Uterine fibroids are very common, becoming more common as women age into their 30s and 40s. Fibroids are benign muscle knots or muscle tumors in the uterus, and they may or may not cause any symptoms depending on their size and their location. By age 50, between 20 to 80 percent of women will have developed fibroids, according to the U.S. Office on Women’s Health.
In this Q&A, Anne Hardart, MD, Co-Director of Urogynecology at Mount Sinai West, answers frequently asked questions about fibroids and treatment options.
Q: What are the symptoms?
The symptoms of fibroids depend on their size and their location. Very small fibroids in the muscle or on the outside of the uterus may never cause any symptoms. Fibroids that are large— they can get up to the size of a melon or even more—may cause pressure symptoms. Fibroids that are inside the uterus can cause heavy periods, irregular bleeding, and cramping. As fibroids grow, they can be uncomfortable or make a person urinate more frequently. However, if fibroids are not causing symptoms, they may not require any treatment, and they are very common, probably present in about 50 percent of women.
Q: Can fibroids cause fertility issues?
While fibroids often are not cause for concern, fibroids can make it difficult to become pregnant for women who are trying to conceive. Not all fibroids cause infertility, but for fibroids that affect the inside cavity of the uterus, it is often recommended that the fibroids be removed if someone is experiencing infertility. Fibroids also can cause difficulties during pregnancy, such as significant pain and increasing the risk of preterm delivery or miscarriage in some cases.
Q: How are uterine fibroids diagnosed?
You may not even know you have fibroids, and that is okay because they are not dangerous or cause for concern if they are not causing any symptoms. However, if you are having symptoms such as abnormal bleeding or pain and you think it may be related to fibroids, your doctor will probably do a pelvic exam and may order an ultrasound or an MRI.
Q: What are the treatment options?
There are many types of treatments for fibroids, and your doctor will work with you to determine the best treatment plan for your situation. Treatment options depend partly on the symptoms.
If the symptoms are abnormal bleeding, that may mean hormonal treatment with low-dose birth control pills, a progesterone IUD, or other medications to help manage heavy bleeding and reduce cramping as well as slowing the growth of fibroids.
For symptoms that are moderate to severe, treatment may mean a surgical procedure, such as removing fibroids (myomectomy) or even the uterus (hysterectomy), often in a minimally invasive way. Minimally invasive surgical approaches include hysteroscopy, which involves inserting a camera into the uterus through the cervix, and laparoscopy, which involves inserting a camera into the abdomen through the belly button.
Symptoms related to pressure, or the bulk of large fibroids, can be managed with medications, a radiologic procedure called embolization, and surgery. Medications that shrink fibroids, such as gonadotropin releasing hormone agonists (GnRHa), are typically given by injection, but newer oral medications are also available. These medications also may be used prior to surgery to make fibroid removal easier. The surgical options for large fibroids are myomectomy and hysterectomy.
If you know you have fibroids, you should probably see your doctor every year, or more frequently if you are having symptoms such as heavy bleeding or pressure symptoms.
With children, it’s never too early to start practicing good sun protection behaviors. In fact, exposure to ultraviolet radiation and a history of sunburns during childhood greatly increases your risk of developing skin cancer later in life.
Nanette Silverberg, MD, Director of Pediatric Dermatology, Mount Sinai Health System, shares some tips for protecting your child’s skin, which is especially important during the warmer months when they may spend so much more time outside in the sun.
Nanette Silverberg, MD, Director of Pediatric Dermatology
Here are five basic steps you should take:
Look for sunscreens that have a sun protection factor (SPF) of 30-50+ and that say they provide “broad spectrum” coverage, meaning they protect against both UVA and UVB radiation. UVA rays have less energy and are mostly linked to long-term skin damage, such as wrinkles, while UVB rays are the ones that cause sunburns, which are thought to cause most skin cancers, according to the American Cancer Society.
Sunscreens should be applied 30 minutes before going outside for the day and then reapplied every two hours.
Sunscreens should be reapplied after swimming or heavy sweating, as they are not waterproof.
In addition to sunscreen, children should wear a wide-brimmed hat and sun protective clothing (UPF 50) such as swim shirts or rash guard shirts. These shirts typically block 98 percent of ultraviolet radiation, according to the Centers for Disease Control and Prevention.
Stay in the shade as much as possible, and avoid the mid-day sun during its peak hours of intensity from 10 am to 2 pm.
Even if you apply sunscreen and practice good sun care, your child may still get a sunburn. What should a parent do to minimize the sting?
Dr. Silverberg, suggests applying a cold compress, or bathing your child in cool water. Over-the-counter hydrocortisone one percent cream can also be helpful to ease red, itchy, or tender skin and help with inflammation. Hypoallergenic moisturizers can soothe the skin.
If the sunburn is painful or widespread, talk with your pediatrician about whether taking ibuprofen is appropriate for older children. If you notice any blistering, you should consider consulting with a pediatric dermatologist. Follow up to check for sun damage and be extra careful with sun protection on healing skin.
Post-pool skincare is also extremely important, especially for young children. Dr. Silverberg says most children tolerate chlorinated water, but she recommends rinsing off after the pool and applying light emollients when coming indoors.
Skincare also includes applying therapies afterwards for children with eczema, and reapplying sunscreen for outdoor play. Additionally, shirts with UPF should be rinsed with water and left to air dry to help maintain their potency and soft feel.
Following a successful drive to get New Yorkers vaccinated against mpox—previously known as monkeypox—last summer, mpox cases in New York City waned just as quickly as they had spiked. The city declared an end to its outbreak in February this year.
However, an uptick of mpox cases in Chicago in May has health experts and officials concerned about a possible return of outbreaks nationwide. The Centers for Disease Control and Prevention issued a health alert in May, informing clinicians and public health agencies about the new clusters and calling on them to raise awareness about treatment, vaccination, and testing.
Between April 17 and May 5, 12 confirmed and one probable case of mpox were reported to the Chicago Department of Public Health. Nine (69 percent) of 13 cases were among men who had received two vaccine doses, and all cases were among symptomatic men. None of the patients was hospitalized.
The virus is most commonly spread through direct contact with a rash or sores of someone who has it. It can also be spread through contact with clothing, bedding, and other items used by someone with mpox.
Symptoms usually start in 3 to 17 days, and can last two to four weeks. Common symptoms include rash or sores that look like blisters—on the face, hands, feet, or inside the mouth, genitals, or anus. Flu-like symptoms such as sore throat, fever, swollen lymph nodes, or headaches are common too.
In this Q&A, Erick Eiting, MD, MPH, Medical Director for the Emergency Department at Mount Sinai Beth Israel and for the Urgent Care Center at Mount Sinai-Union Square, discusses what people can do to protect themselves from mpox and the importance of being fully vaccinated.
What is mpox and should I be worried about it?
Mpox is an orthopox virus (a genus that includes smallpox and cowpox). In spring and summer of 2022, we saw a pretty large number of infections here in New York City, across the country, and even across the globe.
Because of a widespread vaccine campaign, we’re now seeing far fewer infections than we had been seeing in the summer of last year. However, we’ve recently seen a small increase in the number of infections in New York City.
Should I be concerned about it now?
We recently saw a fair number of cases—in fact, there were 13 recent cases in Chicago over a relatively short period of time. And even though the number of infections that we’ve seen across the country has been relatively low, this number has been an increase from what we’re used to seeing.
And that’s really causing us to pay more attention to what’s going on and to make sure that we’re being vigilant in case those numbers continue to rise.
Fast facts about mpox
3,821
Cumulative mpox cases in New York City in 2022
70
Number of daily cases at the peak of mpox outbreak
20
Number of cases in New York City from February to May 2023
45%
Percentage of fully vaccinated at-risk individuals in New York City
Top Three Most Vaccinated Regions
California (306,000 doses)
New York City (153,000 doses)
Florida (94,000 doses)
What can I do to prevent it?
The first, and probably most important, is to make sure that if you are concerned about mpox—if you believe you may have risk factors—you really need to get fully vaccinated. Fully vaccinated means that you received two doses of the JYNNEOS® vaccine, at least four weeks apart.
Two weeks after you’ve received that second dose of the vaccine, you are considered to be fully vaccinated. So if you’re not fully vaccinated, that is probably one of the most important steps that you can take to prevent getting mpox.
The next part is making sure that you’re having conversations with people like sexual partners. Anybody who may have symptoms at the time could potentially pose a risk for infection, and it’s important to have those conversations.
We don’t consider mpox to be a sexually transmitted disease, but we do know that it comes from close physical contact. So having those conversations is really important, and even asking sexual partners about their vaccination status is also an important step.
The third thing is, if you’re concerned that you may have symptoms that are consistent with an mpox infection—and that could be a rash, which is often very painful, as well as fever, body aches, and chills—then it’s really important that you seek medical care as soon as possible. Some studies have shown that that the vaccine can be helpful in preventing mpox infection even after you’ve been exposed. Or that it can make the infection less severe.
If I have only taken one dose of the vaccine and have not completed the series, do I only need to take one more dose? Or do I have to go through the whole series again?
Anybody who’s received one dose already of the JYNNEOS® vaccine only needs one additional dose. You want to make sure that at least four weeks have passed since you’ve got the first dose. You need to get that second dose of the JYNNEOS vaccine in order to be fully vaccinated.
If I had taken both doses last year, should I consider taking another dose?
At this time there is no recommendation for getting a “booster” shot for the JYNNEOS® vaccine, and possibly there may not even be any additional benefit. So at this time we’re not recommending any further doses: two doses are fully sufficient, and if you’ve gotten both of those doses, you’re considered to be fully vaccinated.
Am I adequately protected if I complete my vaccine series now? Am I still protected if I had completed my series last year?
Yes, you will absolutely be protected. You have to keep in mind that no vaccine is perfect; no vaccine will prevent 100 percent of infections. But this is about the best protection that you could potentially have. So if you’ve already gotten those two doses, and two weeks or longer have passed since then, you are fully protected.
Can I stay home if I have symptoms? Who should be seeking treatment?
If you are presenting with symptoms, you should absolutely be seeking treatment. One of the most important steps is getting tested and making sure that we’re confirming the diagnosis of mpox. One of the beneficial parts about this disease is that very few people will go on to have very severe symptoms.
It’s only a very small number of people who have died. The people who are most at risk are people who have some kind of advanced weakened immune system, people who are pregnant, and children.
Diabetes affects nearly 11 percent of the U.S. population. For people living with diabetes, they may be prescribed medication to help them manage their condition.
Reshmi Srinath, MD, Associate Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai and Director of the Mount Sinai Weight and Metabolism Management Program, discusses medications that are available for type 2 diabetes and what you need to know.
There are many different types of medications for type 2 diabetes, including pills and injections. What are the most common treatments, and what are the pros and cons?
There are numerous medications; however, our mainstay starting drug is metformin, a medication that works to relax the pancreas, which produces insulin and make the body more sensitive to insulin. It also reduces liver glucose production and lowers appetite. We start metformin for any patient who has prediabetes or type 2 diabetes that is uncontrolled. It also lowers inflammation and reduces cancer risk.
Newer diabetes medications work on the gut. These are daily or weekly injections that target a hormone that comes from your small intestine called glucagon-like peptide (GLP). These medications help the pancreas control blood sugar and produce insulin. They also have a significant benefit for weight loss as they slow the way food travels through your gut, which leads you to get full quicker and eat less, which helps control your glucose levels.
There is also another class of medications called SGLT2 inhibitors—pills that relax the kidneys and help them filter sugar. They also can help you improve your blood pressure and regulate your weight. Numerous studies have shown benefits from these medications in reducing the risk of heart disease and heart failure and reducing stroke risk. Lastly, there is insulin, our most potent medication that helps regulate blood sugar.
How well do these medications work?
Most medications on the market are quite effective. They help to lower your blood sugar and a marker called hemoglobin A1C, a diabetes risk marker where values over 6.5 percent correlate with type 2 diabetes. Values between 5.7 and 6.4 percent correlate with prediabetes, which is very important for our patients to know. We know that a majority of these medications do help to lower hemoglobin A1C, at least 1 to 2 percent.
What are some of the more significant side effects?
Injectables that work on GLP1 affect the gastrointestinal system, and the most common side effects include bloating, flatulence, and constipation. They also can activate gastric reflux, and potentially worsen constipation. The SGLT2 inhibitors work on the kidney. People on these describe feeling more thirsty, and that they are peeing more. Occasionally, patients may develop urinary tract or yeast infections.
Metformin is well tolerated. People do describe some gastrointestinal side effects in terms of some stomach upset bloating and nausea, but usually that goes away within the first week. The main risk with insulin is making sure patients aren’t developing low blood sugar due to too much insulin being administered.
Why is it important to take medications for type 2 diabetes?
It is very important you take medications. We know that diabetes is tightly linked to the risk of heart disease and stroke, which can be associated with greater mortality and morbidity. We know that diabetes, when uncontrolled, can lead to complications, including vision problems and potentially blindness. Diabetes can also lead to worsening kidney function and potentially kidney failure.
Diabetes itself can lead to symptoms of numbness, tingling in the hands and feet, which can eventually lead to a condition called neuropathy, where patients can actually lose sensation in their extremities, particularly the feet, which can lead to risk of injury, foot ulcers, and potential amputation. These are complications we want to avoid. I think the first step is really being vigilant and taking preventative measures, including taking your medications, being closely monitored by your physician, and monitoring your blood sugar.
Medications to treat type 2 diabetes have been in the news. What are they, and how do they work?
A lot of these medications have been in the news recently because they both help to manage type 2 diabetes and weight, which is a risk factor for type 2 diabetes. By helping patients lose weight, we can prevent them from developing type 2 diabetes. For example, you may have heard of drugs like Ozempic® and Mounjaro™, these are injectables that both work to help control diabetes but also have significant weight loss benefits.
We now have FDA approved versions of these, which are indicated for weight loss. Ozempic® has now what we consider a companion called Wegovy®, both known as semaglutide. These are both medications that work similarly. They’re the same drug, but Wegovy is approved for weight loss, and Ozempic® is approved for type 2 diabetes. Similarly, Mounjaro™, which is one of the newest drugs for type 2 diabetes, is being tested for obesity, and will likely get FDA approval for obesity.
In general, who are the most appropriate candidates for these drugs?
This is really a conversation to have with your primary care doctor or endocrinologist. As I mentioned earlier, obesity and weight gain are risk factors for type 2 diabetes. It’s important that you keep an eye on your blood test results and blood sugar.
We typically assess diabetes risk by looking at fasting blood sugar and at hemoglobin A1C, and sometimes patients even do a glucose tolerance test, which is another way of determining if patients have a risk for diabetes. For patients who definitely have diabetes risk, it is important to have a conversation about your weight and whether you might be candidate for some of these medications, which are FDA approved for obesity. Many medications approved for type 2 diabetes are being closely regulated by insurance companies, so it is now getting harder to get these structures purely off label.
Because falls put you at risk for severe injury and can limit your quality of life and ability to remain independent, older adults need to follow simple steps to drastically reduce your risk of falling, like reviewing medications with your provider or hazard-proofing your living space.
The fear of falling does not have to be a burden on your life and lifestyle. In this Q&A, Charla Sarabia, MPH, Injury Prevention and Community Outreach Coordinator at Mount Sinai Morningside, provides steps to follow to reduce your risk of falling, whether at home or in a care facility.
What are the most common risk factors for falling?
A combination of risk factors causes most falls. The more risk factors you have, the greater your chances of falling. Factors can include age-related changes, such as declines in vision, hearing, balance, and mobility, as well as chronic health conditions like Parkinson’s disease, arthritis, diabetes, and medication side effects. Additionally, environmental risk factors in your home, workplace, care facility, etc., include clutter, inadequate lighting, wet floors, unstable furniture, and improper footwear.
Are there any lifestyle changes I can make to prevent falls?
There are several lifestyle changes you can make to prevent falls, such as:
Increase regular physical activity to improve strength, balance, and flexibility
Review and modify your medications with your provider or pharmacist
Complete home modifications such as removing slippery rugs or clutter and improving lighting can also reduce the risk of falls
Schedule regular eye exams and maintain a healthy diet
Speak with your health care provider to review risks of falling and implement fall prevention strategies.
Are there any conditions that could make me more likely to have a fall?
There are several chronic conditions that can increase the risk of falls, including Parkinson’s disease, stroke, dementia, arthritis, and diabetes. These conditions can cause physical impairments, such as muscle weakness, balance problems, and coordination difficulties. In addition, some chronic conditions can cause cognitive impairment, confusion, or dizziness, increasing the likelihood of falling. Working with your health care provider to identify and manage any factors that may increase your risk of falling is essential.
Can certain medications increase my risk of falling?
Certain medications can increase the risk of falling, with some of the risks including dizziness, drowsiness, or instability. Examples of these medications are pills for anxiety and depression, sleeping pills, pain medications, and antipsychotics, which are used to treat schizophrenia and other mental health disorders. It is important to talk to your provider if you are taking any of these medications and are concerned about falling, as they can explain the side effects of your medications and suggest strategies to minimize the risk of falling.
What can happen after a fall?
Falls can have varying consequences depending on age, health status, and fall circumstances. For instance, falls can result in minor injuries, such as cuts and bruises, that can be treated with basic first aid. However, falls can also result in more severe injuries, such as fractures, especially in older adults. In addition, head injuries ranging from minor bumps to severe traumatic brain injuries can occur after a fall. Besides physical injuries, falls can also lead to psychological effects. For example, a fear of falling can lead to a decrease in mobility and physical activity and can lead to social isolation. Seeking medical attention after a fall, especially if you are an older adult or have underlying health conditions, is crucial to ensure that any injuries are properly evaluated and treated.
If I am concerned about falling, when should I see a doctor?
If you are concerned about falling, it is a good idea to talk to your doctor, especially if you are an older adult or have underlying health conditions. You should see a doctor if you have had a fall or near fall recently, feel unsteady on your feet, have difficulty walking, or fear falling. Your doctor can evaluate your overall health and assess your risk of falling. They may also recommend specific tests or refer you to a specialist, such as a physical therapist, to improve your balance and strength. It is important to seek medical attention early to prevent falls and avoid the potentially severe consequences that can result from them.
What are the best things I can do to prevent falls in my home?
To make your home safer from falls, the most important thing you can do is to take simple measures:
Remove hazards such as clutter, and install handrails
Improve lighting
Use non-slip mats/rugs
Wear appropriate, non-slip footwear
Have regular eye check-ups, and review your medications with your doctor to ensure they do not increase your risk of falling.
On an average day, New York has an air quality index of 30, considered “good.” Because of current wild fires in Canada, the score has risen to 160 and above, in the “unhealthy” range.
You have probably noticed the hazy skies throughout the New York City area. Health experts say everyone should pay close attention. That poor-quality air is unhealthy, especially for vulnerable people, including those with asthma or heart conditions, as well as younger kids and older adults.
The poor air quality, the result of wildfires in Canada, is expected to persist for several days, and it’s something you can actually feel. Experts say you should consider limiting your time outside, especially if you are exercising or doing strenuous tasks; keeping your windows closed at home; and wearing a high-quality N95 or KN95 mask if you need to go out. Those most at risk should stay indoors.
“Many people may have noticed the hazy conditions, but not realized they should be concerned—especially younger people and the elderly, who are at greater risk,” says Linda Rogers, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine) at the Icahn School of Medicine at Mount Sinai. “I think we all should be looking out for the most vulnerable; they are the ones that are at most risk right now. But this has crossed a threshold where the public will feel this.”
Click here for more specific information for parents about kids and air quality.
In this Q&A, Dr. Rogers, who is also Director of the Adult Asthma Program, offers a number of other tips, including what type of mask to consider wearing, whether to turn on your air conditioner, and who is most at risk.
How bad has the air quality been in New York City because of these wildfires?
Our air quality has been in a zone that’s considered dangerous to health, and not just dangerous to sensitive populations. We crossed the threshold where there may be some health effects noticed in otherwise healthy individuals, and it’s something that’s probably hazardous to people who are either elderly, very young, or have underlying heart or lung disease, or other sort of significant health conditions. It’s not something people are normally aware of, though most people going outside will realize that something is up.
Linda Rogers, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine)
How can I tell what the air quality is like in my neighborhood right now?
A good way to see what the air quality is like right now, where you live, is the website AirNow.gov. This site offers a composite score for what we call the big five pollutants—ground-level ozone, particulate matter, carbon monoxide, sulfur dioxide, and nitrogen dioxide. A good score is less than 50. On an average day in New York, we are around 30; we have pretty good air quality. Once it starts getting up over 50, there may be risks for sensitive people. During August, this score can reach 100, due to a combination of heat, humidity, and pollution. Recently the score has risen to 160 due to the wildfires. Any of the common weather apps people have on their phones are also a good source of this information.
What does it mean when the air quality reaches the unhealthy levels we have seen lately?
That’s the red zone. That’s where even healthy members of the general public are going to feel it. The effects on the general public may be mild; it may just be a matter of feeling irritation in your nose or throat. But for really sensitive groups, this is a level that could trigger asthma attacks or flare-ups of other lung diseases, and pose a risk for those already at risk for heart attacks and strokes.
What safety precautions should I take when air quality is at an unhealthy level?
The best thing to do is stay inside with the windows closed. If you have to go outside, make it as short as possible. I don’t think anybody should exercise outdoors while the air quality is at these levels. When you’re exercising, you are taking in more of these contaminants. It depends on your personal circumstances, but when levels are between 100 and 150, you may want to consider limiting outdoor exercise, especially kids.
Should I wear a mask?
You should consider wearing a high-quality mask, such as an N95 or KN95 mask. Surgical-style masks will not be helpful. Those masks offer at least partial protection from viruses transmitted by droplets, but they do not protect you from the extremely small particles that are being produced by these wildfires. And even the N95 and KN95 masks cannot protect you from the gases, such as carbon monoxide, that are being produced by the fires.
What about working outside?
I think it depends on your underlying health, your age, your circumstances, what the work involves, and what the air quality is in the area that you’re working. If you have to work outside, a high-quality N95 mask will be a great idea if it’s possible for you.
Does it help to use my air conditioner?
Air conditioners vary tremendously in terms of how old they are, how they’re built, and what kind of filters they have in their use. Closing your windows and using an air conditioner is better than having the windows open. Ideally, your air conditioning system has a high-efficiency filter. Air purifiers can also help.
Who is most at risk?
Young kids are more at risk because they tend to breathe at faster rates with higher volumes. When there’s an elevated pollutant like this, they’re generally getting more exposure. The elderly are at higher risk for heart and lung disease and have other underlying health conditions. Those with lung diseases, notably asthma and chronic obstructive pulmonary disease (or COPD), are often sensitive to environmental triggers like this, or changes in weather, temperatures, and humidity. Many of those with asthma, for example, often reach out to their doctors in advance to make sure they have emergency medication on hand. But it can be different for those with heart conditions.
What should people with heart disease know about this?
People with heart disease may not be aware that they are at increased risk, but these high levels of pollutants have been linked to visits to emergency rooms with cardiovascular conditions. People who are at risk may want to consider staying indoors to the extent possible. It’s also important to note that there may be a lag in the onset of symptoms. It may take a while for the contaminants you are breathing in to have an effect on your blood vessels. That is why we may sometimes see a lag in visits to the emergency department. The health effects can persist and escalate from 24 to 48 hours after the air quality levels are at their worst.
What are the signs that the air quality is affecting a typical, healthy person?
When the air quality index gets above 100, and then over 150, as it has recently done, you’re going to feel throat irritation, nasal irritation, nasal congestion, runny nose, sore throat—almost cold-like symptoms except without a fever. Some people may feel chest discomfort and headaches. These aren’t particularly dangerous. But for those with underlying conditions, such as lung disease and allergies, they can cause more severe debilitating symptoms. The air is unhealthy for everyone, but some groups are at risk of significant health effects.
Details of the air quality index from the federal government’s AirNow.gov site.
