The BorealisLIFE Approach to Uterine Fibroids

Patient Care

Oct 25

What are Uterine Fibroids?

Uterine fibroids are smooth muscle tumors of the uterus. They affect more than 50% of women and cause a variety of symptoms. The standard treatments have typically involved birth control pills, progesterone IUD, and if this doesn’t work, hysterectomy. This might be just fine for some women, though many women are looking for more options. There have been significant advances in the treatment of uterine fibroids over the past few years and at BorealisLIFE we are committed, and uniquely qualified, to design a treatment plan that best fits each individual patient's situation.

Fibroid Symptoms:

pelvic pain
painful periods
heavy uterine bleeding
pelvic pressure
frequent urination
urination at night

The BorealisLIFE Approach to Uterine Fibroids:

We use a narrative approach with a nurse case manager to get to know you. We take a thorough history and have particular interest in the ways that your symptoms have been affecting your life and determine what your goals are. Do you want to have more children? Are you interested in medical treatments? If you have surgery, how important is the length of recovery? Simply put, we believe you, and we want to work with you to design a treatment program that meets your particular needs.

The next step is to get a pelvic ultrasound to better determine the size and specific location of your fibroids. We have worked with Advanced Sonograms of Alaska to incorporate the FIGO Classification System in every ultrasound they do for us. This system describes where the fibroids are in relation to the lining of the uterus in order to determine the optimal treatment options. If hysterectomy is the only option, then the FIGO System is not necessary, so many doctors are not interested in this information.

At BorealisLIFE, we believe this information is very important.

  
      Fibroid Type
      Description
    
      Type 0
      Pedunculated, intracavitary
    
      Type 1
      Submucosal, <50% intramural
    
      Type 2
      Submucosal, ≥50% intramural
    
      Type 3
      Contact with endometrium, 100% intramural
    
      Type 4
      Intramural
    
      Type 5
      Subserosal, ≥50% intramural
    
      Type 6
      Subserosal, <50% intramural
    
      Type 7
      Subserosal, pedunculated
    
      Type 8
      Other (e.g., cervical, parasitic)

We are familiar with the newest medications that can be used to treat fibroids. There is a relatively new class of medications called GnRH-antagonists which were approved by the FDA in 2020. They are very effective in treating many symptoms and can be used for up to 2 years. They have mild to moderate side effects and are generally well-tolerated. The main contraindication is osteoporosis. The initial studies showed that they can reduce bone mineral density so we need to take this into account when determining whether they are appropriate for each patient.
Dr. Matthew Lindemann is the only gynecologist in Alaska with a speciality in minimally invasive gynecology. He was awarded a Focused-Practice Designation in Minimally Invasive Gynecologic Surgery by the American Board of OB/GYN by passing a rigorous exam process in October 2022. He has performed over 2000 minimally invasive surgeries over the past two decades and has dedicated his career to offering the most advanced, minimally invasive, surgical techniques to women in Alaska.
We are very excited to offer the Acessa Procedure at Borealis LIFE. Dr. Lindemann is one of a handful of gynecologists in Alaska to be trained in this innovative technique. Acessa involved the use of radio-frequency energy to destroy the fibroids. This is done laparoscopically with three small incisions. Patients typically return to normal activities within 3-5 days, much sooner than hysterectomy or even myomectomy.
Dr. Lindemann was one of the first gynecologists to be trained in the Da Vinci robotic platform over 15 years ago. He has done over 100 cases without any major complications. The advantage of this platform is that we are able to perform more complicated surgeries through a minimally invasive approach rather than through a large abdominal incision. Regarding uterine fibroids, this is particularly relevant when we perform myomectomies. These are surgeries where we remove the fibroids but not the uterus. They involve significant suturing to close the defect created when the fibroid is removed and this is much easier using the Da Vinci robot. Experience with the Da Vinci is also helpful in performing hysterectomies minimally invasively.
One modality that is typically underutilized is hysteroscopic myomectomy. This involves inserting a scope into the uterus and removing fibroids or polyps without any incisions. This is particularly useful in the removal of category 0, 1, and 2 fibroids that project into the uterine cavity. Dr. Lindemann has done hundreds of hysteroscopies through his career and has extensive experience with hysteroscopic myomectomy.

When you make an appointment at BorealisLIFE, our RN Case Manager Emily will typically call you. She will welcome you to the clinic and make sure we get all of the appropriate records and determine if an ultrasound is necessary. You will then meet with Dr. Lindemann and he will work with you to determine the best treatment options.

Sometimes this involves multiple approaches to treatment. Our goal at Borealis LIFE is to really get to know each patient so that our treatment plan best meets each person’s needs. The philosophy is to fit the treatment around each patient, rather than try to cram the patients into the standard mold, limited by the experience, skill, and motivation of the doctor. I have met many patients who describe experiences with other doctors where they did not feel heard or validated, or where the doctor only offered them hysterectomy. They have been shamed for questioning the doctor’s recommendation, bullied to accept a treatment because they are desperate for relief but unaware of the extent of options available.

This is not how we do it at Borealis LIFE. It is important to feel comfortable with your doctor and with the treatment plan. We want our patients to be empowered, ask questions, and let us know what their needs and fears are. Only in this way, can we determine the most appropriate care plan and provide comfort to our patients.