Demand For Uterus-Saving Fibroid Treatment

Women are using Internet-based technology to find doctors who will perform cutting-edge procedures that avoid hysterectomy for treatment of bleeding and painful fibroid tumors. One women went to 12 different gynecologists in order to find someone who would offer a minimally-invasive procedure that would shrink the fibroid, yet leave the 35-year-old woman's uterus intact.

Eventually, she found an Internet Web site that directed her to Yale University School of Medicine, where she underwent the procedure known as uterine fibroid embolization. "She is now pregnant," said Dr. Michael Wysoki, clinical assistant professor of diagnostic radiology at Yale University School of Medicine, New Haven, Conn.

At the annual scientific meeting of the Society of Cardiovascular and Interventional Radiology in San Antonio, Tex., Wysoki reported Tuesday on a survey he conducted among 50 women who had undergone UFE. He tried to assess how gynecologists reacted to the woman's requests for alternative treatment aside from hysterectomy in which the uterus and other reproductive system organs are surgically removed. Twenty-one of the women responded to the survey.

In UFE, doctors make a small incision in the leg, and under x-ray guidance, a catheter is snaked through blood vessels until the uterine artery is reached. Then tiny plastic-like bodies about the size of grains of sand and introduced into branch blood vessels which nourish the fibroids. The vessels become clogged, seal off and the fibroids are starved to death, resulting in relief of pain and bleeding episodes.

Wysoki said his study found that even though UFE is performed across the United States, "the vast majority of gynecologists have negative initial opinions toward UFE. Patients who underwent UFE did not continue seeing most of the gynecologists who maintained their negative opinion about the procedure."

He said 76 percent of the women said their doctors were initially opposed to the procedure, but after the operation was performed, 43 percent of the physicians altered their view of UFE to a more favorable position. If the gynecologist remained in opposition, 8 of 9 women refused to return to that practice, Wysoki said.

"I and several of us have all seen patients who have fired their gynecologists over this issue," said Dr. Robert Vogelzang, MD, professor of radiology at Northwestern University School of Medicine. Vogelzang said that gynecologists tend to be an insular group of medical professionals who appear to be slow to accept outside suggestions on treating women's reproductive health conditions.

In a companion part of his survey, Wysoki also asked women about whether the procedure had any effect on sexual function. He said they reported no adverse changes.

Similarly, Dr. Jackeline Gomez-Jorge, assistant professor of clinical radiology, University of Miami, Fla., surveyed her patients regarding sexual function following UFE.

"For the majority of patients, the frequency and strength of orgasm either didn't change of improved after UFE," she said. Her survey included responses from 115 women who returned questionnaires. Vogelzang said the studies by Gomez-Jorge and Wysoki regarding sexual functioning are encouraging but need to be repeated with prospective studies to determine if the procedure improves sexual functioning.

Gomez-Jorge said women seek elimination of fibroids because of bleeding and because the non-cancerous tumors can cause pain during intercourse. "About 200,000 hysterectomies are performed each year because of fibroid problems," she said.

In another related study, Dr. Mahmood Razavi, associate professor of interventional radiology at Stanford (Calif.) University Medical Center, compared outcomes of women who underwent UFE or who had fibroids surgically removed in a procedure known as myomectomy. Myomectomy is a far less extensive procedure than hysterectomy, and it leaves the organs relatively intact.

Relief of pain and bleeding were relieved by both procedures similarly, but women who had UFE didn't spend any nights in the hospital, while the myomectomy patients spent three days in the hospital; the UFE patients required pain killers for about three to four days after surgery compared with a week for the surgery patients; and UFE patients were back at work a week after the procedures, but the myomectomy patients were off work for about a month.

"After several years of offering UFE as an alternative to myomectomy, it's gratifying to finally be able to show that for many women, it is a more appropriate therapy," Razavi said.

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