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Few Women Hear about Uterine Fibroid Embolization (UFE) Treatment Option Directly from Gynecologists. John C. Lipman, MD, FSIR Director, Interventional Radiology Emory-Adventist Hospital Atlanta, Georgia. Fibroid Facts. Most common tumor of female genital tract.
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Few Women Hear about Uterine Fibroid Embolization (UFE) Treatment Option Directly from Gynecologists John C. Lipman, MD, FSIR Director, Interventional Radiology Emory-Adventist Hospital Atlanta, Georgia
Fibroid Facts • Most common tumor of female genital tract. • 1 in 3 women >35yrs. of age. • As high as 75% in reproductive age African-American women. • Most common indication for (>600,000) hysterectomy in the U.S. (hysterectomy 2nd most common surgical procedure in the US). • Costs: $5 billion/year spent in U.S. for fibroids (primarily on the cost incurred from hysterectomy).
Fibroid Symptoms • Most frequent cause of abnormal uterine bleeding. • Typically starts as a prolonged menses, which can lead to anemia (can be severe). • “Gushing”, “flooding”, and soiling clothes in blood. • Millions of “silent sufferers” in US. Women that don’t want hysterectomy yet have been told by their gynecologist that there is no other option.
Menorrhagia • “I have to wear a d**n diaper (Depends), a flat maxi pad heaviest flow, plus a thick pad, plus a super deluxe tampon. When I have a gush, it only stops the clots, not the gush. I’m in trouble no matter how padded up I am. If I’m not near a bathroom, I ‘m a sunken ship. Today, I definitely was sunk because I was out without my Depends on ! I have to work. I just can’t keep getting up and leaving whenever this happens. I bet I’ve raised eyebrows and I can’t afford to lose my job.” • “I’ve been there too. I was shaking my head reading your message. I shop at Costco and buy the hugest box of the biggest, heavy duty pads, along with the super tampons, and Depends. Sometimes, I will have all this “gear” on just to go to the grocery store or a quick errand. It is a pain. I can handle it in the winter, but it’s horrible in the summer. I was at my son’s baseball game one night when a “gusher” hit. Let’s just say it wasn’t pretty. Hope the bleeding stops soon for you.”
Fibroid Symptoms con’t • Bulk symptoms are the other major symptoms from fibroids. • -Pelvic pain/pressure. • -Urinary pressure/frequency. Often wake up in the middle of the night. • -If large can block kidneys, bowel (constipation). • -Painful intercourse.
Uterine Fibroid EmbolizationTechnique • Performed by Interventional Radiologists • Minimally-invasive outpatient (or at most overnight stay) procedure, 4-5 days average recovery, average 1 week away from work. • Arterial catheterization using imaging guidance into the uterine arteries, with occlusion of fibroid vessels by embolic materials (most common acrylic beads or particles made from contact lens material). • The symptoms usually significantly improve or completely resolve within several weeks.
Community Awareness of UFE as a Treatment Option for Symptomatic Fibroids • 105 consecutive patients suffering with fibroids seen in the office • All 105 were given surgery as an option, but only 35 (33%) were given UFE as an option. • Of these 35, 20 of these pts were from Kaiser Ob/Gyn which uniformly inform patients of all their options. • Excluding these 20, only 15 of the remaining 85 (18%), were told about UFE as an option. • 9 of 70 (13%) that weren’t told were looking for a new gynecologist; 0 of the 35 that were told expressed this. • The majority of the 70 women that were not told about UFE, yet came for consultation for UFE, learned about it through the internet.
Conclusions • Scientific evidence of the safety and long-term efficacy of UFE is irrefutable. • While the internet is a great tool, and I encourage patients to empower themselves with knowledge about their medical condition, they should not have to suggest their treatment to physicians. This is the our (physician’s) responsibility. • Gynecologists need to take the lead and incorporate UFE into the treatment algorithm for women suffering with symptomatic fibroids. • I applaud Kaiser Permanente’s gynecologists for taking the lead in the Atlanta area.
