Body & Soul has partnered with Johns Hopkins Medical Centre to provide you with answers to questions you have about your health.Very often we are too uncomfortable to ask our healthcare providers questions about our own health. Sometimes we ask the question and do not understand the answer or don't want to challenge the answer given. If you have such questions please e-mail them to gazettehealth@yahoo.com and we'll have an expert from Johns Hopkins answer it.Body and Soul will feature a question with its answer once a month.I am a black woman in my late 30s. I have uterine fibroids and am losing a lot of blood. What are the best treatment options? My doctor told me that hysterectomy is the only cure but that a dilation and curettage (D&C) might help. Is this true? Also my stomach has become much larger is this due to the fibroids? What could I have done to avoid getting fibroids?Dr Stacey A Scheib, Director of Multidisciplinary Fibroid Center at Johns Hopkins Hospital's Department of Obstetrics and Gynaecology provided the following answer:Fibroids (also called myomas or leiomyomata) are benign tumours of the smooth muscle cells of the uterus. They are extremely common, affecting 70 percent to 80 percent of women. Symptoms may include abnormal bleeding, painful periods, pelvic pressure or pain, altered bladder or bowel function and infertility. However, not all women experience these symptoms. Sometimes the fibroids are large and their size may explain why your abdomen has become larger.While there are no clear causes of fibroids, risk factors are known and include a family predisposition. If your mother or sister had fibroids, your risk is higher than usual of developing them. Black women are more likely than other racial groups to have fibroids and tend to have larger ones. Research also has shown that pregnancy and childbirth seem to have a protective effect and may decrease risk. Treatment options should depend on the severity of symptoms and childbearing plans, as well as the number, size and location of the fibroids.Hysterectomy, or surgical removal of the uterus, is one option, particularly for a woman who has completed her childbearing and is interested in definitive therapy that completely eliminates, rather than improves, symptoms. In most the cases, a minimally invasive procedure using a laparoscope through small incisions can get the job done, avoiding major abdominal surgery. However, it is important to note that only rarely is hysterectomy the only option for women.Among nonsurgical treatment options are non-steroidal anti-inflammatory drugs, effective for pain or discomfort; oral contraceptive pills that can control pain and bleeding; the sex hormone progesterone; and gonadotrophin-releasing hormone (GnRH) agonists.Progesterone can be administered as an injection, pill or implant to thin the lining of the uterus and control fibroid-associated bleeding. GnRH agonists, such as leuprolide, cause oestrogen levels to drop, similar to those found after menopause, so that menstrual bleeding stops. This treatment is not considered a long-term option, and is commonly used for short periods of time and in preparation for surgical treatment.An older treatment that continues to find use is dilation and curettage (D&C), a procedure in which the cervix is dilated, or opened, and the lining of the uterus is thinned by scraping it. This option, too, is a temporary measure and, like GnRH agonists, offers only short-term relief in most cases.Myomectomy, or surgical removal of uterine fibroids without removal of the uterus, can be offered in some cases, depending on the type and location of the fibroids. The main advantage of this procedure is that it allows women to keep pregnancy options open.Another available option is uterine artery embolisation, a minimally invasive procedure that blocks the main blood supply to fibroids, causing them to shrink up to 40 percent to 50 percent over six months. Performed by an interventional radiologist, it relieves bleeding and pressure symptoms in a majority of those who have it. It is important to keep in mind, though, that not all patients are candidates for this procedure, and not every size and type of fibroid can be safely treated this way.Finally, MRI-guided focused ultrasound, a relatively new treatment, uses MRI scanning to guide high-frequency ultrasound waves to the tumours. The treatment heats up fibroid tissue and destroys it. Unfortunately, it is not yet widely available.Modern medicine offers a variety of treatment options for fibroids. It is important to talk to your doctor about them and select the one that is best for you.