An effective, minimal invasive but “vastly underutilized” treatment option for fibroids: Uterine Fibroid Embolization

Statistics by National Institute of Health (NIH) indicate that nearly 3 in 4 women will develop fibroid by the time they reach age 50, but more than half of these women have never heard of Uterine Fibroid Embolization and 11% think that hysterectomy is the only treatment option available to them says the results of a Nationwide survey conducted by Harris Poll between June 23 and 27, 2017.

The survey was conducted on behalf of the Society of Interventional Radiology (SIR) and results were presented at the Society of Interventional Radiology’s 2017 Annual Scientific Meeting.

The survey of almost 1,200 women found that about one third of women did not know what fibroids are, 37% did not know anybody else with the diagnosis of fibroid, and nearly 60% did not think that they are at risk of developing fibroid.

Courtesy: Linkedin.com 

One in 5 women thought fibroids are cancerous and surgery is the only treatment option they have.

A majority of women (62%)have never heard of Uterine Fibroid Embolization, and 73% of women who knew about UFE reported that they got the information elsewhere, other than their Ob/Gyn.

As per National Uterine Foundation, nearly 600,000 hysterectomies performed annually in the United States out of which ~170,000 - ~300,000 are due to uterine fibroids. A review of published studies has shown that nearly 1 in 5 hysterectomy is unindicated and 40% of patient who have hysterectomy do not receive full information about other medical or less invasive procedures available to them. It appears that it was presented to them as the best treatment option available, says the SIR report.

James Spies, MD, MPH, a professor of radiology at Georgetown University Medical Center, Washington, DC, and the president-elect of SIR said, "Misperceptions about uterine fibroids and the treatments available often lead women to undergo invasive and potentially unnecessary surgery for their fibroids, despite more than 20 years of clinical use supporting uterine fibroid embolization.”

"Unfortunately, still many health care professionals start and end with hysterectomy as the recommendation for patients," he further added.

An NIH study showed that 165,000 more hysterectomies were performed than UFEs (167,650 vs. 2,470) nationwide, a difference of whopping 67% between the two procedures.

The study also reported that nine out of 10 women who have uterine fibroid embolization have significant improvement. Many women report their symptoms disappear completely.

UFE also helps women in getting back to normal lives quickly after the procedure, with no residual effects of early menopause and sexual dysfunction, as often experienced after hysterectomies.

It is also minimally invasive with a hospital stay of one day or less, cost effective, low rate of complications and few women require follow up treatment. If the fibroids recur, they can be again be treated: A second UFE is not contraindicated, said Dr Spies.

It’s also a great option for women desiring future pregnancies.  A study published in Radiology Journal showed a 41.5 percent pregnancy rate after an average follow-up of almost six years.

The ACOG has included UAE in its FAQs on Uterine Fibroids. The procedure was included as one of the treatment option in its 2008 bulletin, reaffirmed again in 2016. The bulletin concludes, "Based on long- and short-term outcomes, uterine artery embolization is a safe and effective option for appropriately selected women who wish to retain their uteri." 

Courtesy: SIR

UFE is performed by an interventional radiologist who inserts a thin catheter into the artery at the groin or wrist. The doctor guides the catheter to the fibroid’s blood supply where small particles, about the size of grains of sand, are released to float downstream and block the small blood vessels and deprive the fibroid of nutrients. This results in the fibroid softening, bleeding less, and shrinking in size.

Does  the push to promote UFE by SIR means promoting self-interest? No, it only means that women diagnosed with fibroids deserve to know about all the options they have and the clinicians should be able to inform them about it. 

Executive summary of survey, Full PDF, SIR news release
RCOG recommendations for UAE for Fibroids