Women Would Rather Switch Than Fight With Gynecologist Over Uterine Fibroid Embolization
SAN ANTONIO — Women seeking treatment for uterine fibroids are switching gynecologists if their doctors don't support their decision to have uterine fibroid embolization (UFE), a minimally invasive procedure that is an alternative to hysterectomy. Women also are the ones raising the possibility of the non-surgical alternative rather than being advised about it by their gynecologists, according to a Yale University study released today at the 26th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR).
"We're finding that women are really taking charge of their own destinies and are not totally depending on their gynecologists' opinion," said Michael G. Wysoki, M.D., clinical assistant professor of radiology, section of interventional radiology, Yale University School of Medicine, New Haven, Conn. "The Internet has made the greatest difference, with women doing quite a bit of research online as they explore alternative treatments for fibroids."
Yale researchers surveyed 21 women who had UFE and found 8 of 9 women (89 percent) whose gynecologists remained opposed to the procedure even after it was performed are now seeing other gynecologists. Nineteen of 21 women (90 percent) said they initiated discussion of UFE with their gynecologists. All of the gynecologists initially recommended hysterectomy, a procedure they generally perform. One-third of the more than 600,000 hysterectomies performed each year are for uterine fibroids. After the women asked about alternatives to hysterectomy, 1 gynecologist (5 percent) offered UFE. Although exact numbers were not recorded, some of the gynecologists in the study suggested their patients have myomectomy, a less invasive surgical alternative to hysterectomy for fibroids, with about 35,000 performed each year. Myomectomy also generally is performed by gynecologists.
Only 5 of 21 gynecologists (24 percent) had an initial favorable opinion of UFE, and 16 (76 percent) were opposed or strongly opposed to the procedure. Of those opposed, 7 (44 percent) changed their minds and were indifferent or favorable after the patient had UFE.
"Some of the women described their gynecologists as Œbelligerent' or Œangry and unreasonable' when asked about UFE," said Dr. Wysoki. "Most of our patients are self-referred. It's a shame that more gynecologists either aren't aware of UFE or are unfamiliar with its merits. Studies have shown symptoms significantly improve in up to 90 percent of patients who have UFE and it is now commonly performed, with more than 8,600 procedures in the U.S. alone."
UFE is a nonsurgical procedure in which an interventional radiologist makes a small nick (less than 1/4 inch) in the skin of the groin, places a catheter in the femoral artery and guides it to the uterus while watching the progress of the procedure via a moving X-ray (fluoroscopy). The interventional radiologist then injects small plastic and/or gelatin sponge particles into the vessels supplying blood to the fibroid to cut off the blood flow, or embolize it. The right and left uterine arteries generally are embolized during the procedure.
UFE and Fibroid Facts:
Co-authors of a paper on the topic being presented by Dr. Wysoki are B.P. Byrd, M.D.; K. Onze, R.T.; M. Rosenblatt, M.D.; J. Pollak, M.D.; and C. Burdge, C.N.P.
An estimated 5,000 people are attending the SCVIR Annual Scientific Meeting. The Society, based in Fairfax, Va., is the professional association for physicians who specialize in minimally invasive interventional radiology procedures.
An interventional radiologist is a physician who has special training to diagnose and treat conditions using miniature tools and imaging guidance. Typically, the interventional radiologist performs procedures through a very small nick in the skin, about the size of a pencil tip. Interventional radiology treatments are generally easier for the patient than surgery because most involve no surgical incisions, less pain and shorter hospital stays.
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Copies of 2001 SCVIR news releases are available online at www.pcipr.com/scvir beginning Monday, March 5.
Editor's note: Study numbers are current as of February 19, and may change upon presentation at the SCVIR annual meeting.
General consumer information on interventional radiology is available online at http://www.scvir.org/.