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

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.


Pelvic MRI


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 EmbolizationTechnique


Pre & 6 months Post UFE


Pre & 6 months Post UFE


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.


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