking about a topic that affects
00:00:47.600 a lot of women, and that’s fibroids.
00:00:50.000 Now, fibroids can happen earlier in life
00:00:52.239 or it can also rise in pmenopause as our
00:00:55.039 progesterone starts to decline and you
00:00:57.520 start to see big fluctuations in
00:00:59.280 estrogen levels. This can lead to growth
00:01:01.600 in the uterus. It’s a non-cancerous
00:01:03.440 growth, this fibroid, but it can lead to
00:01:05.680 a lot of different symptoms that can
00:01:08.159 really be easy to miss. Things like
00:01:09.680 bloating or kind of a distended belly,
00:01:12.479 heavier menstrual cycles, things like
00:01:14.479 that that women oftentimes put off.
00:01:17.280 Today’s guest is a real expert in this
00:01:19.840 topic because she is a board-certified
00:01:22.320 gynecologist and a fellowship trained
00:01:24.240 specialist in minimally invasive
00:01:26.159 gynecological surgery, but also she
00:01:28.799 suffered with fibroids herself and went
00:01:30.880 through all the things that women go
00:01:32.479 through when they get diagnosed like am
00:01:33.840 I still going to be able to have a baby?
00:01:35.520 Worrying about the symptoms and even
00:01:37.520 being brushed off a little bit maybe
00:01:38.880 along the way. Our guest today, Dr. Dr.
00:01:41.520 Sini Hawkins is a co-founder and medical
00:01:44.079 director of the fibroid and pelvic
00:01:45.840 wellness center of Georgia where she
00:01:47.680 treats fibroids and endometriosis,
00:01:50.000 pelvic pain and abnormal bleeding using
00:01:52.240 advanced laparoscopic and robotic
00:01:54.079 techniques. She’s a real dedicated
00:01:55.920 advocate for women who are going through
00:01:57.520 fibroids. And she draws on her personal
00:01:59.439 experience to empower women through
00:02:01.119 education, outreach, and media like this
00:02:03.360 today. I’m so excited to talk with her.
00:02:05.200 She partners often with functional
00:02:06.640 medicine providers. we get the chance to
00:02:08.399 talk about lifestyle techniques, about
00:02:10.000 medication, and about the surgical
00:02:11.760 options that are available to women. So,
00:02:13.840 without further ado, let’s go ahead and
00:02:15.280 dive in. All right. Well, I’m so excited
00:02:17.520 to have you here, Dr. Hawkins, with me
00:02:19.200 today because we’re going to talk about
00:02:20.319 a topic that affects a lot of women. Um,
00:02:23.520 you know, and we talk a lot about
00:02:24.400 permenopause. This is the time where
00:02:25.760 this really starts to come up for women
00:02:27.599 as well, and you get a lot of diagnosis.
00:02:29.280 We’re talking about fibroids. Um, so can
00:02:32.080 you start by just explaining a little
00:02:33.440 bit about like what is a fibroid for our
00:02:35.519 listeners and why do they happen in some
00:02:37.760 women?
00:02:38.319 >> Oh, absolutely. That’s an easy one. So,
00:02:40.640 fibroids are happening in in women
00:02:43.760 because women hold the hormones that can
00:02:46.080 fester and make fibroids grow. Um,
00:02:48.800 fibroids are literally coming from the
00:02:51.200 cells of our uterus. So, all you have to
00:02:53.040 do is be a woman with a uterus with
00:02:55.599 active hormones. So it happens in the
00:02:57.920 premenopausal years of our lives and
00:03:00.560 those small cells in the uterus just
00:03:02.879 grow and this causes a tumor which is
00:03:04.959 the fibroid and they grow over time and
00:03:08.319 can lead to symptomatology usually based
00:03:10.400 on where they’re located and the size
00:03:12.720 that they grow to but all women can at
00:03:15.440 some point develop fibroids.
00:03:17.360 >> Now can you talk a little bit about how
00:03:19.440 um estrogen and progesterone each play a
00:03:21.760 role in the development of fibroids?
00:03:23.840 >> Absolutely. So the two main hormones
00:03:26.239 that we as women make are estrogen and
00:03:28.480 progesterone as you noted and we make
00:03:30.080 them mainly from our ovaries but can
00:03:32.799 come from other organs as well. And the
00:03:35.280 estrogen is usually what allows fibroids
00:03:37.760 to grow over time. That’s why we see it
00:03:39.840 in the premenopausal years. And
00:03:41.599 progesterone in and of itself can kind
00:03:43.680 of sustain it a little bit like add to
00:03:45.680 vascularization if it’s present. Um but
00:03:48.159 it needs that estrogen to actually grow.
00:03:50.480 >> Okay. Do you notice any specific hormone
00:03:52.159 patterns in women who develop fibroids
00:03:54.720 that kind of differentiates them from a
00:03:56.560 woman who doesn’t develop fibroids?
00:03:58.879 >> Yeah. So, there’s the potential of that.
00:04:02.000 There’s something called estrogen
00:04:03.840 dominance that we kind of feel that
00:04:06.239 women with fibroids that grow to be
00:04:08.159 symptomatic because like I said, 70% of
00:04:10.319 women have fibroids, but they’re not all
00:04:12.080 symptomatic. Probably only a good 40 to
00:04:14.959 60 are symptomatic based on the
00:04:17.120 literature. But those patients that are
00:04:18.798 symptomatic usually have a bit more of a
00:04:21.279 um estrogen hormone dominance. So they
00:04:23.280 do have heavier cycles. Sometimes they
00:04:25.600 have more bloating. They’ll have more
00:04:27.840 fatigue and discomfort with those cycles
00:04:29.919 and cramps which are the symptoms that
00:04:32.320 come along with fibroids. But again also
00:04:35.199 with that excessive estrogen that they
00:04:37.520 may have in their system.
00:04:39.280 >> How did you get so interested in
00:04:40.400 fibroids?
00:04:41.520 >> So I have a personal um experience with
00:04:44.320 fibroids myself. I had them, didn’t know
00:04:46.400 they were there. they grew to be
00:04:48.000 extremely large and when I became
00:04:50.160 symptomatic I was at the point where I
00:04:52.320 had to have surgery. Um it was I was
00:04:54.800 young but I was recently married too and
00:04:57.520 knew I wanted a family and it was
00:04:59.680 impacting all of the above. My new
00:05:01.680 marriage
00:05:03.840 >> my symptoms I was in school and I wanted
00:05:06.000 baby so I ended up having to have
00:05:07.520 surgery and um now I am a minimally
00:05:10.800 invasive gynecological surgeon. So most
00:05:13.199 of my patients by the time they see me
00:05:15.120 are looking and seeking to have some
00:05:16.800 type of surgical intervention. But
00:05:18.320 that’s how that’s how my passion grew
00:05:19.840 from.
00:05:20.240 >> It’s so interesting. So much so many
00:05:21.759 times what we pursue in medicine is like
00:05:23.759 the field that affected us or you like
00:05:26.400 wish that your experience was different
00:05:27.919 or you wish you could help people in a
00:05:29.440 way that you weren’t helped. It’s
00:05:30.960 awesome that as a minimally invasive
00:05:32.720 surgeon, you must see a lot of this.
00:05:36.240 >> So can you talk a little bit about some
00:05:37.840 of the symptoms that come up for women?
00:05:39.600 Like what are the earliest signs of
00:05:40.960 fibroids? And if you did nothing, what
00:05:43.039 would you experience over time?
00:05:44.960 >> So the earliest signs of fibroids are
00:05:47.520 usually very subtle changes in the
00:05:49.280 menstrual cycle. Um maybe their cycles
00:05:52.000 becoming a little bit longer, usually
00:05:54.240 typically cycles are anywhere from five
00:05:57.280 maybe to seven days. The textbooks
00:05:58.800 really say five is normal. Um but as
00:06:01.120 they grow in time and also heaviness. So
00:06:04.560 a normal menstrual cycle amount is 80
00:06:07.440 cc’s of blood, which just looks like
00:06:09.120 maybe a couple two shot glasses. That’s
00:06:11.520 80 cc’s. So if you’re doing more than
00:06:13.600 that, you’re actually abnormal. Or just
00:06:16.319 generally if you’re like, "Oh, my cycles
00:06:17.919 are heavier than they were two years ago
00:06:19.600 or my girlfriend’s cycles aren’t like
00:06:21.360 mine. Something is wrong. That might be
00:06:23.360 an early sign of fibroids."
00:06:24.800 >> Yeah. Especially if there’s like a
00:06:26.319 change, you know, and actually this is
00:06:28.000 something that we’ve talked a lot about
00:06:29.280 per menopause this spring um in this
00:06:31.680 year. And I think that one of the
00:06:34.479 challenges with pmenopause and fibroids
00:06:36.560 is well I know that there’s kind of a
00:06:38.400 more relative estrogen dominance because
00:06:40.000 progesterone tends to decline before you
00:06:42.160 might have spikes of really high
00:06:43.440 estrogen in your cycles in permenopause
00:06:45.919 and we know that the prevalence of them
00:06:47.520 goes up when you’re over 40 really like
00:06:49.520 between 40 and menopause right so 40 to
00:06:51.520 52 do you see that you know you see the
00:06:54.000 cycle changes of getting heavier anyway
00:06:56.720 >> and yet aligns with the timing that
00:06:58.479 fibroids are most commonly problematic
00:07:01.039 like How can women know, you know,
00:07:03.599 should they is they get checked? Is that
00:07:05.039 something that gets looked at at every
00:07:06.160 gyne exam?
00:07:07.520 >> Absolutely. It’s something that should
00:07:09.440 be checked at every gyne exam. Not
00:07:11.440 necessarily specifically, but indirectly
00:07:14.160 because you should be getting what we
00:07:15.280 call a pelvic exam. So remember fibroids
00:07:16.960 or tumors are growth. As your uterus
00:07:19.039 grows, your doctor might be able to feel
00:07:20.720 the difference in that growth from year
00:07:22.400 to year and say, "Last year it felt
00:07:23.919 normal. This year it feels a little bit
00:07:25.280 enlarged." That’s the first sign for us
00:07:27.360 as providers along with you telling us
00:07:30.560 something is different about my cycles.
00:07:33.039 But yes, it makes sense that we see it
00:07:35.120 the prevalence is higher in those that
00:07:37.039 40 to 50 age range because you’ve had
00:07:39.759 more years with your uterus. You had
00:07:41.599 more years with your hormones
00:07:43.840 >> and that exactly the hormonal
00:07:45.599 fluctuation that you’re talking about.
00:07:47.599 That kind of imbalance of the hormones
00:07:49.919 that’s happening in those pmenopausal
00:07:51.759 years also will fester not just the
00:07:54.560 fibroids and the way they grow but the
00:07:55.919 symptomatology and how severe it is for
00:07:58.400 women in that kind of you know 40 to 50
00:08:01.280 age range.
00:08:02.720 >> Now what are the what’s like the most
00:08:04.319 common size that you would end up
00:08:06.240 picking up a fibroid? Because I know
00:08:07.599 I’ve heard of them like baseball size,
00:08:09.280 cantaloupe size. Like I’ve seen some
00:08:11.440 pretty big fibroids on reports. I mean,
00:08:15.039 women can go a long time without
00:08:16.479 noticing that or just writing it off or
00:08:19.120 maybe not getting diagnosed properly.
00:08:21.039 >> Yeah, that was me. Unfortunately, my
00:08:23.759 uterus was about what we say 16 to 18
00:08:27.039 cm. And that’s a 16 to 18 week size
00:08:29.759 pregnancy.
00:08:30.720 >> Wow.
00:08:31.280 >> That’s unbelievable. And how big the
00:08:32.880 uterus normally is like smaller than
00:08:34.479 your fist.
00:08:35.120 >> 8 centimeters, right? The size of your
00:08:37.039 fist. And um I didn’t even know it was
00:08:39.519 that big. So, I never get shocked when
00:08:41.440 patients come in here and they say, "Oh,
00:08:42.880 I just started to notice my symptoms a
00:08:44.959 year ago and I’m like, "But it’s already
00:08:46.560 at your belly button. How did you how
00:08:48.560 did you not I don’t ask that question."
00:08:50.800 Um, because I know how they don’t know.
00:08:53.120 >> Um, and a lot of that, uh, comes with
00:08:56.080 normalizing and just, you know, carrying
00:08:58.160 on and doing other things in life and
00:08:59.760 other stressors. Um, usually I see them
00:09:02.480 when they’re larger, to answer your
00:09:03.920 original question, because I’m a
00:09:05.200 surgeon. So patients are seeking me when
00:09:07.519 they’ve kind of failed every other
00:09:09.040 method, lifestyle modifications,
00:09:10.720 medications, nothing is really helping
00:09:12.320 to abate their symptoms. Um, but
00:09:14.399 hopefully most generalists are catching
00:09:16.560 them when they’re smaller.
00:09:18.240 >> Yeah, two, three centimeters.
00:09:20.000 >> I can imagine it would be, you know,
00:09:21.839 tough. You could miss it on a pelvic,
00:09:23.760 but not if it’s that big. You would feel
00:09:25.519 this hard mass. But I mean, women can
00:09:27.680 probably palpate themselves if they’re
00:09:30.080 feeling in their pelvic region. You
00:09:31.680 would feel like a hard mass, right?
00:09:33.279 >> Yeah. over 12 centimeters is probably
00:09:35.360 above the pubic brim we call it or that
00:09:38.800 hard bone by your bladder and that’s
00:09:40.880 usually when patients start to feel it
00:09:42.399 or they’ll see it in their side profile
00:09:44.399 when they put on a tight dress.
00:09:46.160 >> Yeah. Oh, that’s interesting. So, tell
00:09:48.240 me a little bit about like how are they
00:09:49.760 diagnosed? If a woman thinks she has a
00:09:51.279 fibroid, obviously she needs to make a
00:09:52.720 trip to her gynecologist, but are these
00:09:54.800 usually diagnosed via ultrasound or is
00:09:56.720 there more invasive?
00:09:58.480 >> So, more Yeah. The great thing about
00:10:01.040 fibroids as opposed to some things some
00:10:03.279 other ailments endo, right? You can’t
00:10:06.399 really see that on images. Fibroids
00:10:08.399 can’t really miss it on imaging. Those
00:10:10.800 will show up on ultrasound. Ultrasound’s
00:10:12.720 cheap and easy to do and most OB/GYNs do
00:10:15.600 it even in their office. Um, so it’s not
00:10:18.079 a difficult study. The problem,
00:10:20.240 unfortunately, is that sometimes it’s
00:10:21.839 just not done. But I encourage my
00:10:24.800 patients when I talk, when I do podcasts
00:10:26.800 like these and these platforms, it’s a
00:10:29.120 great opportunity to educate women that
00:10:30.800 if something feels different, just ask
00:10:32.399 for an ultrasound. It’s so simple.
00:10:34.320 >> Yeah. It’s not painful or, you know,
00:10:37.120 it’s just an easy procedure that usually
00:10:39.040 you like walk in the next room and then
00:10:40.560 they do it. It’s if you’ve ever been
00:10:41.920 pregnant, you’ve had them done before,
00:10:43.200 too. So,
00:10:44.240 >> um, pretty simple um, to pick to pick
00:10:47.519 that up or to ask for that. That’s
00:10:48.800 great. So, you talked about some other
00:10:51.200 things that are typically tried before
00:10:53.040 surgery. Can you kind of walk us through
00:10:55.120 what’s it what would be an optimal
00:10:57.200 situation? Like where would you start
00:10:58.480 with a woman who’s diagnosed with let’s
00:11:00.000 just say like a moderate size fibroid
00:11:01.600 that’s not needing surgery immediately.
00:11:04.079 >> Yeah. So, it’s all about the symptoms.
00:11:06.160 If I have patients that I find fibroids
00:11:08.399 in, which is not usually the case, but
00:11:10.399 maybe their generalist finds fibroids in
00:11:12.959 and they’re small and maybe their
00:11:14.959 symptoms are starting to change. I I
00:11:17.519 encourage to start with a lifestyle
00:11:18.800 modification. Start with things that
00:11:21.519 maybe can potentially slow down the
00:11:23.440 growth, halt the growth, or abate the
00:11:26.240 symptoms. Um especially if they haven’t
00:11:28.560 fulfilled their family making goals. If
00:11:31.200 they haven’t had their children yet,
00:11:33.120 maybe we can forego surgery or delay the
00:11:35.680 time and necessity to surgery so they
00:11:38.480 can have their babies first. or if they
00:11:40.560 do end up needing surgery, they’re
00:11:42.160 closer to when they would need their ba
00:11:44.640 when they would have their babies
00:11:46.160 because fibroids can come back. M. So,
00:11:48.480 usually I talk about, you know,
00:11:50.480 eliminating red meats, beef and pork,
00:11:53.760 eliminating processed foods that have a
00:11:56.000 lot of additives in it, eliminating
00:11:58.880 things like um a lot of soybased
00:12:02.000 products, which believe me, when I’m in
00:12:03.839 full menopause, on parmenopause, and
00:12:05.440 when I’m in full menopause, I’m eating
00:12:06.800 soy every day of my life because it has
00:12:09.279 a beautiful natural estrogen. But before
00:12:11.760 menopause, I tell my patients, your body
00:12:14.160 doesn’t need help. It doesn’t need you
00:12:16.160 to add what we call exogenous estrogen
00:12:18.639 to it.
00:12:19.920 >> Be conscious of the things you put on
00:12:21.440 your skin, your hair.
00:12:22.399 >> I was gonna ask about that.
00:12:24.240 >> Your hair products, you know, the
00:12:26.399 plastics and what we call hormone
00:12:28.959 disruptors that are just in our natural
00:12:30.959 environment, pesticides, like those
00:12:33.519 things our bodies as women as as human
00:12:35.760 beings are sensitive to. I’m so glad to
00:12:37.920 hear you talk about that like as a
00:12:39.360 conventionally trained gynecologist
00:12:41.680 because it’s something that the data is
00:12:43.839 pretty astounding. I mean, it’s early.
00:12:46.079 In fact, the first studies on BPA and
00:12:48.880 fertility were only like 15 years ago.
00:12:51.519 It’s like really very new with
00:12:53.440 literature. But there’s so much out
00:12:55.600 there that gets released into the
00:12:57.600 environment before it really is tested
00:12:59.920 or it was used 20 30 years ago before we
00:13:03.360 realized it was so toxic and it’s just
00:13:05.519 lingering, you know, but it’s such a big
00:13:07.279 problem for women. I think about that
00:13:08.560 with fibroids and endometriosis and
00:13:11.680 these estrogen driven conditions. I
00:13:14.079 mean, there’s many other problems with
00:13:15.360 them as well, but you know, it’s just
00:13:17.440 it’s it confounds the issue and it can
00:13:19.600 be so hard to avoid. Absolutely true.
00:13:22.000 >> Great. So, you’re starting with kind of
00:13:23.279 cleaning up the body. What is there any
00:13:24.959 kind of other than avoiding red meat?
00:13:27.040 Anything that we can do to like improve
00:13:29.040 estrogen clearance or do you think about
00:13:30.560 that at all? I mean, at Dutch, we always
00:13:32.320 look at like estrogen metabolism because
00:13:33.920 a lot of metabolites actually are very
00:13:36.079 potent as well. And we this hasn’t we
00:13:38.320 haven’t published this data but we’ve
00:13:39.519 seen trends where um and I don’t think
00:13:41.839 there’s any studies that I’ve come
00:13:42.959 across but women who have fibroids tend
00:13:45.120 to have a higher metabolism pathway
00:13:47.600 through the 16 hydroxy estrogen pathway
00:13:50.160 which is just very estrogenic. We just
00:13:51.839 see a lot with fibroids and
00:13:53.600 endometriosis interestingly.
00:13:55.600 >> Yeah. So it’s great that they’re doing
00:13:58.480 more in the research. They’re publishing
00:14:00.639 more to look at that specifically
00:14:02.000 because these are the questions my
00:14:03.120 patients ask me all the time. Where do
00:14:05.519 patients where do fibroids come from?
00:14:07.279 Especially after we do surgery. How can
00:14:08.639 I prevent?
00:14:09.279 >> Yeah. Why me? Right.
00:14:10.160 >> Why me? And how could I not have to do
00:14:12.480 this again? That was my big question
00:14:13.760 with fibroids. 10 years after my first
00:14:17.120 fibroid surgery before they started to
00:14:18.959 bother me again, which is remarkable. A
00:14:21.360 lot of patients might not make it past
00:14:22.800 three or five years before another
00:14:24.720 recurrence. So, I’m so excited about
00:14:26.639 that type of research. I actually
00:14:27.920 partner with a lot of naturopaths and
00:14:29.920 holistic doctors in my community
00:14:33.040 specifically to make sure that my
00:14:34.560 patients are aligned with someone that
00:14:36.240 can look at the their like levels, their
00:14:38.800 toxins, look at their liver function,
00:14:41.120 look at their stress level, look at
00:14:42.399 their cortisol. All of those things
00:14:44.560 which are factors that we know
00:14:46.639 potentiate fibroid growth, but also
00:14:48.880 potentially can help prevent recurrence
00:14:51.920 for those patients who may have had to
00:14:53.600 have surgery. I tell patients, you know,
00:14:56.320 when you come see me, it’s a little bit
00:14:58.959 of a marriage. Even though most of my
00:15:00.560 patients, it’s a high turnaround. I
00:15:02.160 might only be their best friends for 3
00:15:04.079 to six months, but I don’t want them to
00:15:06.240 ever forget this part of their journey
00:15:08.320 because we don’t want to be here again.
00:15:10.720 I don’t need you to come back and have
00:15:12.320 surgery with me again in five years. I’d
00:15:14.160 rather
00:15:14.399 >> they’re like, I like you very much, but
00:15:15.920 I hope I never have to see you again.
00:15:17.839 >> Right. So, so understanding everything
00:15:21.600 that you just spoke to, how to clear it,
00:15:24.480 how to balance their hormones, the root
00:15:27.120 causes is extremely important.
00:15:29.519 >> Yeah, it’s so I’m glad to hear that you
00:15:31.120 partner because I think there is just
00:15:32.160 such a there is such a great marriage
00:15:33.920 between kind of that conventional
00:15:35.600 surgical option and natural options and
00:15:37.279 a lot of patients need that support,
00:15:39.440 that kind of coaching even through those
00:15:42.000 lifestyle changes so they can be
00:15:43.360 successful uh in hopes to never have to
00:15:45.839 go back into your office door.
00:15:47.440 >> Yeah. So um tell me a little bit about
00:15:49.680 if lifestyle factors aren’t enough do
00:15:52.000 they typically try with a medication
00:15:53.839 option like a tmoxifen or some kind of
00:15:55.759 anti-estrogen medication. So we try
00:15:58.720 anti-estrogens that are G&R antagonist
00:16:01.759 or agonist. We have both in the um in
00:16:05.040 our armamentarium now. So there are
00:16:07.279 medications like simple birth controls
00:16:09.920 that some generalists will try first and
00:16:12.480 that’s more about the symptomatology
00:16:14.399 trying to decrease the heavy bleeding or
00:16:16.399 the pain if it is associated with their
00:16:18.160 bleeding and that’s only because when
00:16:20.240 they’re given that once a day birth
00:16:22.160 control is keeping their hormone levels
00:16:24.240 kind of balanced steady. It’s not really
00:16:26.399 decreasing their estrogen. It won’t
00:16:28.240 shrink their fibroids, not make them
00:16:29.839 disappear overnight. It’s only kind of
00:16:33.120 helping the symptoms. um little bit of a
00:16:35.839 band-aid as fibroids grow. So that can
00:16:38.079 be helpful in smaller fibroids. From a
00:16:40.480 lifestyle perspective, it’s important
00:16:42.079 that we meet our patients where they
00:16:43.519 are. If their most bothersome symptom
00:16:45.199 are their symptoms, not necessarily your
00:16:47.279 fibroid himself, I’d love to be able to
00:16:49.839 say, "Look, these are things that might
00:16:52.320 give you immediate help with your next
00:16:54.079 cycle, right?" But from a more specific
00:16:58.000 standpoint, the G&RH analoges um are
00:17:01.519 actually going to help decrease their
00:17:02.880 body’s natural estrogen that they make
00:17:04.720 from their ovaries. And that does help
00:17:07.199 with fibroid symptoms and it could even
00:17:09.119 shrink fibroids, but temporarily, only
00:17:11.280 while they’re taking the medicine, and
00:17:12.720 you cannot take those medicines forever.
00:17:15.280 >> Okay. Is there an approach where they
00:17:16.880 try to like shrink tumors before
00:17:18.319 starting surgery as well?
00:17:20.400 >> It depends on the surgeon. So, I don’t
00:17:22.880 do that often because I like them big
00:17:24.799 and bad. No, I’m just kidding. I don’t
00:17:27.359 mind them big and bad because I do
00:17:28.799 complex surgeries. So, to be honest with
00:17:30.960 you, I try to avoid medications in my
00:17:33.679 patients because those medications also
00:17:36.000 come with side effects. Um, only in the
00:17:38.559 most severe cases and my shrinking
00:17:40.480 fibroids. But in a rural area where your
00:17:43.120 generalist is doing the surgery and they
00:17:45.039 feel like they need a little bit of help
00:17:46.640 or room, they may put a patient on a
00:17:50.240 Lupron or Alyssa or My Fimbri or
00:17:52.160 something to try to get some shrinkage
00:17:53.760 before. I like my fibroids virgin. Like
00:17:57.440 I like them untouched. Um because
00:17:59.840 sometimes those medications can alter
00:18:01.600 the cellular like how it feels. It
00:18:03.919 softens it. Um but again, symptoms
00:18:07.280 matter. So, I’m not going to make my
00:18:08.640 patients suffer to make my surgery uh
00:18:11.200 harder or easier. It really, really
00:18:13.679 depends on what they look like. I have
00:18:15.760 patients that are like, "I’m in grad
00:18:18.000 school. I can’t do surgery right now.
00:18:20.400 Maybe in two years. Help me get through
00:18:22.240 the next two years." And those
00:18:23.919 medications are beautiful to help in
00:18:25.600 that process because they decrease that
00:18:27.440 estrogen for them.
00:18:29.280 >> Okay. Now, are there any like seasonal
00:18:32.000 changes or other lifestyle things that
00:18:34.480 you see that really flare fibroids?
00:18:37.120 Yeah. Number one, stress.
00:18:39.120 >> Okay.
00:18:39.919 >> Stress, stress, stress. That cortisol
00:18:42.880 factor is um you know, the research is
00:18:46.480 amazing in showing how much that
00:18:48.559 contributes to fibroids. We know it’s
00:18:51.120 lifestyle. It’s the things that we eat
00:18:52.960 and put on our skin. It’s vitamin D
00:18:54.799 deficiency and it’s stress. Stress is an
00:18:57.840 important portion of that. Um, and
00:19:01.440 seasonally we I think that patients if
00:19:04.400 you know over time are most symptomatic
00:19:06.960 times like now in these hot months
00:19:10.160 when their body is actually being trled
00:19:12.240 and tested and dehydrated and they’re
00:19:14.960 eating more salty foods at barbecues and
00:19:18.240 >> drinking more, drinking more, all of the
00:19:21.039 above. They’re living in summertime and
00:19:24.240 their symptoms flare to boot because we
00:19:27.039 know that these are attached to um you
00:19:30.160 know how we live unfortunately.
00:19:32.720 But I think the the biggest one to
00:19:34.960 answer your question is stress.
00:19:36.960 >> It’s so interesting because I think and
00:19:38.720 even me personally like you hear this
00:19:40.400 all the time how stress influences most
00:19:43.440 conditions. It’s kind of hard to take
00:19:45.120 that in and like I I wonder if patients
00:19:47.280 really believe it. It’s like now that
00:19:49.280 there’s so much data mounting, it’s
00:19:51.440 something that I think is hard for
00:19:52.720 patients to absorb or do something
00:19:55.120 about. Do you resonate with that?
00:19:56.960 >> Yeah, absolutely. And it’s almost like
00:19:58.720 you have to show it to like you have to
00:19:59.919 prove it to them.
00:20:00.640 >> Yeah.
00:20:01.440 >> And I’ll even be like, well, think about
00:20:03.039 the times of,
00:20:06.000 let’s be frank, co I saw the highest
00:20:09.760 surge in fibroid growth in my patients
00:20:11.760 in CO.
00:20:12.480 >> Really?
00:20:13.360 >> And a part of that may have been the
00:20:15.200 fact that I had to pause my surgeries.
00:20:17.520 is I I was limited on what I could do
00:20:19.919 for them. We used a lot more medications
00:20:22.720 >> um to abate symptoms because just
00:20:24.240 because CO was happening didn’t mean
00:20:25.760 fibroids weren’t growing and people
00:20:26.960 weren’t hemorrhaging, right? So, we
00:20:28.799 still had to treat these patients. But
00:20:30.240 when they came back for their surgery,
00:20:32.880 I’m like I’m talking serious growth of
00:20:35.039 those fibroids and that was a very
00:20:36.799 stressful point for us in humanity
00:20:39.280 period, all of us, right? um I saw very
00:20:42.480 rapid growth and a lot of that uh could
00:20:45.840 um have a lot to do with that very
00:20:47.760 stressful time. So patients a lot of
00:20:50.559 times will even tell me look I’m I have
00:20:52.960 a stressful job or I’ve noticed that my
00:20:55.120 symptoms were it’s worse when I was
00:20:57.520 dealing with that manager. It can be so
00:20:59.760 specific sometimes you almost have to
00:21:01.200 prove it to them that that’s a factor.
00:21:03.120 >> That’s so fascinating but it makes a lot
00:21:04.880 of sense. And with COVID in particular,
00:21:06.799 I mean, if you were married, you were
00:21:08.720 with your spouse all the time without a
00:21:10.320 break. If you were have children, you’re
00:21:11.919 with your kids all the time, you’re
00:21:12.960 working from home trying to get that
00:21:14.720 juggle. I mean, that was a stressful
00:21:16.320 time for all of us. It’s interesting
00:21:17.760 that you saw a change in your patients
00:21:20.400 during that time as well with the
00:21:22.000 severity of fibroids, which is such a
00:21:23.760 like you think of it as like a physical
00:21:25.600 mechanical illness versus something that
00:21:29.120 is like a hormone balance. It’s a little
00:21:30.960 bit more fluctuating.
00:21:32.720 >> Yeah. Yeah.
00:21:34.799 You mentioned hydration as well. Is that
00:21:37.039 an important factor with fibroids?
00:21:39.760 >> It is. It’s an important factor. I think
00:21:41.840 not just with fibroids, but just overall
00:21:44.960 the cellular health of how our body is.
00:21:47.840 I I feel like it was like the first
00:21:49.360 lesson we were taught on first day of
00:21:50.880 medical school, right? Is that our body,
00:21:52.799 majority of our body is water and we
00:21:55.120 kind of need water to survive. And you
00:21:56.960 you watch those survivor shows, they can
00:21:58.799 go a long time without food. They cannot
00:22:01.520 go a long time without water. that’ll
00:22:03.360 that’ll take them out. And it the same
00:22:05.520 is in for the factors especially for our
00:22:07.840 female organs. When you think about the
00:22:11.039 blood loss that we have during that time
00:22:13.679 of month, every month the anemia that
00:22:15.840 can come with it. Um dehydration will
00:22:18.559 definitely potentiate the symptomatology
00:22:20.640 and that discomfort, cramping even, you
00:22:24.000 know, it makes a difference when
00:22:25.600 patients in these summer months are not
00:22:27.280 well hydrated.
00:22:31.280 We’ll be right back with more from the
00:22:33.039 Dutch Podcast.
00:22:36.240 Here on the Dutch Podcast, we talk a lot
00:22:38.559 about hormone health. And if you’re new
00:22:40.480 here, you might be wondering what Dutch
00:22:42.640 even stands for. It’s an acronym for
00:22:45.200 dried urine test for comprehensive
00:22:47.120 hormones. And it’s the cornerstone of
00:22:49.200 what we do at Precision Analytical.
00:22:51.200 We’re a clinical lab founded by hormone
00:22:53.360 experts. And we created the Dutch test
00:22:55.440 to give providers the most accurate,
00:22:58.159 actionable insight into their patients
00:23:00.559 hormonal health. Whether you’re a
00:23:02.320 practitioner or a patient looking to
00:23:04.240 better understand your own body, the
00:23:06.080 Dutch Test can help you uncover what’s
00:23:08.240 really going on so you can take the next
00:23:10.320 step forward. Explore more at
00:23:12.240 duttest.com.
00:23:15.280 Welcome back to the Dutch podcast. I
00:23:17.840 want to also shift gears because you
00:23:19.200 mentioned fertility as like a big maybe
00:23:21.039 a big reason why women seek care or when
00:23:22.720 they get diagnosed with fibroids. Can
00:23:24.799 you talk a little bit more about the
00:23:25.919 connection with fibroids and fertility?
00:23:29.039 >> Absolutely.
00:23:29.919 >> I’ve done a lot in fertility and it’s a
00:23:31.280 little bit controversial. I mean, some
00:23:32.720 fibroids can affect fertility, but I
00:23:34.559 think women also maybe overindex the
00:23:36.880 role of a fibroid in their infertility.
00:23:38.480 I just want to hear your perspective on
00:23:39.679 this.
00:23:40.080 >> Thank you for starting there because I
00:23:41.440 always start there. I always start with
00:23:43.280 hope, right? I always start with the
00:23:46.159 fact that many women are actually
00:23:47.840 diagnosed with their fibroids when they
00:23:50.240 get their pregnancy ultrasound. They
00:23:51.840 didn’t even know it was there. Yeah.
00:23:53.679 Because that might be the first
00:23:54.720 ultrasound they’ve ever had as a woman.
00:23:56.559 >> They’re like, "This is a giant baby. The
00:23:58.320 baby’s
00:23:59.360 >> right. What’s going on in there?"
00:24:01.039 >> But they were they’re pregnant, right?
00:24:02.960 And they a lot of successful pregnancies
00:24:05.520 with fibroids.
00:24:07.039 >> The hard part about that is predicting
00:24:09.520 it. You really cannot predict how the
00:24:12.159 fibroid will behave in pregnancy. Will
00:24:14.799 it grow? Will it be painful? Will it
00:24:17.679 cause them to need a cescareian section
00:24:19.360 or not be able to deliver vaginally
00:24:21.279 successful? But I always start with hope
00:24:23.679 because you can get pregnant with
00:24:25.279 fibroids. A lot of the rate limiting
00:24:27.919 factor is where it’s located. So
00:24:29.679 fibroids that are closer to the cavity,
00:24:31.919 what we call sub mucosal in their
00:24:33.440 location and interfere with the space
00:24:35.600 where we naturally menrate, but also
00:24:37.360 that same space in the middle of the
00:24:38.960 cavity is where the baby grows. If
00:24:41.200 there’s a fibroid pressing in on it,
00:24:43.520 it’s hard for the baby to attach and
00:24:45.200 then it’s hard for it to grow without
00:24:46.799 getting knocked off. So fibroids in that
00:24:48.720 location, increased risk of miscarriage,
00:24:51.039 increased risk of preterm delivery,
00:24:52.640 increased risk of preeie babies,
00:24:54.480 obviously increased risk of hemorrhage
00:24:56.559 at the time of delivery. We don’t like
00:24:58.799 them there.
00:24:59.919 >> But fibroids in other locations in the
00:25:02.240 muscle, some patients are not even don’t
00:25:06.320 know what’s there. Those fibroids
00:25:08.320 usually do not cause problems with
00:25:10.159 pregnancy. So, it really depends. But I
00:25:12.880 always tell patients, start from a place
00:25:14.159 of hope. Don’t think that the diagnosis
00:25:16.320 of fibroids is the end of your, you
00:25:19.120 know, your your desired motherhood or
00:25:21.360 family planning. Um, a lot can be done
00:25:23.840 and if patients need them removed, I
00:25:25.360 remove a lot of fibroids from fertility.
00:25:27.679 uh sake for fertility sake just to get
00:25:29.679 them out of the way.
00:25:31.039 >> So the fibroids it might be good to kind
00:25:32.880 of dive in a little bit to the locations
00:25:35.919 for fibroids because you mentioned this
00:25:37.200 slightly but there’s different layers of
00:25:38.480 the uterus and your fibroid can be in
00:25:41.039 the muscle layer. It can be closer to
00:25:42.880 the endometrial layer. Um you know
00:25:45.600 there’s and that will impact probably
00:25:48.080 impact the lining as well like the
00:25:49.760 health of the lining or inflammation in
00:25:51.440 the lining of your uterus.
00:25:53.120 >> Absolutely. So we generally break up
00:25:55.840 fibers into three locations. It can
00:25:58.559 either be in the lining of the uterus
00:26:00.159 which is what we just mentioned that sub
00:26:01.919 mucosal space and that usually causes
00:26:04.080 heavier bleeding. That’s usually the
00:26:06.000 space that can cause problems with pain
00:26:08.720 from cramping and clots forming that
00:26:11.679 push put like pressure on the muscles of
00:26:14.080 the uterus and usually is the space that
00:26:16.400 impacts fertility the most and even like
00:26:19.039 you said inflammation because it’s it’s
00:26:21.039 a foreign body. I tell patients one of
00:26:22.960 the problem problems with fertility is
00:26:24.720 it’s a natural IUD in that space like
00:26:26.960 you the sperm the egg they just they’re
00:26:28.799 confused. They can’t meet when something
00:26:30.400 is in the way. Um but some of my
00:26:32.880 patients will have more discharge even
00:26:35.039 like this yellowish clear non odorous
00:26:38.159 discharge. They think it’s urine but it
00:26:40.000 doesn’t smell like urine. That’s when
00:26:41.520 they’re in the lining. And the muscle is
00:26:44.000 the place where fibroids can live and
00:26:46.080 grow and you’re none the wiser um if
00:26:48.799 they’re not pushing on the inside or
00:26:50.400 outside. That’s the in in the um excuse
00:26:52.880 me intramural fibroids in the muscle in
00:26:55.919 between the cavity and the skin and
00:26:58.080 subscorerosal is on the skin towards the
00:27:00.320 outside. So those patients if it’s just
00:27:02.320 there usually will have more bulk
00:27:04.159 symptoms. They’ll see it first and that
00:27:06.000 that body contrast or they’ll feel it or
00:27:08.960 they’ll have more discomfort with
00:27:10.159 intercourse if it’s close to their
00:27:11.679 cervix. It’ll mess with intimacy or they
00:27:14.720 may have more pressure on their bladder
00:27:16.080 and they have more urgency. I got to go
00:27:17.919 to the bathroom all the time or
00:27:19.520 constipation or back pain if it’s
00:27:21.120 pressing more towards their rectum or
00:27:22.720 their spine. So, the location means
00:27:25.600 everything. It tells the story honestly.
00:27:28.960 >> It’s so interesting because yeah, it’s
00:27:30.480 like the type of presentation that women
00:27:32.400 have, you know, really can impact the
00:27:35.039 symptom picture that they show up with.
00:27:37.360 So with surgery, if women if a woman’s
00:27:40.640 trying to get pregnant or she has it in
00:27:42.320 her plan to get pregnant, let’s say in
00:27:43.679 the next year, what’s the recovery time
00:27:46.000 from surgery between when you’d say like
00:27:48.480 really this needs to heal or when you
00:27:50.320 see that fertility is impacted due to
00:27:52.320 just recovery from a surgery?
00:27:54.159 >> Yeah, generally speaking, it depends on
00:27:55.760 the surgery. So as a minimally invasive
00:27:58.159 surgeon, I’m always going to be trying
00:27:59.520 to do the least to get the most for my
00:28:02.000 patients. So now with the newest
00:28:04.240 technologies, we can shrink fibroids. we
00:28:06.240 don’t even have to cut them out anymore
00:28:08.080 depending on their size and location and
00:28:10.000 number of course
00:28:11.600 >> but if they’re a candidate for those
00:28:13.120 shrinkage procedures um which we call
00:28:15.200 radio frequency ablation some of them
00:28:16.799 can even be done through the cervix and
00:28:18.399 if that’s the case they they’re back to
00:28:20.240 work in three days yeah and if we do it
00:28:23.039 laparoscopically they’re back to work in
00:28:24.720 a week and taking motin to recover and
00:28:27.360 we usually would say wait about 3 months
00:28:29.039 for fertility in that case three to four
00:28:31.440 months depending on the location of the
00:28:32.720 fibroids if we have to cut them out
00:28:34.880 that’s called tradition ally a
00:28:36.399 myomectomy and depending on how thick we
00:28:39.520 cut into that muscle again getting
00:28:42.240 closer to the cavity those patients
00:28:44.640 usually wait six months I had to wait
00:28:46.240 six months before I tried for pregnancy
00:28:47.919 after myomectomy and that’s pretty
00:28:50.080 standard across the board and that’s
00:28:51.840 just to give that muscle time to heal
00:28:53.919 that area now is just I tell my patients
00:28:56.399 weaker than how God made it because my
00:28:58.159 sutures have to get strong and heal and
00:29:01.120 then it can start to stretch very slowly
00:29:03.440 and if it’s that deep they usually need
00:29:05.600 a C-section for just for babies. I had
00:29:07.840 two for my sons.
00:29:09.760 >> You think about Yeah. The muscle of the
00:29:11.840 uterus has to end up holding
00:29:13.600 >> Yeah.
00:29:14.000 >> your six to 10 pound
00:29:16.320 >> correct
00:29:16.720 >> baby in your inside. So definitely want
00:29:19.039 to make sure it’s healthy and strong so
00:29:20.480 you don’t have any kind of complication.
00:29:22.080 Um do you recommend any kind of hormone
00:29:24.000 testing for women when they are going
00:29:26.960 through, you know, when they’re kind of
00:29:28.799 getting ready or when they’re trying to
00:29:29.919 figure out what’s going on or why they
00:29:31.120 have a fibroid?
00:29:32.240 >> Sure. It depends on where they are in
00:29:34.399 their journey. If I can again catch them
00:29:36.960 earlier in their journey and they’re not
00:29:38.559 just focused on just give me some
00:29:40.640 relief. Um, and knowing what their level
00:29:44.080 and and again even after surgery is
00:29:46.640 still important because their uterus is
00:29:48.559 still there. If they haven’t chosen to
00:29:49.679 have a hyerectomy and their uterus is
00:29:51.120 still there, it’s important after
00:29:52.720 surgery to I think that it makes the
00:29:54.640 most sense then because then patients do
00:29:57.200 want to find out a bit more about their
00:29:58.960 estrogen versus progesterone imbalance
00:30:01.600 if they’re more dominant. You know, some
00:30:03.679 of these patients have other ailments
00:30:05.200 like endometriosis or PCOS, which it
00:30:08.159 also is very hormonally driven. Um, and
00:30:11.039 then like I said, that’s when I partner
00:30:12.640 with a lot of my um, if if their primary
00:30:16.240 gyn does it them, but most of the time
00:30:19.039 we’re partnering with naturopaths and
00:30:21.120 holistic doctors. Um, a lot of them are
00:30:24.080 OBGYNS too, right? or family medicine
00:30:27.120 physicians that will do those very um uh
00:30:31.200 comprehensive panels like your panel
00:30:32.799 like the Dutch test that will give them
00:30:35.120 a good insight into their hormones,
00:30:37.840 their liver function, what is what are
00:30:39.679 their what is their adrenal gland doing?
00:30:41.679 How much is their body working?
00:30:43.600 >> I don’t want to say against them but but
00:30:45.679 really what is the reality of their
00:30:47.520 picture of health, right? not their
00:30:48.960 cousins or their aunties but their
00:30:50.399 picture of health that can help guide
00:30:53.440 basic things like lifestyle
00:30:55.279 modifications where we started this
00:30:57.039 conversation.
00:30:58.559 >> You know, one thing that you said I like
00:31:00.159 want to dive into because when you said
00:31:01.600 like working against us and it’s our
00:31:03.440 bodies working against us and I think
00:31:04.480 that’s such a common
00:31:06.799 thought for women that when they come in
00:31:08.320 and something like this is happening, it
00:31:10.159 can be so frustrating. You can feel
00:31:11.520 almost like disappointed or let down.
00:31:13.520 But I want to just reframe that because
00:31:15.679 and I think this is like such an
00:31:16.960 important thing to think about. Our body
00:31:18.399 is like immediately brilliant. I mean if
00:31:20.559 you get a cut within day it like stops
00:31:22.799 the bleeding in minutes and then like
00:31:24.480 it’s gone, right? We are basically like
00:31:26.640 Wolverine on X-Men and we can heal just
00:31:29.120 not as fast as he can, right? So um I
00:31:31.840 just think it’s amazing that our bodies
00:31:33.600 are so innately smart. And I think about
00:31:35.360 that with a lot of the conditions that
00:31:38.159 people deal with. Even things like type
00:31:39.600 two diabetes is so prevalent. We’re
00:31:41.440 going to get off topic here. Um but it
00:31:43.840 that is an adaptation response right
00:31:45.840 that happens because our body is trying
00:31:47.840 to work with the situation that it’s in
00:31:50.159 you know where your blood sugar is high
00:31:51.840 it has to release more insulin and then
00:31:53.600 over time the cells are just covering
00:31:56.000 their ears because the insulin’s
00:31:57.200 screaming but that my point is that
00:31:59.039 that’s like a good thing happening
00:32:00.640 within our body we would have more
00:32:02.240 problems if we didn’t develop type two
00:32:04.559 diabetes and I mean I think about that
00:32:06.880 as well with hormone balance let me just
00:32:08.480 bring it back now um because I do think
00:32:11.679 that women can feel so
00:32:14.320 frustrated that things are not going the
00:32:16.480 way they want. And I it’s really hard,
00:32:18.799 but I do try to like reframe that that
00:32:21.120 you know our body is adapting. Maybe
00:32:22.480 it’s to exogenous estrogens in our
00:32:24.720 environment. Maybe it’s to the stress
00:32:26.240 level that we have. But all the things
00:32:28.080 that are happening within us are
00:32:29.840 happening for us, not against us. We
00:32:31.600 just have to figure out how to like
00:32:33.039 remove those barriers to allow our body
00:32:35.600 to be a little bit more in line with
00:32:38.399 what we would like.
00:32:39.840 >> Yeah. Yeah. I love that. I I always tell
00:32:42.640 patients, our estrogen is what makes us
00:32:46.320 beautifully and uniquely women.
00:32:48.640 >> Yes.
00:32:49.039 >> It’s what protects us from heart
00:32:50.399 attacks. It’s what fortifies our bones.
00:32:52.640 It’s what allows us to, you know, have
00:32:55.600 all of our our curves and our sex appeal
00:32:57.919 and bring beautiful human beings into
00:33:00.320 the world. Um, but it it also is a very
00:33:02.960 delicate thing that we do have to pay
00:33:04.880 attention to. We can’t um deny nor can
00:33:08.399 we um can we what’s the right word for
00:33:11.840 neglect,
00:33:12.720 >> right? That’s a good way to put it.
00:33:14.320 Yeah. Yeah. Estrogen is so interesting
00:33:16.240 because I think culturally I see this at
00:33:18.960 least like online everyone talks about
00:33:21.200 progesterone and progesterone I call it
00:33:23.200 like the princess hormone. Progesterone
00:33:25.600 is like the one wearing the crown. It
00:33:27.039 gets all the accolades.
00:33:28.320 >> No.
00:33:29.120 >> Estrogen gets maligned. But it’s really
00:33:31.679 interesting and I think there’s a lot of
00:33:33.039 reasons for that because we’ve talked
00:33:34.159 about its connection with breast cancer,
00:33:36.320 with fibroids, with endometriosis, but
00:33:38.880 it’s also kind of like the Beyonce of
00:33:40.399 hormones. Like it is what makes us
00:33:42.240 female. It’s what it’s what’s amazing
00:33:44.080 about us. And it I like that you
00:33:45.919 mentioned like cardiovascular protection
00:33:47.679 because I think the WHI when that came
00:33:49.919 out around menopausal hormone
00:33:51.279 replacement, estrogen got very much
00:33:53.440 tagged with being problematic. But we
00:33:56.399 know now that we’ve done more
00:33:57.919 literature, more studies that actually
00:34:00.080 that’s not the case. And it was probably
00:34:01.440 progesterrogens are the problem which
00:34:02.880 are synthetic progesterone. But estrogen
00:34:04.880 is actually still very protective for
00:34:06.640 most women as long as it’s continuous.
00:34:08.399 But yeah, I mean do patients come in
00:34:10.480 upset about estrogen. There’s I think I
00:34:13.199 think we need a cultural shift around
00:34:14.560 estrogen.
00:34:15.520 >> They do. They do. They do. But this
00:34:17.599 estrogen is a beautiful thing.
00:34:19.440 >> It is. It’s like we’re so thankful for
00:34:21.520 all the things that it does. Look at
00:34:23.040 like the healthy skin, healthy heart,
00:34:25.839 you know, the fact that we have a
00:34:26.879 menstrual cycle and we can
00:34:28.719 >> grow children. I mean, it’s absolutely
00:34:30.800 amazing. Thank you, ovaries.
00:34:34.320 >> Um, I want to understand a little bit
00:34:36.560 more about the type of surgery that you
00:34:38.560 do, the minimally invasive surgery,
00:34:39.918 because I think that’s a huge
00:34:42.399 huge improvement in what’s happened
00:34:44.639 medically over the last 20 20 years. Is
00:34:46.800 it even 20 years? How long has this been
00:34:48.320 around? We’ve always been trying to
00:34:49.599 improve it, but
00:34:50.639 >> yeah, about that long because I feel
00:34:53.199 like I did my training on the cusp when
00:34:56.879 things were starting to shift because I
00:34:58.880 had open procedure,
00:35:00.480 >> but if I would go to the same surgeon,
00:35:02.480 he’s since retired, but if I had gone to
00:35:04.240 him even five years later, he would have
00:35:07.440 done my surgery robotically because
00:35:08.880 that’s what he taught me to do. I
00:35:10.160 actually went back to a surgeon who did
00:35:12.000 my surgery and did my minimally invasive
00:35:14.000 fellowship and training um because he
00:35:16.240 was one of the best in the country.
00:35:17.839 That’s awesome.
00:35:18.640 >> And in that short period of time,
00:35:21.440 robotics really took off. So, I was
00:35:24.400 trained at a time where I’m a robotic
00:35:26.640 surgeon, but I’m also a laparoscopic
00:35:28.480 surgeon. I’m also a vaginal surgeon. I’m
00:35:30.560 also a reconstructive surgeon. And I’m
00:35:32.960 so grateful for that opportunity to to
00:35:35.119 to learn all of these, you know, ways to
00:35:38.560 do surgery for the women that I take
00:35:40.160 care of. But I was very blessed to just
00:35:42.560 come at the right time in my training.
00:35:45.440 Um, and now we have, like I said, radio
00:35:48.400 frequency ablation. And I go across, you
00:35:52.000 know, the US and teach other doctors to
00:35:54.079 do it. I was the first in the Southeast
00:35:55.599 to do it. And I’ve done over 300
00:35:57.119 procedures only because I was not afraid
00:36:00.320 of bringing, you know, something new to
00:36:03.200 the fold, which is, you know, the beauty
00:36:05.200 of medicine, the beauty of research, the
00:36:06.960 beauty of innovation is not being afraid
00:36:09.440 to take that leap into what we know for
00:36:12.000 our patients could enhance and improve
00:36:14.160 their options. and their, you know,
00:36:16.000 survivability, their what we call
00:36:17.839 mobility and mortality. And so the
00:36:21.440 technology has advanced significantly.
00:36:23.359 Minimally invasive surgery,
00:36:25.920 um, is a subsp specialty. And I I pray
00:36:28.880 that more women learn about it and learn
00:36:32.079 that they have more options outside of
00:36:35.040 just a hyerectomy or more options
00:36:37.200 outside of being cut open. It’s kind
00:36:39.760 that’s very old school now. You don’t
00:36:41.599 always have to take that route.
00:36:43.680 Sometimes we still have to do it but but
00:36:45.599 a lot of times um there are many many
00:36:47.680 more options out there to to offer
00:36:50.160 patients.
00:36:51.119 >> Can you share more about the radio
00:36:52.560 frequency ablation? Like how does that
00:36:54.240 process work?
00:36:55.440 >> Yeah. So radio frequency ablation is
00:36:57.520 done there’s two ways to do it. Um you
00:37:00.320 can either do through the cervix or you
00:37:02.000 can do it laparoscopically meaning
00:37:04.000 through very very small incisions in the
00:37:06.079 belly about the size of my pinky nail
00:37:08.000 across. Um, and we put in essentially
00:37:10.640 with that both actually usually a camera
00:37:12.880 to take a look and see what’s going on,
00:37:14.800 but more importantly a ultrasound in
00:37:17.119 real time to see where the fibroids are.
00:37:19.680 And then we put a needle into each
00:37:21.520 fibroid one by one, heat it up with
00:37:24.079 radio frequency energy um, and it’s
00:37:26.800 heat. So we’re not destroying all of the
00:37:29.040 vessels. We’re not stopping blood flow
00:37:30.640 to the uterus or the fibroids. That heat
00:37:33.119 is actually going to kill the same the
00:37:35.119 cells to a sustained death so that they
00:37:37.280 can shrink and they cannot regrow
00:37:39.839 because they’re dead. And with that, we
00:37:42.880 haven’t cut anything. We haven’t stolen
00:37:45.280 any blood supply. We haven’t actually
00:37:48.079 like interfered with the architecture of
00:37:50.320 the overall uterus. And that’s the
00:37:52.320 beauty of that growth in technology. So
00:37:55.200 those patients heal faster usually with
00:37:57.520 Motrin. They go home the same day.
00:37:59.359 they’re back to working um you know two
00:38:01.599 times f three times faster than they
00:38:03.440 would if I did even a traditional
00:38:05.040 laparoscopic myomectomy
00:38:07.359 um and um they still are maintaining
00:38:10.079 their uterus and their ability to uh
00:38:12.560 potentially even have children um and
00:38:15.119 potentially even have vaginal
00:38:16.560 deliveries. Remember earlier I was
00:38:17.839 telling you a lot of myctomies have
00:38:19.359 c-sections. So the beauty in that radio
00:38:22.880 frequency approach is it is again an
00:38:25.440 even less invasive way to take care of
00:38:28.240 fibroids if the patient is a candidate
00:38:30.160 for it. But that shrinkage
00:38:32.640 I think I think that’s going to be um
00:38:35.440 what turns around
00:38:38.000 how patients have to live with their
00:38:39.760 fibroids because now we can get to it
00:38:41.520 earlier with a very minimally invasive
00:38:44.160 approach. And I want us to eventually at
00:38:46.800 some point start to treat fibroids more
00:38:48.400 of not a preventative disease, but maybe
00:38:50.720 we can prevent it from becoming super
00:38:52.720 distressful for women
00:38:53.920 >> or more Yeah. more proactively. I mean,
00:38:55.599 I think that probably most physicians
00:38:58.880 struggle with, you know, how disrupted a
00:39:02.400 patient’s life is by their fibroid
00:39:04.240 versus the invasive and cost of a
00:39:07.760 >> and I’m sure insurance dictates that too
00:39:09.200 of like when can you intervene
00:39:10.560 surgically. So with a less expensive,
00:39:13.040 less invasive option, hopefully that
00:39:15.200 allows you and it sounds like you can
00:39:16.400 treat multiple fibroids as well
00:39:18.240 >> with that procedure that it allows you
00:39:19.839 to
00:39:20.880 >> intervene sooner before it’s as
00:39:22.800 impactful.
00:39:23.760 >> Yep. That’s the goal.
00:39:25.680 >> So when you do that, basically the
00:39:27.599 fibroid’s left intact when you leave,
00:39:29.440 but then the body goes in and remodels.
00:39:31.440 Is that what happens?
00:39:32.560 >> So it actually loses that water, which
00:39:35.920 is what we’re mostly made up of, and
00:39:38.000 that cellular content and what’s left
00:39:39.839 behind. I tell patients it’s the
00:39:42.000 blackbone of the fibroid. All that’s
00:39:43.839 left behind is the collagen, the the
00:39:46.640 scaffolding
00:39:47.359 >> right away.
00:39:48.240 >> Right away. Like so it so right away the
00:39:51.680 heat softens it. So it goes from more of
00:39:54.240 like a baseball consistency to a
00:39:55.920 marshmallow. That happens right away.
00:39:57.760 The shrinkage happens over time. So I
00:40:00.240 see I used to do I was part of a lot of
00:40:02.320 studies. So I used to do ultrasounds at
00:40:03.839 4, six, and 12 months. um the final what
00:40:07.200 we call IDE or FDA clearance studies
00:40:10.320 that they did way back in 2012 when it
00:40:13.040 was um FDA cleared they looked at one
00:40:16.079 year but I see a lot of shrinkage even
00:40:18.240 at that four month mark right so the
00:40:20.560 average shrinkage is 45% at one year I
00:40:24.400 see a great majority of that very early
00:40:26.800 even that’s why I usually would
00:40:28.000 recommend patients maybe wait about 3
00:40:30.320 months before they try for pregnancy
00:40:32.560 just to give it some time to do some
00:40:34.160 shrinkage um because it won’t happen
00:40:36.320 right right away. But
00:40:37.680 >> and what about symptom resolution post
00:40:40.400 surgery? Faster
00:40:42.079 >> faster
00:40:43.760 only because um it’s not as taxing on
00:40:47.680 their bodies from a healing perspective.
00:40:49.440 But at the end of the day, no. The
00:40:51.520 patients actually look very similar at
00:40:53.440 the 3 to four month mark in the um
00:40:55.520 research studies that we’ve done to a
00:40:58.000 patient with a myomectomy. As far as the
00:41:00.079 heaviness of their bleeding, it still
00:41:01.920 takes some time. myomectomy or radio
00:41:04.640 frequency ablation for the cycles to
00:41:06.800 self kind of self-regulate and get back
00:41:08.800 to a more normal cycle. So that
00:41:11.200 improvement in the heaviness of their
00:41:12.560 bleeding happens um about the same time
00:41:14.960 as a traditional myomectomy or a
00:41:17.040 laparoscopic myomectomy. However, the
00:41:19.839 course in getting there because it was a
00:41:21.760 less stressful procedure on their body.
00:41:24.400 Patients from a quality of life
00:41:26.319 standpoint will have more quality of
00:41:28.160 life improvement measurements sooner.
00:41:31.200 >> Okay. So, I’d love to just kind of pick
00:41:33.599 your brains. I think it’s amazing that
00:41:35.040 you have the surgical experience and
00:41:36.800 medical background and also you’ve gone
00:41:38.960 through this yourself.
00:41:40.960 >> What would you tell if you could have
00:41:42.480 like three things that you wish women
00:41:44.400 knew early on in their journey about
00:41:47.200 fibroids or maybe even before they get
00:41:49.119 diagnosed, what would those things be?
00:41:50.880 Like what would you change?
00:41:52.240 >> I know what’s normal.
00:41:54.960 >> Okay.
00:41:56.480 >> Versus abnormal. Cuz I think as women,
00:41:58.960 we just keep going. We just keep
00:42:01.119 pushing.
00:42:01.599 >> We just pile it on. We can take we can
00:42:03.119 take more on.
00:42:04.400 >> Just like, yeah, something didn’t feel
00:42:05.760 right last month, but we let’s see what
00:42:07.680 it looks like next month and a month
00:42:09.200 after and a year later. Um, pay
00:42:12.160 attention to those changes. Um, and and
00:42:15.599 and advocate for yourself even when you
00:42:19.200 go to the doctor and you say something
00:42:20.880 didn’t feel right or my men’s just
00:42:22.800 starting to change and they’re like,
00:42:23.839 "Oh, you know, it’s okay. It’s just part
00:42:25.599 of being a woman." Advocate for
00:42:27.359 yourself. That’s not enough. ask for
00:42:28.720 that simple ultrasound now that you’re
00:42:30.240 listening to this podcast and you know
00:42:32.480 how simple the ultrasound is. Just tell
00:42:34.960 them that’s what you want. Don’t ask for
00:42:36.640 it. Tell them it’s I need an ultrasound.
00:42:39.280 Um and I think that
00:42:42.720 the support system is important. I think
00:42:46.720 that uh like for instance, my husband is
00:42:50.319 a talker. Believe it or not, as much as
00:42:52.880 I do and as much as you know I’ll speak
00:42:55.200 on this topic all day long. I’m I think
00:42:57.119 I’m a introverted I’m a introverted
00:42:59.839 extrovert if that’s you know that whole
00:43:02.079 >> you can do it you can pull through but
00:43:03.839 you prefer
00:43:05.520 >> I’ll be the one at the doctor’s office
00:43:07.280 that won’t tell everything in the story
00:43:09.440 and my husband like whoa whoa whoa wait
00:43:10.800 a minute tell them about this bring that
00:43:14.240 friend bring that family member bring
00:43:16.640 that person that’s going to even
00:43:17.920 advocate for you when you feel like you
00:43:19.359 can’t advocate for yourself bring them
00:43:21.280 to your doctor’s appointment
00:43:22.480 >> I love that suggestion
00:43:23.839 >> absolutely I think that we don’t empower
00:43:26.160 ourel enough with all the resources we
00:43:28.800 have and sometimes our support system is
00:43:30.720 our biggest resource.
00:43:32.240 >> Those are great suggestions. Um,
00:43:35.280 anything else that we haven’t talked
00:43:36.560 about that you think our listeners would
00:43:37.920 need to should know about or need to
00:43:39.599 know about fibroids?
00:43:40.960 >> No, this was fun.
00:43:42.240 >> This was great. I learned a lot.
00:43:44.400 >> Yeah, I really enjoyed talking with you
00:43:45.760 and I think that I love for me it’s
00:43:48.000 been, you know, I went to medical school
00:43:49.440 like 20 years ago, so myctomy was still
00:43:51.520 the standard at that time. I’ve and I’m
00:43:53.839 not I’m a naturopath, so I don’t do
00:43:55.440 surgery. I do outpatient. So, hearing a
00:43:58.000 little bit more about the the updates
00:44:00.160 that are available um in treatment
00:44:02.640 options for women is amazing and I’m so
00:44:05.280 grateful for doctors like you who invest
00:44:06.960 the time to kind of learn and update so
00:44:08.640 that women can have a better experience.
00:44:10.640 >> No, I appreciate this. I appreciate your
00:44:12.400 platform and the time and that you guys
00:44:14.240 even give care to this topic.
00:44:16.640 >> Absolutely. It affects a lot of women so
00:44:18.720 we definitely want to make sure we get
00:44:20.319 the chance to talk about it.
00:44:21.520 >> Yeah. Um, if people want to learn more
00:44:23.680 about you, how can they follow you? Are
00:44:26.000 you online or where can they learn about
00:44:27.359 your practice?
00:44:28.319 >> Absolutely. So, my practice website is
00:44:30.400 simple. If we’re thinking about
00:44:31.520 fibroids, it’s get fibroidelp.com.
00:44:34.400 For me personally, um, I’m at Seni
00:44:37.760 Hawkins MD on everything on Instagram,
00:44:40.400 on Tik Tok, which I’m not great at,
00:44:43.760 on um, all of the things. X, all of the
00:44:46.480 things is Seni Hawkins. S O Y I N I
00:44:49.520 Hawkins MD. Awesome. Thank you. Thank
00:44:52.640 you so much for joining me today.
00:44:54.079 >> Thank you. Thank you for having me.
00:44:55.680 >> And thank you to all of you who are
00:44:56.800 listening. I encourage you to check out
00:44:58.880 um Dr. Hawkins online and we’ll post her
00:45:01.440 links in our show notes as well for you
00:45:03.280 to make it easy for you to find for the
00:45:05.119 website and social. And while you’re at
00:45:07.200 it, be sure to follow us at Dutchest on
00:45:09.680 all the platforms as well. And if you
00:45:12.079 like what you heard today and you want
00:45:13.599 to hear more from us at the Dutch
00:45:15.280 podcast, I encourage you to follow us
00:45:17.359 and subscribe to our podcast anywhere
00:45:19.520 that you stream them now. We post a new
00:45:21.680 podcast every Tuesday and we will see
00:45:24.160 you guys next week.
00:45:26.880 Thanks for joining us on the Dutch
00:45:28.319 Podcast. Join us every Tuesday for new
00:45:31.119 conversations with leading functional
00:45:32.960 health experts. If you like what you’ve
00:45:35.040 heard, be sure to like, follow, and
00:45:37.119 subscribe wherever you get your
00:45:39.040 podcasts.