DG DISPATCH - SCVIR: Women Encounter Negative Response About Uterine Fibroid Embolization
By Robert H. Carlson
Special to DG News

SAN ANTONIO, TX -- March 5, 2001 -- Many gynecologists have a negative opinion about uterine fibroid embolization -- an alternative to surgical hysterectomy for fibroids -- and they actively discourage women from undergoing the procedure, a study shows.

The study was prompted because interventional radiologists -- who perform uterine fibroid embolization (UFE) -- often hear from patients that their doctor discouraged them from the procedure, said Michael G. Wysoki, MD, a clinical assistant professor of Radiology at Yale University School of Medicine in New Haven, Connecticut.

Dr. Wysoki presented the findings at the annual meeting of the Society of Cardiovascular and Interventional Radiology, in San Antonio, Texas.

UFE is a minimally invasive non-surgical procedure that can be used to treat uterine fibroids. The interventional radiologist places a catheter into the woman’s femoral artery through a small incision, and uses radiographic imaging to guide it to blood vessels that supply the uterus. A minute amount of plastic or gel is injected through the catheter into the blood vessel leading to the fibroid, embolizing the fibroid so it shrinks and disappears.

Twenty-one women who underwent UFE later completed questionnaires relating their experiences when they had first seen a gynecologist about fibroids, Dr. Wysoki said.

All 21 gynecologists initially recommended hysterectomy, a procedure performed by gynecologists.

Nineteen women said they initiated discussion of UFE with the gynecologist. Only five of the gynecologists had an initially favorable opinion of UFE, the women said, while 16 were rated as opposed or strongly opposed to the procedure.

Dr. Wysoki said some women described their gynecologists as “belligerent, angry or closed-minded” when asked about UFE. One woman said she had seen 12 gynecologists and not one had mentioned UFE.

Pregnancy is still possible in some women after UFE, and studies show that fibroid symptoms improve in about 90 percent of patients after UFE.

Dr. Wysoki said that seven women reported their gynecologists had changed their opinion about UFE after it was performed, from negative to positive or indifferent.

Nine women said their gynecologists had remained opposed to UFE after the procedure was performed. Interestingly, eight of those nine women said they subsequently changed gynecologists.

"UFE has a patient-driven referral pattern, and gynecologists who portray a negative opinion of it risk losing their patients," Dr. Wysoki said.

Other speakers at this meeting noted that the topic of uterine fibroids is widely discussed on the Internet, with hundreds of Web sites offering information. Many women learn about UFE from the Internet and then ask their gynecologists about it.