A Limited Embolization Approach: Results of a UFE Fertility Study
Alicia Armeli

Fertility After UFE

More than half of women will develop uterine fibroids by the time they reach 50.1 These noncancerous tumors can be the cause of severe menstrual symptoms, leaving many women searching for a cure. Because fibroids are especially common during a woman’s 30s—a time when many women are trying to conceive—finding a treatment that works and preserves fertility can be a challenge.

Uterine fibroid embolization (UFE), a minimally invasive treatment that shrinks fibroids, significantly improves symptoms in 85%–90% of patients;2 and yet it’s still unclear how this procedure affects fertility. But new research is emerging. A recent French study found that women who had UFE performed by way of a limited embolization technique were able to give birth and showed an encouraging delivery rate following treatment.3

The study, published in European Radiology, evaluated the fertility of 15 women who chose to undergo UFE instead of myomectomy, a procedure that surgically removes fibroids and is performed by a gynecologist.3  Women participating in the study were approximately 35 years of age and had no known infertility factors.

Unlike myomectomy, UFE is performed by an interventional radiologist—a type of doctor who uses specialized imaging equipment to see inside the body and treat disease without surgery. A nick is made in the wrist or groin area to access the blood vessels leading to the uterine arteries. By inserting a thin tube called a catheter into the uterine arteries, tiny particles are then injected and block the fibroids’ blood supply, causing them to shrink and symptoms to subside.

Whether or not UFE should be used as a first-line fibroid treatment for women trying to get pregnant is still debated in the medical community. Concerns over how UFE will affect ovarian reserve—the ovaries’ ability to produce viable eggs—and the uterine lining as well as uterine muscle tissue have been expressed.3  Because of this, UFE is commonly recommended as a second-line treatment or for women who are not candidates for myomectomy.3

Taking into consideration these concerns and to better support future fertility, the researchers of this study used a fertility-sparing technique that specifically targets vessels only surrounding the fibroids but spares nearby normal myometrial arteries, or the arteries that flow to unaffected smooth muscle tissue of the uterine wall. “Women without infertility factors suffering from symptomatic fibroids were durably treated by a limited fertility-sparing [UFE] and experienced a substantial rate of subsequent fertility,” the researchers write. “For women choosing [UFE] over abdominal myomectomy, childbearing may not be impaired.”3

During the year following UFE, nine women who were actively trying to conceive had five babies.3  After about three and a half years, data show eight women gave birth to 10 babies.

Ovarian reserve was also tracked as well as uterus size and quality of life after the procedure. The researchers found that ovarian reserve remained stable, fibroid symptoms improved by 66%, and uterine size was reduced by 38%.3  Completed questionnaires showed that quality of life scores improved by 112%. Five women experienced recurring symptoms, needing further treatment.

Despite the positive results seen, the authors also noted that because only select vessels are embolized when using this technique—unlike with traditional UFE—there might be a risk for symptom recurrence in the future, requiring a second treatment.3  In this study, however, UFE was seen to control fibroid symptoms and preserve fertility, allowing women to complete their families.

At this time, myomectomy is often recommended as the fibroid treatment for women wanting to conceive, and the researchers note that more studies are needed before UFE can be recommended as a first-line treatment.3 But this study provides hope and another potential option for women who need immediate relief from fibroid symptoms and who want to retain their fertility.

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. She is a paid consultant of Merit Medical.

 REFERENCES

  1. Office on Women’s Health, U.S. Department of Health and Human Services. (2019, Apr 1). Uterine Fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
  2. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675–
  3. Torre, A., Fauconnier, A., Kahn, V., et al. (2017). Fertility after uterine artery embolization for symptomatic multiple fibroids with no other infertility factors. Eur Radiol, Jul;27(7):2850–
Phthalate Exposure Linked to Increased Uterine Volume in Women with Fibroids
Alicia Armeli

Fibroids and Phthalate

It’s officially Women’s Health Week, a full seven days dedicated to your well-being. While this may conjure images of joining a gym or eating more fruits and vegetables, a chance to be healthier could also be sitting right on your bathroom counter: beauty products.

Instagram feeds are full of them and we, as women, can’t seem to get enough. There’s no denying how, even on the worst of days, a brand-new bottle of nail polish or shampoo can make anything seem possible.

But there’s a downside to using many of the beauty and personal care products we see on the market today. A widespread chemical ingredient called phthalates used in hundreds of products may be linked to an increased burden of uterine fibroids,1 a common noncancerous tumor of the female reproductive tract that can cause heavy periods, pelvic pain, and other serious symptoms.

Phthalates, also called plasticizers, are a group of chemicals used to make plastics more flexible; some phthalates are also used as solvents or dissolving agents.2 Along with being found in obvious products, such as vinyl flooring, plastic clothing (raincoats), and plastic food and beverage containers, phthalates are also found in personal care products, such as soaps, shampoos, hair spray, nail polish, deodorant, and perfume.2,3 Phthalates found in personal care items are commonly a fragrance ingredient used to help prolong the scent of the product.4 The ones typically used in these products (and in plastic food and beverage containers) are known as DBP, DEP, DEHP, and DMP.3

According to the Centers for Disease Control and Prevention, human health effects from exposure to low levels of phthalates are unknown, but animal studies have shown some types of phthalates to affect the reproductive system.2 It’s also important to know that reports have shown adult women to have higher levels of urinary metabolites than men for phthalates that are used in shampoos, soaps, body washes, cosmetics, and other personal care products.2

Research examining the possible link between phthalate exposure in women and uterine fibroid burden was published in a recent issue of Fertility and Sterility.1 The study included 57 premenopausal women undergoing either hysterectomy (surgical removal of the uterus) or myomectomy (surgical removal of fibroids) for fibroid treatment. Researchers checked urine samples for 14 phthalate biomarkers and used patient medical records to find the diameter of the largest fibroid as well as uterine size. Factors like fibroid size and number can enlarge the uterus.5

Results showed that higher concentrations of phthalates, especially for individual DEHP metabolites (MEHHP, MEOHP, MECPP), ∑DEHP, and ∑AA phthalates, were linked to an increase in uterine volume.1 Researchers found that twice the ∑DEHP and ∑AA phthalates was associated with a 33.2% and 26.8% increase in uterine volume, respectively. They found few associations between phthalate biomarkers and fibroid size.

Although this was a preliminary study and more research is needed to verify the relationship between phthalates and fibroids, there are steps you can take to reduce your phthalate exposure around the home:3,4

Read labels. Avoid products with “fragrance” or “perfume” ingredients. Go for “phthalate-free” or “no-synthetic fragrance” products instead.

Check your plastic. When using plastic bottles, numbers 3 and 7 may have phthalates. Avoid plastic wrap made from PVC.

Switch to glass. Recycle your plastic food containers and invest in glass and/or stainless steel containers and water bottles. If using plastic, never microwave it. Heat allows chemicals to transfer from the plastic into your food or drink.

Go organic. Eat more organic food items, especially fruits and vegetables. Try to eat less food packaged in plastic.

Filter your water. Purchase a home water-filtration system that removes phthalates.

Exercise more.  Phthalates stored in the body could be excreted in sweat.

Until we know more about how phthalates affect our bodies and reproductive systems in particular, hold onto your credit card the next time you see that must-have beauty product. A little patience and research can go a long way.

REFERENCES

  1. Zota, A. R., Geller, R. J., Calafat, A. M., et al. (2019). Phthalates exposure and uterine fibroid burden among women undergoing surgical treatment for fibroids: A preliminary study. Fertil Steril, Jan;111(1):112-121.
  2. Centers for Disease Control and Prevention. (2017, Apr 7). Phthalates factsheet. Retrieved from https://www.cdc.gov/biomonitoring/Phthalates_FactSheet.html
  3. Kahn, J. (2019). 5 new reasons to avoid phthalates + how to limit your exposure. Retrieved from https://www.mindbodygreen.com/0-24825/5-new-reasons-to-avoid-phthalates-how-to-limit-your-exposure.html
  4. Made Safe. (n.d.). #ChemicalCallout: Phthalates. Retrieved from https://www.madesafe.org/science/hazard-list/phthalates/
  5. Fibroid Treatment Collective. (2016, May 6). Noticing a stomach bulge? You may have fibroids. Retreived from https://fibroids.com/blog/noticing-stomach-bulge-may-fibroids/
Why Women with Fibroids Should Take Anemia Seriously
Alicia Armeli

Anemia

If you have fibroid-related heavy periods, you’re probably no stranger to feeling spent. And we’re not talking about the type of fatigue that comes with not having enough hours in the day.

We’re talking about menstrual-related anemia. In fact, nearly half of women who suffer from both heavy periods and menstrual-related severe anemia were also found to have fibroids.1

Let that sink in.

Anemia may be “the norm” among women with fibroids, but it shouldn’t be, and it’s not a condition that can be ignored. Left untreated, abnormal menstrual bleeding to the point of becoming anemic can lead to many other health complications. The good news is iron-deficiency anemia is treatable and even preventable.

The type of anemia associated with abnormally heavy or prolonged menstrual bleeding is called iron-deficiency anemia. According to the National Heart, Lung, and Blood Institute, iron-deficiency anemia happens when you don’t have enough iron in your body to make healthy red blood cells.2 Without adequate iron, you can’t produce hemoglobin, a part of the red blood cell needed to carry oxygen throughout your body.3

Bleeding heavily during your period can make you lose blood cells and iron faster than your body can replace.3 As your body tries to make more hemoglobin, it uses up your iron stores.4 This process can increase your risk of iron-deficiency anemia.4

Knowing whether or not you have iron-deficiency anemia can be tricky. At mild or moderate stages, symptoms may not even show.2 At this point, many women who are anemic don’t even know it.

But as iron-deficiency anemia progresses, common signs and symptoms to look for include tiredness, weakness, dizziness, pale skin, and shortness of breath.3 Find a list of symptoms here. Left untreated, iron-deficiency anemia puts extra strain on the heart and can result in serious health complications, such as heart failure.2,3

If you think you may have iron-deficiency anemia caused by heavy periods, the road to recovery starts with talking to your doctor. This can help you receive a proper diagnosis for the anemia and get to the root of your heavy periods, so you can receive the right treatment.

In addition to treating the cause of heavy bleeding, your doctor will also take steps to treat your anemia. Depending on the severity, iron-deficiency anemia treatments may include doctor-prescribed iron supplements, intravenous (IV) iron therapy, or a blood transfusion.2

With your doctor’s guidance, preventative measures may also be recommended, such as making the following easy changes to your diet:3

Eat more iron-rich foods. Good sources of iron include lean meats, dark, leafy greens, and beans.

Incorporate vitamin C-rich foods that help with iron absorption, including citrus fruits (oranges and grapefruits), berries (strawberries, raspberries, blueberries), broccoli, and green peppers.5 Find a list of vitamin C-rich foods here.

Avoid coffee or tea with meals. These beverages can inhibit iron absorption.

Eat a balanced diet. Healthy food choices will help you get the nutrients needed to prevent iron-deficiency anemia.

Tell your doctor about any and all supplements you’re taking. Some supplements, like calcium, make it difficult for your body to absorb iron, whereas taking iron supplements without the guidance of a medical professional may result in getting too much iron, which can also be dangerous. Work with your doctor to find the best way to get the vitamins and minerals you need to be healthy.

Don’t ignore heavy periods that zap your energy. Get your life back by working with your doctor to find the right treatment for you.

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 well-being. She is a paid consultant of Merit Medical.

REFERENCES

  1. Nelson, A. L., & Ritchie, J. J. (2015). Severe anemia from heavy menstrual bleeding requires heightened attention. Am J Obstet Gynecol, Jul;213(1):97.e1-97.e6.
  2. National Heart, Blood, and Lung Institute. (n.d.). Iron-deficiency anemia. Retrieved from https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia
  3. S. Department of Health and Human Services Office on Women’s Health. (2019, Apr 1). Iron-deficiency anemia. Retrieved from https://www.womenshealth.gov/a-z-topics/iron-deficiency-anemia
  4. Mayo Clinic. (n.d.). Menorrhagia. Retrieved from https://www.mayoclinic.org/diseases-conditions/menorrhagia/symptoms-causes/syc-20352829
  5. S. National Library of Medicine. (2017, Jan 1). Vitamin C. Retrieved from https://medlineplus.gov/ency/article/002404.htm
UFE Doesn’t Affect Ovarian Reserve in Women Under 40, Study Suggests
Alicia Armeli

A woman’s AMH levels

Uterine fibroids are frequently seen in the later reproductive years, especially during a woman’s 30s and 40s.1 These noncancerous tumors may not be an issue, but they can be the cause of serious symptoms, such as pelvic pain, heavy periods, and urinary frequency. For many of these women, finding a cure that also preserves fertility is important. A recent study found that uterine fibroid embolization (UFE)—an effective minimally invasive treatment—doesn’t impact ovarian reserve in women younger than 40 years as once believed but instead may be considered an option without concern for it negatively affecting fertility.2

Click here to watch how UFE treats fibroids.

The study, published earlier this year in Minimally Invasive Therapy & Allied Technologies, discussed the effects of UFE on ovarian reserve as measured by Anti-Müllerian hormone (AMH) levels—a marker that reflects ovarian reserve or the ovaries’ ability to produce good-quality eggs.2 Diminished AMH, and thereby ovarian reserve, is believed to be a cause of infertility.

Earlier research suggested that UFE caused diminished AMH levels and shouldn’t be performed on women who want children.3 But this finding was based on data collected from women who were of an average age of 45—relatively older in comparison to many women who desire future pregnancy.

“We studied women under the age of 40,” says Bruce McLucas, MD, board certified gynecologist, founder of Fibroid Treatment Collective, a medical group of fibroid experts dedicated to curing fibroids with minimally invasive therapy, and the study’s lead author. “Over the age of 40, statistically, it’s more likely that any number of factors could impact infertility.” Factors, according to Dr. McLucas, include anovulatory cycles and diminished egg quality—both of which can happen with age and negatively affect fertility.

Dr. McLucas and his team observed 89 women aged 23-40 years who underwent UFE for treatment of symptomatic fibroids.2 Hormone levels were measured before and after the procedure. Results confirmed that AMH levels decreased with age but that UFE didn’t contribute to this natural decline. Thirty-two patients consented to multiple blood draws over the course of almost four years post-UFE. The researchers found that UFE didn’t negatively affect ovarian reserve over the long term.

“We controlled for the fact that, for example, at age 30 a woman’s AMH levels are going to be higher than at 32 and so on,” Dr. McLucas explains. “We looked at the age patients had UFE and then again years later. According to initial pre-UFE AMH levels, after the procedure we saw a falloff that continued through all the premenopausal years. Overall our data showed a decline that reflected somebody who had not had UFE.”

This was the case for over 60% (54 patients) of the women who participated in the study.2  An even bigger finding was that AMH levels actually increased in 36% (32 patients) of the women tested. AMH levels remained unchanged in the remaining 3% (3 patients).

“The fact that AMH levels increased in a third of patients, despite the tendency for those people to have a lower AMH with age, is really a very positive finding,” Dr. McLucas tells Ask4UFE. “In our patient population, there was a lot more variability than we thought for any age.”

For younger patients, under the age of 40, UFE may be an effective option because the procedure shrinks fibroids that could otherwise be responsible for pregnancy complications, such as premature birth and increased risk of caesarian section.

“The uterus survives UFE because of collateral circulation,” says Dr. McLucas. “Even though the vessels that feed the fibroids are treated, there are plenty of other blood vessels that supply the uterus that aren’t affected. Leaving the uterus intact allows many women to have a vaginal delivery.” Almost half (48%) of women in the study became pregnant, with most carrying to term and delivering healthy babies.2

For women in their 40s, UFE can still effectively treat fibroids, but research shows there’s a risk (7%) of premature menopause. Of these women who lost menstruation, 86% were older than 45. “This occurrence doesn’t seem to affect the younger population,” Dr. McLucas continues. “As a woman approaches menopause, the ovarian blood supply becomes more fragile. Everyone is different. In our practice, nobody under the age of 46 has had a cessation of menses after UFE.”

This advantage may prove to be an asset for younger women who aren’t quite ready to start a family but need fibroid symptom relief. “These are the women who I think benefit the most from UFE,” Dr. McLucas says. “After myomectomy, doctors tell patients the traditional golden period to try and get pregnant is within six months. Wait any longer than that, and you run the risk of new fibroids growing. UFE offers long-term relief from severe symptoms. Women often wait as long as five or six years to have a pregnancy after UFE and without any fibroid regrowth.”

Research in favor of UFE’s ability to treat symptoms and preserve fertility is growing. This is another advancement in women’s health that moves us in the direction of better fibroid care.

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 well-being. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR   Bruce McLucas, MD, is a board certified gynecologist and founder of Fibroid Treatment Collective, a medical group of fibroid experts dedicated to curing fibroids with minimally invasive therapy. Fibroid Treatment Collective was the first group to perform UFE in the U.S., and Dr. McLucas was the first OB/GYN qualified to perform UFE nationally. Since then he’s performed over 8,000 UFE procedures and has dedicated much of his career to UFE education and outreach. Dr. McLucas trains other doctors in UFE and lectures around the globe.

REFERENCES

  1. S. Department of Health & Human Services, Office on Women’s Health. (2018, Mar 16). Uterine fibroids. https://www.womenshealth.gov/a-z-topics/uterine-fibroids
  2. McLucas, B., Voorhees, W. D., & Snyder, S. A. (2018). Anti-Müllerian hormone levels before and after uterine artery embolization. Minim Invasive Ther Allied Technol, Jun;27(3):186-190.
  3. Tulandi, T., Sammour, A., Valenti, D., et al. (2002). Ovarian reserve after uterine artery embolization for leiomyomata. Fertil Steril, Jul;78(1):197-198.
Can UFE Treat Pedunculated Subserosal Fibroids?
Alicia Armeli

Pedunculated Subserosal Fibroid UFE

Uterine fibroid embolization (UFE) is a well-established, minimally invasive fibroid treatment that’s recommended for select women who want to retain their uterus. Improving -related symptoms in 85%­­­­­–90% of women treated, UFE targets fibroids of different sizes and locations in the uterus, relieving symptoms like heavy periods, pelvic pain, and urinary dysfunction.1 Watch a helpful video about how the UFE procedure works.

And yet, despite these advantages, whether UFE should be used to treat pedunculated subserosal (PS) fibroids—a type of fibroid that grows on a stalk on the outer uterine wall—is still debated. Research has shown a very low risk—only three major complications related to treating PS fibroids with UFE have been reported2-4 —that involves a PS fibroid separating from the uterus, causing infection and subsequent sepsis if not naturally discharged from the body.5 To better address concerns, researchers at Yonsei University College of Medicine in Seoul, Korea, evaluated UFE’s treatment of PS fibroids and found it to be safe and effective even in cases considered high risk.5

“More data on [UFE] for PS [fibroids] may help in making better treatment recommendations,” the researchers write in the Journal of Vascular and Interventional Radiology study.5

The 9-year study enrolled 55 women with PS fibroids who underwent UFE.5 Researchers labeled each PS fibroid by risk, depending on the thickness of the fibroid stalk: High-risk PS fibroids have thinner stalks, whereas low-risk PS fibroids have thicker stalks. Three months following UFE, the women had MRIs to measure how well the procedure worked. Any complications were also noted.

Results showed that over 96% of the women experienced symptom improvement.5 Minor complications occurred in three women and included fibroid expulsion—or the passing of fibroids from the body—and temporary pelvic pain. None of the women had major complications related to PS fibroids.

“This report dismisses the commonly held idea that [UFE] in patients with PS fibroids is associated with unique and significant risk of complications,” the researchers conclude. “[UFE] is safe and effective even in PS [fibroids] having extremely narrow stalks.”5

Because this study had a relatively short follow-up period of 3 months, “the university maintains a website where patients can report complications over the long term. However, the researchers note that complications related to PS fibroids haven’t been reported.

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. She is a paid consultant of Merit Medical.

REFERENCES

  1. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: A focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  2. Braude, P., Reidy, J., Nott, V., et al. (2000). Embolization of uterine leiomyomata: Current concepts in management. Hum Reprod Update, Nov-Dec;6(6):603–608.
  3. Tropeano, G., Amoroso, S., Di Stasi, C., et al. (2014). Incidence and predictive factors for complications after uterine leiomyoma embolization. Hum Reprod, Sep;29(9):1918–1924.
  4. Ravina, J., Aymard, A., Ciraru-Vigneron, N., et al. (1998). Embolisation artérielle particulaire: Un nouveau traitement des hémorragies des léiomyomes utérins. Presse Med, 27(9):299–303.
  5. Kim, Y. S., Han, K., Kim, M. D., et al. (2018). Uterine artery embolization for pedunculated subserosal leiomyomas: Evidence of safety and efficacy. J Vasc Interv Radol, Apr;29(4):497-501.

Meet UFE Pioneers Who Are Still Fighting for Your Uterus
It's been more than two decades since the first UFE, and the fight for awareness continues.

UFE Fibroid Pioneers Header

More than 20 years ago, the first uterine fibroid embolization (UFE) was performed in the U.S. for the treatment of uterine fibroids.1 Although an effective alternative to hysterectomy, this uterine-sparing, minimally invasive option was first met with some skepticism by the medical community. Since then, UFE has grown in popularity—but not without a fight.

Even today, uterine fibroids remain the number one reason women have a hysterectomy.2,3 To understand the struggle to get UFE on the list of possible treatment options for more women who suffer with fibroids, we spoke with two interventional radiologists who’ve advocated for UFE since day one.

“My initial experience with UFE was in the late-1990s working with the group of doctors at UCLA who first started performing the procedure,” explains Richard A. Reed, MD, interventional radiologist at Huntington Hospital in Pasadena, Calif. “Women were coming from all over the country, even outside of the country, to be treated. They wanted to avoid hysterectomy at all costs.”

UFE was a real game-changer for women who were told surgery was their only option for relief. Unlike hysterectomy that surgically removes the entire uterus, UFE allows women to be treated through a tiny puncture in the groin area. And currently, access site options have expanded to include being treated via the wrist.

Under conscious sedation, the UFE procedure begins with a doctor called an interventional radiologist inserting a catheter (thin tube) into the access site. Using specialized x-ray equipment, the catheter is guided to the uterine arteries that supply fibroids with blood. Tiny particles are then released that block blood flow to the fibroids, causing them to shrink over time and symptoms like heavy, painful periods to resolve.

“My actual first experience with UFE was as a patient. I was one of the first UFE patients at University of Southern California in 2001. After UFE, my symptoms resolved and never recurred,” recalls M. Victoria Marx, MD, FSIR, professor of clinical radiology at the Keck School of Medicine of University of Southern California in Los Angeles, Calif., and president of the Society of Interventional Radiology (SIR). “Shortly after that is when I performed my first UFE, and I’ve treated many patients over the years.”

As time went on, UFE was gaining awareness but was still viewed by the general medical community as new and investigative. This unfamiliarity often led to health insurance companies denying patients coverage for the procedure. “Many women were willing to pay cash to have the procedure done,” Dr. Reed tells Ask4UFE. “To help these patients, I met with the boards of several insurance companies who made decisions about whether procedures were considered investigational. Fortunately, around the early 2000s, most insurance companies were covering the procedure.”

According to both doctors, another major resistance point came from gynecologists. Along with hysterectomy, gynecologists are trained to perform myomectomy, a procedure that surgically removes fibroids from the uterus. UFE, on the other hand, is only performed by interventional radiologists, who specialize in nonsurgical procedures that treat disease by targeting specific blood vessels.

“For conditions like fibroids, the traditional source of information is a woman’s gynecologist, with whom she typically has a long relationship,” Dr. Marx says. “It has been a challenge because UFE is a treatment for a gynecologic condition that has come out of a completely different field of medicine.”

In 2008 the American College of Obstetricians and Gynecologists released a statement based on long- and short-term data that said UFE is a safe and effective option for women who want to keep their uteri and who are appropriate candidates for the procedure.4 According to Dr. Reed, despite this statement and its numerous clinical benefits, some gynecologists still don’t inform their patients about UFE.

To reach the patient community directly, interventional radiologists often get creative in their approach. Along with community women’s health talks, Dr. Marx and Dr. Reed used the power of the media to spread the word. “Our hospital worked with the LA Times and other local papers to do articles about the procedure,” Dr. Reed recalls.

“At the time, I was chairman of the SIR public relations committee, and I called our public relations consultant,” Dr. Marx adds. “She put me in touch with The Today Show, and I appeared with Katie Couric talking about UFE. It wasn’t all streaming like it is today, but UFE did get national airtime.”

And national airtime it deserved. UFE is a uterine-sparing, outpatient procedure that improves fibroid-related symptoms like heavy periods, pelvic pain, and urinary dysfunction—all with a nearly 90% success rate.5 In comparison to hysterectomy, UFE has virtually no blood loss and allows women to recover faster with a lower complication rate.6 Although the UFE procedure itself has changed little over the years, advances in pain management protocol and imaging techniques have only furthered UFE’s reputation as an effective, minimally invasive fibroid treatment option.

Given these advantages, it’s shocking to see that 600,000 hysterectomies are performed annually in the US, with the majority done to treat fibroids.2,7 What’s more, a recent Harris Poll surveying over 1,100 women found that among those diagnosed with fibroids, a staggering 44% had never heard of UFE.8 “We need to continue to educate women through community health talks and encourage gynecologists to offer UFE as an option,” Dr. Reed says. “When comparing fibroid-related symptom relief, UFE is comparable to the surgical options.”

“The ideal setting is where doctors of all specialties work together, offer all options, and advise the patient on which treatment is best for her,” Dr. Marx continues. “UFE is a highly researched fibroid treatment. It’s very effective and can help women get back to their normal lives with minimal down time.”

Although the road to widespread UFE awareness has been long, progress is being made. Large studies comparing the long-term clinical outcomes of UFE and different fibroid treatment options have provided valuable information. For example, 10-year outcomes of the EMMY Trial, a landmark trial that compared UFE with hysterectomy, showed that health-related quality of life after both procedures remained comparably stable and that in about two thirds of patients treated with UFE, a hysterectomy was avoided.9

A national registry to collect information from women undergoing fibroid treatment is also currently underway. Conducted by researchers at Duke University, “Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF),” is following 10,000 women from nine medical centers in the U.S. for about three years as they make decisions about their fibroid treatment.10 Researchers will use the registry information to compare treatment options and their ability to provide symptom relief, preserve reproductive function, and achieve patient needs and preferences.11 The goal is to help patients and clinicians make informed decisions about fibroid treatment.10

Given this progress, perhaps over the next 20 years, the vision of doctors working together to offer women the best fibroid care can become a reality.

 ABOUT THE DOCTORS

Victoria Marx, MD, FSIRis a professor of clinical radiology at the Keck School of Medicine of University of Southern California in Los Angeles, Calif., and president of the Society of Interventional Radiology (SIR). In addition to these positions, Dr. Marx leads an active clinical practice where collaboration of fibroid care is offered.

 Richard A. Reed, MD, is an interventional radiologist at Huntington Hospital in Pasadena, Calif. One of the first physicians in the US to perform UFE, Dr. Reed advocates for UFE public awareness and works to ensure women know all their fibroid treatment options.

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. She is a paid consultant of Merit Medical.

REFERENCES

  1. Goodwin, S. C., Vedantham, S., McLucas, B, et al. (1997). Preliminary experience with uterine artery embolization for uterine fibroids. J Vasc Interv Radiol, Jul-Aug;8(4):517-526.
  2. The American College of Obstetricians and Gynecologists. (2015, Mar). Hysterectomy. Retrieved from https://www.acog.org/Patients/FAQs/Hysterectomy
  3. Broder, M. S., Kanouse, D. E., Mittman, B. S., et al. (2000). The appropriateness of recommendations for hysterectomy. Obstet Gynecol; 95:199-205.
  4. The American College of Obstetricians and Gynecologists. (2008, Aug). ACOG Practice Bulletin—Alternatives to Hysterectomy In the Management of Leiomyomas. Retrieved from http://www.mintir.com/page/pop_page1.pdf
  5. Silberzweig, J. E., Powell, D. K., Matsumoto, A. H., et al. (2016). Management of uterine fibroids: a focus on uterine-sparing interventional techniques. Radiology, Sep;280(3):675-692.
  6. Spies, J. B., Cooper, J. M., Worthington-Kirsch, R., et al. (2004). Outcome of uterine embolization and hysterectomy for leiomyomas: Results of a multicenter study. Am J Obstet Gynecol, Jul;191(1):22-31.
  7. Centers for Disease Control and Prevention. (2017, Nov 20). Data and Statistics (Hysterectomy). Retrieved from https://www.cdc.gov/reproductivehealth/data_stats/index.htm
  8. Society of Interventional Radiology. (2017, Aug 29). The Fibroid Fix: What Women Need to Know. Retrieved from https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/patient-center/fibroid/sir_report_final.pdf
  9. de Brujin, A. M., Ankum, W. M., Reekers, J. A., et al. (2016). Uterine artery embolization vs hysterectomy in the treatment of symptomatic uterine fibroids: 10-year outcomes from the randomized EMMY trial. Am J Obstet Gynecol, Dec;215(6):745.e1-745.e12.
  10. Comparing Options for Management: Patient-Centered Results for Uterine Fibroids (COMPARE-UF). (n.d.). Home. Retreived from http://www.compare-uf.org
  11. 11. U.S. National Library of Medicine. (2018, Feb 22). Patient Centered Results for Uterine Fibroids (COMPARE-UF). Retrieved from https://clinicaltrials.gov/ct2/show/NCT02260752

5 Self-Care Tips for Women with Uterine Fibroids

Practicing self-care is essential for a woman’s mental, emotional, and physical well-being. And yet, a recent Jean Hailes Women’s Health Survey found that more than one in four women aged 36-50 don’t get enough time to themselves each month.1 Between demands at work and home, finding that “me time” can be tough. It gets even more complicated if you’re a woman with uterine fibroids—a condition where the concept of self-care extends far beyond the occasional candlelit bath.

Uterine fibroids are the most frequently seen tumors of the female reproductive system.2 They become more common as women age, especially during the 30s and 40s through menopause—a time when self-care is so often placed on the back burner.3 It’s predicted that by age 50, up to 80% of women will develop fibroids.3

We sat down with Linda Bradley, MD, OB/GYN and professor of surgery, vice chair of the OB/GYN & Women’s Health Institute, and director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio, to discuss self-care tips that can keep women with fibroids healthy.

1. See Your Gynecologist Regularly

According to Dr. Bradley, this piece of advice is for all women with fibroids—with or without symptoms. “Staying in contact with your gynecologist will help monitor your fibroids and the development of any symptoms,” Dr. Bradley explains. “For women already with symptoms, it’s a good idea to see your gynecologist regularly to talk about improvement, no improvement, or worsening of symptoms.”

Open dialogue between gynecologists and patients can help to establish a partnership in care, which is especially important when discussing all available fibroid treatment options.

2. Keep a Symptom Journal

Fibroids are most commonly known for heavy, prolonged periods. As fibroids grow, a woman may also notice her belly getting larger. This growth can press on surrounding organs, like the bowel and bladder, resulting in constipation or urinary frequency. Other symptoms may include a chronic watery discharge and fertility issues.

Symptom journaling is a useful tool that can help a woman keep track over time of how she feels. By journaling symptoms with dates, it’s easier to be clear with your gynecologist about what you’re experiencing. “It’s important to notice trends,” Dr. Bradley clarifies. “If a woman has noticed her periods lasting longer or that she’s having increased discomfort and missing work, taking a moment to journal those dates and changes can help her be more objective with her doctor.”

3. Get Creative in the Kitchen

With blogs floating around encouraging women with fibroids to eat this and not that, it can get a bit confusing. Research has shown that eating a diet high in fruits and vegetables may be protective against fibroids—but to date we don’t have studies that definitively support any particular diet as a clear path to fibroid prevention or cure.4,5 “To put it simply, a healthy diet is good for everyone,” Dr. Bradley says.

Taking time to prepare a nutritious meal can count as self-care for both body and mind. Not only does cooking healthy meals at home help to ensure a diet full of the nutrients your body needs, it can also serve as a major stress reliever. Culinary therapy, or harnessing the calming therapeutic power of cooking, is now being used as part of treatment plans for conditions like anxiety and depression.6 And the best part? After all of the mindful meal prep, there’s always a delicious and nutritious meal that follows.

4. Move Your Body

Just like carving out the time to cook healthy meals, engaging in regular exercise can be a self-care practice that may help women with fibroids in several ways.

“Exercise may help with pain, cramping, and bloating,” Dr. Bradley says. “It can also help maintain a healthy weight.” Research suggests that being obese or overweight may potentially increase the risk of fibroids, so when it comes to weight management, both diet and exercise are important.

5. Find Ways to Reduce Stress

In addition to the physical symptoms fibroids may cause, the emotional toll they take can be a lot to handle and may impact other areas of well-being. “Fibroids can be quite symptomatic, and the stress that may follow can lead to poor sleep hygiene,” Dr. Bradley explains. “Without good sleep, it can be difficult for patients to deal with life’s uncertainties.”

Lack of sleep and the inability to cope may then contribute to an ongoing cycle of stress.

The American Institute of Stress explains in a recent blog that not getting enough sleep puts the body under additional stress, triggering an increase in stress hormones during the day.7 To help stay balanced, Dr. Bradley encourages self-care routines that include mindfulness practices, such as yoga, spirituality, and therapy.

Above all, it’s essential to notice if your periods are the source of your stress. “Menstruation can be a nuisance, but it should never interrupt a woman’s life or cause social embarrassment with bleeding through clothing. That’s not normal,” Dr. Bradley explains. “Patients get used to tolerating symptoms, but normal cycles shouldn’t derail your activities. It’s important to talk with your doctor to understand what’s normal and seek out the right care.”

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 well-being. She is a paid consultant of Merit Medical.

ABOUT THE DOCTOR  Linda Bradley, MD, is an internationally recognized gynecologic surgeon, professor of surgery, vice chair of the OB/GYN & Women’s Health Institute, and director of the Center for Menstrual Disorders, Fibroids, and Hysterscopic Services at the Cleveland Clinic in Cleveland, Ohio. As founder of the Celebrate Sisterhood program, Dr. Bradley is dedicated to empowering multicultural women to take charge of their health and embrace self-care.

REFERENCES

  1. Jean Hailes for Women’s Health. (2018). Women’s health survey 2018. Retrieved from https://jeanhailes.org.au/contents/documents/News/Womens-Health-Survey-Report-web.pdf
  2. UCLA Health. (n.d.). Fibroids. Retrieved from http://obgyn.ucla.edu/fibroids
  3. S. Department of Health & Human Services, Office on Women’s Health. (2018, Mar 16). Uterine fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
  4. Chiaffarino, F., Parazzini, F., La Vecchia, C., et al. (1999). Diet and uterine myomas. Obstet Gynecol, Sep;94(3):395-398.
  5. He, Y., Zeng, Q., Dong, S., et al. (2013). Associations between uterine fibroids and lifestyles including diet, physical activity and stress: A case-control study in China. Asia Pac J Clin Nutr, 22(1):109-117.
  6. Wasmer Andres, L. (2015, May 19). Kitchen therapy: Cooking up mental well-being. Retrieved from https://www.psychologytoday.com/us/blog/minding-the-body/201505/kitchen-therapy-cooking-mental-well-being
  7. The American Institute of Stress. (2018, Jul 9). 10 tips to boost your vitamin Z—sleep strategies. Retrieved from https://www.stress.org/10-tips-to-boost-your-vitamin-z-sleep-strategies/

The content in this article is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of a qualified physician regarding any medical questions or conditions. 

Radiologists Travel to Kenya to Provide Women with Life-Saving UFE


It’s well documented in medical literature that women of African descent develop uterine fibroids five to six years earlier and are more than 5 times as likely to have severe symptoms than Caucasian women of a similar family history.1

With the increasing number of women requiring fibroid treatment, hospitals in Kenya have welcomed international doctors to treat their patients with uterine fibroid embolization (UFE).

In July 2018, Dr. Darren Klass, interventional radiologist with Vancouver Coastal Health in Vancouver, British Columbia, Canada, traveled to Kenya with Merit Medical Systems Inc.—sponsor of Ask4UFE—to educate Kenyan gynecologists and radiologists on this uterine-sparing, minimally invasive option. By providing one-on-one UFE training to gynecologists—the doctors responsible for referring patients to radiologists for treatment—they can start recommending and providing this option to their patients.

In an intensive 10 days, Dr. Klass hosted a number of UFE training courses to several clinical teams in Karen and Kenyatta National Hospital in Nairobi and Aga Khan in Mombasa. Patients were also scheduled to undergo UFE in both cities. To help make this treatment possible, Merit Medical donated a portion of the embolic particles used for UFE procedures, called Embosphere® Microspheres. Dr. Klass observed and trained the clinical teams while they treated their own patients.

Traditionally, UFE has been performed through the femoral artery in the groin area. However, UFE can now be done via the radial artery in the wrist—a technique known as transradial access. This approach proved to be an eye-opener to both the Kenyan interventional radiologists and their clinical teams. Doctors observed how their patients were able to move and walk immediately post UFE and how patients could make themselves comfortable without having to lay still on their backs, which is required with femoral UFE.

All of the clinical skills taught and the education provided proved especially useful on the eve of the final day in Mombasa. Following a long day of training, Dr. Klass was called by a gynecologist to discuss an emergency case. A bedside consultation was done together with the referring gynecologist at around 8pm. The patient underwent a successful UFE procedure the following day and was discharged 24 hours post UFE. In this particular case, due to extenuating patient circumstances, UFE provided not only a uterine-sparing therapy for symptomatic fibroids but also a life-saving option. This experience was more than enough to show referring gynecologists that UFE is an effective fibroid treatment option. The gynecologist presented the case to an audience of doctors at a weekly Kenyan Medical Association meeting the night following the procedure.

The skills learned by the Kenyan radiologists can have a far-reaching impact, even beyond UFE. Because of the training with Dr. Klass, radiologists in both Mombasa and Nairobi can now also perform embolization for post-partum hemorrhage. Statistics show that 6,300 women die in Kenya each year during pregnancy and childbirth.2 A 2015 Kenyan policy document reported the maternal mortality rate at over 2,000 per 100,000 live births in North Eastern Kenya, and 212 per 100,000 live births in Nairobi, with hemorrhage accounting for 44% of those deaths.2

“Post-partum hemorrhage is an avoidable complication of childbirth and providing the radiologists here with the ability to treat this devastating complication with an effective therapy will hopefully have a dramatic impact on this shocking statistic,” Dr. Klass explains.

The time spent in Kenya was brief, but the main objective was achieved. Kenyan doctors can now provide these essential services to women.

“I arrived here wanting to improve the lives and care of women in Kenya,” Dr. Klass tells Ask4UFE. “I am pleased that by training radiologists in Kenya to perform this life-changing procedure, I saw this happening. Every single person I met in Kenya was grateful for the purpose of this trip.”

REFERENCES
1. Huyck, K. L., Panhuysen, C. I., Cuenco, K. T., et al. (2008). The impact of race as a risk factor for symptom severity and age at diagnosis of uterine leiomyoma among affected sisters. Am J Obstet Gynecol, Feb;198(2):168.e1-9.
2. National Council for Population and Development. (2015, Jun). Reducing Maternal Deaths in Kenya (Policy Brief No. 46). Retrieved from http://www.ncpd.go.ke/wp-content/uploads/2016/11/Policy-Brief-46-Maternal-Deaths-in-Kenya-1.pdf.

Is There a Link Between Uterine Fibroids and Polycystic Ovary Syndrome (PCOS)?
Alicia Armeli

Uterine fibroids and polycystic ovary syndrome (PCOS) are two common reproductive health concerns for women. Both are hormone-related diseases that can affect the menstrual cycle, incite pelvic pain, and affect fertility. But beyond a few common symptoms and complications, are these two conditions linked?

A landmark study found that among African American women, the incidence of fibroids was 65% higher among those who have PCOS compared to women without PCOS.1

What Are Fibroids?
Uterine fibroids are the most common tumors within the female reproductive system and grow within the muscle tissue of the uterus. About 20% to 80% of women develop fibroids by the time they reach age 50.2 Fibroids are non-cancerous and may cause no symptoms at all, but for many women they bring about severe symptoms like heavy periods, pelvic pain or pressure, and frequent urination.

The cause of fibroids is still unknown, but research suggests that genetics, hormonal imbalance (particularly estrogen and progesterone), and naturally occurring substances in the body called growth factors may play a role in fibroid growth.3

Some risk factors for fibroids include heredity, onset of menstruation at an early age, obesity, vitamin D deficiency, use of birth control, alcohol consumption, and a diet high in red meat and low in green vegetables.3 Race also plays a role, as black women have been found more likely to have fibroids than other racial groups, develop fibroids at a younger age, and to have more or larger fibroids.3

What Is PCOS?
Both women and men produce male hormones called androgens, but when a woman has PCOS, she produces more than normal. This occurrence along with an imbalance of female hormones, such as luteinizing hormone (LH) and follicle stimulating hormone (FSH), make it difficult for the ovaries to develop and release an egg each month, as seen during the ovulation phase of a healthy menstrual cycle. This leads to multiple cysts, or fluid-filled sacs, that develop on the ovaries.

Between 5% and 10% of women of childbearing age have PCOS.4 PCOS symptoms include an irregular menstrual cycle, acne, excess facial hair, male-pattern baldness, and weight gain.

The cause of PCOS isn’t clear, but factors include heredity, inflammation, and elevated levels of male hormones as well as high levels of insulin—a hormone that regulates how the food you eat is changed into energy and used by your body.5 Obesity may worsen PCOS symptoms.5

Fibroids and PCOS: What the Research Says
To investigate the possible connection between fibroids and PCOS, researchers at Boston University Slone Epidemiology Center examined findings collected from a large ongoing study that took place in 1995 called the Black Women’s Health Study.1 Within a 6-year period, over 23,000 African American premenopausal women with no history of fibroids were followed. To track participants’ health status, women were asked to complete mailed questionnaires every 2 years.

During this follow up, 3,631 new cases of fibroids were confirmed and reported.1 The researchers found that the incidence of fibroids was 65% higher among women with PCOS than women without PCOS.

What’s the Connection?
Given these results, the researchers concluded that PCOS was associated with an increased risk of fibroids, at least among African American women. But why?

Although we don’t know for sure, the researchers had a few theories. One possibility is that women with PCOS commonly have high levels of LH—a hormone that stimulates ovulation.1 LH may not only affect the ovaries but also directly influence the uterus and at high levels is associated with an increased risk of fibroids.1,6 What’s more, because LH levels are constantly elevated, ovulation often doesn’t happen.7

That being said, irregular ovulation is a hallmark of PCOS, and the researchers note that this also might influence the risk of fibroids.1 When the ovaries don’t release an egg during the menstrual cycle, they explain, estrogen continues to be released in the body without being balanced by progesterone. This imbalance may encourage the development and growth of fibroids.1

Our Thoughts
It’s important to note that although some research, as mentioned in this article, found a link between fibroids and PCOS, other research hasn’t found such a connection.8 For this reason, more research needs to be dedicated to this topic. However, if you’re experiencing any of the aforementioned symptoms, it’s important to educate yourself on both conditions and talk to your doctor about your medical history, risks and complications involved, and the possible treatments available.

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. She is a paid consultant of Merit Medical.

REFERENCES
1. Wise, L. A., Palmer, J. R., Stewart, E. A., et al. (2007). Polycystic ovary syndrome and risk of uterine leiomyomata. Fertil Steril, May;87(5):1108-1115.
2. U.S. Department of Health and Human Services Office on Women’s Health. (2018, Mar 16). Uterine fibroids. Retrieved from https://www.womenshealth.gov/a-z-topics/uterine-fibroids
3. Mayo Clinic. (2018, Mar 06). Uterine fibroids. Retrieved from https://www.mayoclinic.org/diseases-conditions/uterine-fibroids/symptoms-causes/syc-20354288
4. U.S. Department of Health and Human Services Office on Women’s Health. (2018, May 22). Polycystic ovary syndrome. Retrieved from https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
5. Mayo Clinic. (2017, Aug 29. Polycystic ovary syndrome (PCOS). Retrieved from https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
6. Baird, D. D., Kesner, J. S., & Dunson, D. B. (2006). Luteinizing hormone in premenopausal women may stimulate uterine leiomyomata development. J Soc Gynecol Investig, Feb;13(2):130-135.
7. Center for Young Women’s Health. (2016, May 25). PCOS (polycystic ovary syndrome): General information. Retrieved from https://youngwomenshealth.org/2014/02/25/polycystic-ovary-syndrome/
8. Abdel-Gadir, A., Oyawoye, O. O., & Chander, B. P. (2009). Coexistence of polycystic ovaries and uterine fibroids and their combined effect on the uterineartery blood flow in relation to age and parity. J Reprod Med, Jun;54(6):347-352.

How Much Are Your Fibroids Costing You?
Alicia Armeli

Women with uterine fibroids pay thousands of dollars more each year in health care costs compared to their healthy peers, a collection of studies show.1

Uterine fibroids, a non-cancerous tumor that grows within the muscle tissue of the uterus, affects nearly 70% of white women and more than 80% of black women by age 50.2 Many women with fibroids won’t experience symptoms, but for those who do, heavy menstrual cycles, pelvic pressure, painful intercourse, and urinary dysfunction are common, causing as many as half to seek treatment.1

To understand what it means to have fibroids from a cost perspective, a team of researchers led by Ahmed M. Soliman, MD, PhD, associate director of Health Economics and Outcomes Research at AbbVie, Inc., analyzed a collection of studies from around the globe that were published between January 2000 and November 2013.1  Direct costs and indirect costs of uterine fibroids were recorded. Charges accrued as a result of direct patient care, such as drug costs, procedure fees, and medical service costs were considered direct costs. Indirect costs included those related to loss of work and productivity.

“Given the high prevalence of uterine fibroids, the associated debilitating symptoms that affect daily activities and the invasiveness of treatment options, the economic burden of uterine fibroids is considerable,” the team writes.1

Results showed the following:1

  • Direct costs in the year after fibroid diagnosis ran an average of over $9,000 per patient.
  • Indirect costs totaled approximately $2,400-$15,500 per patient.
  • Total costs—that included direct and indirect charges—ranged from about $11,700-$25,000 per patient per year after diagnosis or surgery.
  • Compared to their healthy peers, women with fibroids have an additional annual cost of $2,200-$16,000.

Although fees varied across the board, this information showcased the significant cost of uterine fibroids to health care payers and society. In the United States alone, total direct costs soared well into the billions, with a handful of studies estimating between $3.5 billion and $10.3 billion in a single year.1

A sizeable chunk goes to pay for fibroid treatments, which include hysterectomy or the surgical removal of the uterus. Myomectomy is another surgical option that involves keeping the uterus but removing the fibroids. A gynecologist performs both of these options.

Non-surgical treatments include uterine fibroid embolization (UFE), a minimally invasive procedure performed by an interventional radiologist. Tiny particles are injected into the uterine arteries, blocking blood flow to the fibroids. Once deprived of a blood supply, fibroids shrink and symptoms subside.

Endometrial ablation, another nonsurgical procedure that was investigated, is performed by a gynecologist and destroys the lining of the uterus. Ablation doesn’t treat fibroids, but it may help to decrease fibroid-related heavy menstrual bleeding. Medications that either control symptoms or temporarily reduce fibroid size were also discussed.

Not included in these numbers is the monthly cost of menstrual products, which can be a significant financial burden to women who experience heavy fibroid-related menstrual bleeding. Previous to successful treatment with UFE, a patient named Carmen, who wasn’t involved in the study, admitted to wearing multiple products at a time during her period to absorb her heavy flow. This included a tampon, pads, an adult diaper, and Spanx® to support it all.

“I would have a regular maxi-pad in the seat of the Spanx just in case the super absorbency tampon, the ultra long maxi-pads, and the Spanx couldn’t keep it together,” Carmen tells Ask4UFE. “I also had all that stuff in my bag just in case I had to change, which was about every hour.”

Several patient characteristics influenced cost.1  For example, increasing age and having other chronic conditions like heart failure, diabetes, obesity, high blood pressure, and pulmonary disease increased hospital length of stay and costs. Black women and those of Asian or Pacific Island race were also observed to have longer hospital stays.

The researchers concluded that although these results shed light on the cost of fibroids, more studies are needed to understand the true financial impact of this disease and “elucidate fully the economic burden…including burden to patients and the entirety of indirect costs.”1

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. She is a paid consultant of Merit Medical.

REFERENCES

  1. Soliman, A. M., Yang, H., Du, E. X., et al. (2015). The direct and indirect costs of uterine fibroid tumors: A systematic review of the literature between 2000 and 2013. Am J Obstet Gynecol, Aug;213(2):141-160.
  2. 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.