Disparities In Healthcare: UFE Underutilized Among Women In Rural America
Alicia Armeli

Earlier this year, a large nationwide study investigating the treatment of uterine fibroids showed a startling healthcare disparity. Researchers at the University of Miami Leonard M. Miller School of Medicine found that uterine fibroid embolization (UFE), a minimally invasive, outpatient fibroid treatment performed by interventional radiologists, is underutilized in comparison to hysterectomy—especially in rural and smaller hospitals.1

“Even though UFE was introduced two decades ago, these findings suggest its awareness among patients and even our physician colleagues is very limited,” says Prasoon Mohan, MD, MRCS, Assistant Professor of Interventional Radiology at the University of Miami Leonard M. Miller School of Medicine and the study’s lead author.

Uterine fibroids are the most common noncancerous tumor in women of childbearing age.2 And although some women will never experience fibroid-related symptoms, many will seek treatment for heavy periods, pelvic pain and pressure, painful sexual intercourse, and incontinence.

Dr. Mohan and his team analyzed 2012-2013 data taken from the Nationwide Inpatient Sample (NIS), the largest all-payer inpatient healthcare database in the US.1 By examining billing codes that indicated which treatment women received, the researchers discovered that more than 165,000 hysterectomies were performed than UFE (167,650 vs. 2,470). In rural hospitals, 9.4% of hysterectomies were performed in comparison to only 0.4% of UFE procedures. Moreover, 67.4% of UFE procedures were performed in large hospitals versus a staggering 7.9% performed in small hospitals.

According to the American Hospital Association, rural hospitals—which are typically smaller than urban hospitals—face unique barriers to quality care including long distances to diverse healthcare providers, modest budgets, and not enough doctors.3 These factors can leave rural and smaller hospitals vulnerable and unable to offer high-quality services that reflect current standards of care.3,4

And in some cases, patients who are candidates for minimally invasive procedures may not even be informed of all their options. “Not all patients who seek treatment for fibroids are informed about UFE,” Dr. Mohan explains. “A recent study found that 38% of women who received hysterectomy were not counseled about alternative treatments.”

When patient education is offered, research has shown it impacts an individual’s decision-making process. Multiple studies have suggested that patients who have access to informational tools regarding their options had more knowledge and understanding of their care—and were more likely to choose less invasive treatments.5

“When a patient meets with a specialist, she should inquire about all options for treatment, including UFE, and ask whether she is a candidate for the procedure,” Dr. Mohan continues. “There’s also a lot of free quality information available on the internet, such as Ask4UFE. Self-education by using these resources puts you in a better position to choose your treatment option.”

When seeking out treatment, it’s also important for patients to look for gynecologists who work collaboratively with interventional radiologists. “Specialties that work together toward complementary care can improve patient outcomes,” Dr. Mohan tells Ask4UFE. “In the past, interventional radiologists were utilized on a referral basis only. This has been changing rapidly. Interventional radiology now acts as an independent specialty with direct access to patients and can collaborate with other specialties.”

In addition to UFE awareness at the clinician-patient level, patient education must be a priority throughout the medical and scientific communities. Dr. Mohan notes that whether it’s at the national level with fibroid campaigns, more funding for fibroid research, or increased publicity to make this research known, there’s always room to improve UFE awareness—with the goal of reducing the number of hysterectomies.

Hysterectomy, or the surgical removal of the uterus, is a common treatment for fibroids. It’s so common that the majority of the 600,000 hysterectomies performed each year in the US alone are done to treat fibroids.6,7 Unlike hysterectomy, UFE is an outpatient procedure that only requires a small puncture in the upper thigh or wrist. By guiding a catheter to the uterine arteries, tiny embolic particles are released and block the vessels that lead to fibroids. Deprived of blood, fibroids soften and shrink, causing symptoms to subside. UFE has been found to have an approximate 90% cure rate.8

What’s more, Dr. Mohan and his team found UFE was linked to shorter hospital stays and to be less expensive than hysterectomy.1 “UFE is safe, effective, and minimally invasive. It lets women get back to work and normal life much quicker than surgery,” Dr. Mohan says. “Because of its many patient benefits, it’s important that we continue to increase UFE awareness and find ways to make it more accessible to patients everywhere.”

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR   Prasoon Mohan, MD, MRCS, is an Assistant Professor of Interventional Radiology at the University of Miami Leonard M. Miller School of Medicine. Dr. Mohan’s clinical interests include arterial embolization, interventional oncology, and endovascular aortic aneurysm repair. In addition to his research, Dr. Mohan specializes in Vascular & Interventional Radiology and Diagnostic Radiology at the Sylvester Comprehensive Cancer Center in Miami, Fla.

REFERENCES

  1. S. Narayanan; A. Gonzalez; A. Echenique; P. Mohan. (2017). Nationwide analysis of hospital characteristics, demographics and cost of uterine fibroid embolization [Abstract 106]. University of Miami Miller School of Medicine, Miami, FL. SIR Annual Scientific Meeting, March 4–9, 2017.
  2. National Institutes of Health. (2017). Uterine Fibroids. Retrieved from https://medlineplus.gov/uterinefibroids.html
  3. American Hospital Association. (2011). Trendwatch: The Opportunities and Challenges for Rural Hospitals in an Era of Health Reform. Retrieved from http://www.aha.org/research/reports/tw/11apr-tw-rural.pdf
  4. Rural Health Information Hub. (2015). Rural Hospitals. Retrieved from https://www.ruralhealthinfo.org/topics/hospitals
  5. Stacey, D., Bennett, C. L., Barry, M. J., et al. (2011). Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev, Oct; 5(10): CD001431.
  6. The American College of Obstetricians and Gynecologists. (2015). Frequently Asked Questions Special Procedures: Hysterectomy. Retreived from https://www.acog.org/Patients/FAQs/Hysterectomy
  7. Centers for Disease Control and Prevention. (2017). Data and Statistics: Hysterectomy. Retrieved from https://www.cdc.gov/reproductivehealth/data_stats/index.htm
  8. McLucas, B., Voorhees, W. D., & Elliott, S. (2016). Fertility after uterine artery embolization: a review. Minim Invasive Ther Allied Technol, 25(1): 1-7.

Say Buh-Bye to 10 Period Problems with These Food Tips
Alicia Armeli

The monthly joys of womanhood are here again leaving you feeling less than your best. Approximately four out of five women experience period symptoms like bloating, irritability, and fatigue.1 Hormone fluctuations and changes in brain chemistry during your period can be partly to blame but so can lifestyle factors like diet.

Scroll down to find your common period pains and learn easy food solutions to help get you through the worst of it.

  1. On Edge Like Whoa.

For some of us ladies, having our period means feeling irritable or anxious. Don’t want to blow a fuse at work? Try cutting down on caffeine. Caffeine stimulates your central nervous system, potentially making you feel more agitated. Coffee isn’t the only culprit. Make sure to thoroughly vet your teas and even other brews considered healthy.

  1. Feeling Down.

Mood swings and depression are a common period frustration. One minute you’re fine and the next you’re crying over a copy machine malfunction. Wine at the end of the day may seem like the best way to relax, but alcohol is a depressant and can end up making you feel worse. Instead, treat yourself to a meal of tryptophan-rich foods. Tryptophan is a type of amino acid that converts to mood-stabilizing serotonin in the brain. Foods rich in tryptophan include nuts, chia and pumpkin seeds, eggs, poultry, oats, and fish like tuna and salmon. Salmon also has vitamin D, a necessary nutrient to convert tryptophan to serotonin, whereas pumpkins seeds contain depression-fighting zinc.2

  1. Snoozing At Your Desk.

Feeling tired during your period can be worsened by your meal pattern choice throughout the day. Eating large meals can lead to a carb overload, leaving you feeling sleepy. Instead, keep your blood sugar balanced and energy up by eating smaller meals and snacks throughout your day that are protein-rich and contain complex carbs and healthy fats.

  1. Food Cravings.

We’ve all had food cravings that just won’t quit and usually for the unhealthy stuff. Try for healthier versions and in moderation. If you’re craving fries, try baked sweet potato fries. Are you a chocolate monster? Instead of gobbling down a bag of candy-coated sweets, swap in some dark chocolate instead—a healthier tradeoff that naturally contains mood-stabilizing serotonin. Make sure to eat regularly to avoid being ravenously hungry. Keeping yourself fed can help you make healthy food choices versus grabbing junk food.

  1. Trouble Sleeping.

Try foods that help boost melatonin, a hormone that regulates sleep cycles. Tart cherry juice naturally contains melatonin and has been seen to improve sleep.3 Inside the body, melatonin is derived from the amino acid tryptophan, so having a balanced evening snack with tryptophan-rich foods can help your body make the conversion (refer back to #2 for tryptophan-rich foods).

  1. Acne.

Acne is caused in part by hormone fluctuations during your cycle. But it’s possible to consume food and drink that works with your skin instead of against it. Drinking plenty of water keeps you hydrated and skin moisturized. It also helps to flush toxins and wastes from the body that may contribute to acne. Avoiding sugar, refined carbs (think white pastas and breads), and dairy can also help keep skin clear.

  1. Upset Stomach.

An easy way to sooth an upset belly is to sip calming decaffeinated teas. Teas like ginger, mint, and chamomile can help with tummy distress. Peppermint tea may also help with relieving menstrual cramps.

  1. Bathroom Blues.

Having the period poops (or lack thereof) is the worst. If you find yourself with diarrhea, eating foods rich in soluble fiber (think oats, sweet potatoes without the skin, chia seeds, and bananas) can help. Soluble fiber works as a sponge, absorbing fluid in the gut that contributes to diarrhea.

Fiber can also help constipation. If you’re constipated, try consuming foods rich in insoluble fiber (think whole grains, nuts and seeds, and fruits with the skin). Prune juice is another option that works as a natural laxative. According to the Cleveland Clinic, drinking ½ to 1 cup of prune juice in the morning can help stimulate a bowel movement.4

No matter what ails you, staying hydrated is a must. Drinking eight or more cups of liquid per day is essential. If you have diarrhea, drinking plenty of water and sipping coconut water (with no added sugar) can help replace fluids and electrolytes. If you’re constipated, drinking water works with fiber in your diet to move stool along.

  1. Gassy Girl.

Beat the bloat by first staying away from foods that make you gassy. Foods like cruciferous veggies (think broccoli, kale, and cabbage), beans, and dairy may add to feeling bloated. Sugar, salty foods, and carbonated beverages can also worsen the problem.

It may sound counterintuitive, but drinking plenty of water actually protects against fluid retention. What’s more, eating foods like cucumbers, and potassium-rich foods like bananas, sweet potatoes, watermelon, and butternut squash can help reduce swelling and fluid retention.

  1. Pain in the…

Muscle pain is a common period symptom. Whether it’s menstrual cramps or back pain, magnesium may help relax muscles and relieve pain. Foods rich in magnesium include nuts and seeds, fish, bananas, peas, avocados, and dark chocolate.

  1. Brain Fog.

Your usual cognitive catlike reflexes are now mocking you. But combating brain fog doesn’t have to be a losing battle. It can be as easy as starting your day with a balanced protein-rich meal. Eating breakfast within the first hour of waking can help balance blood sugar levels, keeping your energy up and your brain sharp. Focus on foods rich in brain-boosting nutrients like omega-3s; magnesium; vitamins E, D, C; and the family of B-vitamins. Brain-boosting foods include: walnuts; pumpkin and hemp seeds; avocados; eggs; sweet potatoes; fruits like oranges, bananas, and berries; oats; and plant milks fortified with vitamin D.

Most of us can’t escape period symptoms completely. But knowing how to work with your body during this time of the month can help. If you’re experiencing severe symptoms, visit your doctor and meet with a dietitian to make a specific health plan that’s right for you.

PLEASE NOTE: The above information should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad and volunteering in her community. She is a paid consultant of Merit.

REFERENCES

  1. Association of Reproductive Health Professionals. (n.d.) Menstruation and Menstrual Suppression Survey Fact Sheet: Women & Their Menstrual Cycles. Retrieved from http://www.arhp.org/Publications-and-Resources/Studies-and-Surveys/Menstruation-and-Menstrual-Suppression-Survey/fact-sheet
  2. Lang, U. E., Beglinger, C., Schweinfurth, N., et al. (2015). Nutritional aspects of depression. Cell Physiol Biochem, Sep; 37(3): 1029-1043.
  3. Howatson, G., Bell, P. G., Tallent, J., et al. (2012). Effect of tart cherry juice (Prunus cerasus) on melatonin levels and enhanced sleep quality. Eur J Nutr, Dec; 51(8): 909-916.
  4. Cleveland Clinic. (2014). Nutrition Problems & Their Solutions. Retrieved from https://my.clevelandclinic.org/health/articles/nutrition-problems-and-their-solutions

 

 

July Is Fibroids Awareness Month and We Can Wear White
Alicia Armeli

It’s that time of year again. Across the nation, women are showing up and showing off their chic white dresses. You may think this is an obvious indication that summer has arrived, but this fashion statement carries an even bigger message of female solidarity:

July Is Fibroids Awareness Month and We Can Wear White.

“July by itself is a great month to wear white, but I also have a personal connection to the month. In July 2013, I had 27 fibroids removed,” explains Tanika Gray Valbrun, Founder and Executive Director of The White Dress Project, a non-profit organization dedicated to promoting uterine fibroid awareness. “Having fibroids has been life changing. With my experience came a lot of clarity, and thus The White Dress Project was born.”

If you or someone you know has had uterine fibroids, you’re probably aware of how frustrating and hopeless the condition can be. Fibroids develop in the wall of the uterus, and although noncancerous, these growths can be the cause of relentless periods, pelvic pain, and uncomfortable bloating. Statistics show that more than 80% of black women and nearly 70% of white women will develop fibroids by age 50 and many will seek treatment for relief from bothersome symptoms.1 For these women, wearing a white dress seems nearly impossible.

But defeat was never an option for Mrs. Valbrun and her White Dress Warriors. Instead, the white dress is seen as a symbol of empowerment and persistence. Through fundraising efforts, The White Dress Project has helped to advance fibroid research. It has also worked with our nation’s legislators, declaring July as Fibroids Awareness Month in Maryland, Florida, Washington DC, New York, Pennsylvania, South Carolina, Georgia, and the city of New Orleans. Houston has recently declared July 22nd as Fibroids Awareness Day. This progress has instilled hope in the hundreds of thousands of women battling this all-too-common disease.

“Women can look forward to many great events this year. We’re excited about our Night In White fundraiser on July 13th. This is our biggest fundraiser in DC,” Mrs. Valbrun says. “Women of Houston can also expect a White Dress event on July 22nd that coincides with Houston’s Fibroids Awareness Day.” During these White Dress events, women will have the opportunity to come out dressed to the nines and have their fibroid questions answered as part of what Mrs. Valbrun calls a “Dialogue with the Doctors.” A therapist will be available to address emotional issues surrounding fibroids.

Also in DC, The White Dress Project is partnering up with department stores to host a fashion show where style meets practicality. “We’re always trying to educate women and make a difference in their lives,” Mrs. Valbrun continues. “This year, we’re starting the conversation about what to wear under white. We’ll be showcasing undergarments women can wear to help protect themselves from fibroid-related accidents.”

Probably one of the most noteworthy strides The White Dress Project has made involves its Ambassador Program. Starting out as a way for women to become fibroid advocates across the nation, The White Dress Ambassador Program is now heading overseas. “We’ve been fortunate to gain interest of several supports and sponsors, which has allowed us to take The White Dress Project globally,” Mrs. Valbrun explains. “I’m excited to say we now have an ambassador in South Africa and we’re in the middle of planning a White Dress Project event there this coming fall.”

No doubt, The White Dress Project is living up to its White Dress Pledge to proudly wear white, increase fibroid awareness, and support sisters everywhere who are dealing with fibroids. “We’re continuously creating a space both nationally and now internationally for women to come together and converse,” Mrs. Valbrun says. “We want women to know they’re not alone.”

This month, #JoinTheFight. Because #WeCanWearWhite.

ABOUT THE AUTHOR   Alicia Armeli is a Freelance Writer and Editor, Registered Dietitian Nutritionist, and Certified Holistic Life Coach. She has master’s degrees in English Education and Nutrition. Through her writing, she empowers readers to live optimally by building awareness surrounding issues that impact health and wellbeing. In addition to writing, she enjoys singing, traveling abroad, and volunteering in her community. She is a paid consultant of Merit Medical. 

REFERENCES

  1. Baird, D. D., Dunson, D. B., Hill, M. C., et al. (2003). High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol, Jan; 188(1): 100-107.