Uterine fibroids, non-cancerous muscle tumors in the uterus, affect most American women at some point in their lives. While the majority of cases aren’t symptomatic and therefore don’t require treatment, around 20-25 percent include heavy menstrual bleeding, intense pain, or frequent urination. But as one of the most common health issues for women, and more commonly African American women, the treatment options offered to patients are sometimes more limited—and life-altering—than they should be, say a couple of North Texas physicians.
The National Institute of Health cites over 200,000 hysterectomies performed on fibroids each year, a procedure that involves the removal of the uterus through major surgery and up to six weeks of recovery. Dr. Suzanne Slonim, an interventional radiologist at Precision Vascular & Interventional Radiology in Dallas, says the prevalence of the surgeries are a result of standard medical training—but there are other options.
Slonim is an advocate for uterine fibroid embolization (UFE)—a first procedure that interventional radiologists like herself are marketing directly to patients—which kills off fibroids by blocking their blood supply. It’s a cheaper and less-invasive treatment that resolves all symptoms with a 90 percent success rate. Recovery time is just a week, and Slonim says it’s often overlooked as an option. That’s something she and other interventional radiologists in the area want to change.
“There was an article published in the interventional journal about why gynecologists perform hysterectomy over embolization so frequently, and it’s not that they want to make money, or it’s not that they have any ill intentions,” Slonim says. “It’s just that it does not cross their mind to think of embolization unless the patient brings it up.”
A UFE procedure can be done on an outpatient basis. Once the patient is given sedation, a tube is fed into the artery down to the fibroid’s blood supply. Slonim says she often goes in through the wrist for the patient’s comfort. X-ray dye is used to show where the tube should be placed, and FDA-approved particles are injected to plug the blood supply to the fibroids. Afterwards, pelvic pain can sometimes follow, but the only evidence of the procedure is a small nick in the skin.
“I think a [UFE procedure] gives them a more minimally invasive option to help treat and get their symptoms under control,” says Brian Giles, an interventional radiologist with Radiology Associates of North Texas and the Center for Diagnostic Imaging in Texas. “It gives you an option that’s not as permanent.”
Not all patients are eligible for a UFE. Women who are pregnant, had their symptoms misdiagnosed, or have something unexpected (and rare) like an ovary mass, cannot undergo the procedure.
If a patient still wants to get pregnant, Slonim recommends a myomectomy, a surgery that preserves the uterus. Other treatment options include medications that target hormones to shrink fibroids, an MRI-guided ultrasound procedure that targets them with a beam, and other minimally invasive procedures that use things like heat or cold to destroy the tumors. Slonim argues that other options don’t target all fibroids at once—a concern for patients who want to treat multiple—or don’t completely destroy them.
Both Slonim and Giles say the word has slowly gotten out about UFEs, and that their patient volumes are increasing. But as for what has stopped UFEs from becoming more standard practice, both Giles and Slonim point to a lack of knowledge about their specialization.
“An OBGYN, they deliver babies. A cardiologist treats your heart. An orthopedic surgeon fixes broken bones,” Giles says. “If I say, ‘Hey, I’m an interventional radiologist,’ would you even know what that is or know what I would do?”
Slonim says most people think of a radiologist sitting in a dark room—but, that’s not the case in the sub-specialty of treating fibroids.
“The woman’s health is delivered by the gynecologist, and they’re not very familiar with [UFE],” she says. “UFE is the first procedure that interventional radiologists started marketing directly to patients.”