Few women hear about uterine fibroid embolization ufe treatment option directly from gynecologists
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John C. Lipman, MD, FSIR Director, Interventional Radiology Emory-Adventist Hospital PowerPoint PPT Presentation


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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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John C. Lipman, MD, FSIR Director, Interventional Radiology Emory-Adventist Hospital

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Few women hear about uterine fibroid embolization ufe treatment option directly from gynecologists

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

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

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

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

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.


Pelvic mri

Pelvic MRI


Uterine fibroid embolization technique

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.


Uterine fibroid embolization technique1

Uterine Fibroid EmbolizationTechnique


Pre 6 months post ufe

Pre & 6 months Post UFE


Pre 6 months post ufe1

Pre & 6 months Post UFE


Community awareness of ufe as a treatment option for symptomatic fibroids

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

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.


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