- November 11, 2019
- Posted by: cmcdonald
- Category: Uterine Fibroid Embolization (UFE)
Uterine fibroids affect millions of women each year. Approximately 60% of the estimated 600,000 hysterectomies performed in the United States every year are due to fibroids in the uterus. We recently sat down with Dr. M. Yvonne Dang, one of New York’s top interventional radiologists and a team member at American Endovascular, to learn about uterine fibroid embolization (UFE) and how UFE compares to other treatment options, such as hysterectomy.
Q: So many women are affected by uterine fibroids. What are the causes or contributing factors?
Dr. Dang: There isn’t any one contributing factor that causes fibroids, it’s multifactorial. We know that there is a relationship between age, race, and also to family history.
As we get older, the more likely we are to develop fibroids or to develop more of them. There is a genetic predisposition. If the women in your family have fibroids, that increases your chance of developing fibroids two to three times.
We see more fibroids in African-American women as opposed to Caucasian women, and we would also see African-American women having more symptoms from the fibroids. But having said that, it’s very common, so a lot of women will have them. Asian women, African-American women, Caucasian women, European women, Latin women, and Caribbean women all get fibroids.
Any of us can have them.
Q: Can you tell me a bit about uterine fibroid embolization (UFE)? What is it exactly?
Dr. Dang: It’s a minimally invasive procedure, developed as an alternative to hysterectomy. It opens options for women who do not want to undergo a surgery or the extended recovery time that a hysterectomy may require. It’s effective, it’s safe, and it’s usually done in an outpatient setting. It is performed through a small incision in the groin area at the top of the leg.
Q: What is the difference between UFE and hysterectomy?
Dr. Dang: UFE is minimally invasive, performed through a tiny incision at the top of the leg. The incision is less than a centimeter in size. It is an outpatient procedure that takes around an hour to an hour and a half. The patient recovers for maybe another two hours in our center, and then we discharge the patient home to recover in the comfort of their own home.
A hysterectomy requires an incision that depends on how large the fibroid is and what approach is taken. It is usually performed in a hospital. It usually takes longer to recover. The standard had been around four to six weeks for hysterectomy, whereas UFE usually is around 7-10 days.
Read our blog on Uterine Fibroid Embolization vs Hysterectomy.
Q: How does it compare to other treatments such as radio-frequency ablation or anti-hormonal drugs?
Dr. Dang: Radio-frequency ablation falls under the umbrella of endometrial ablation and that can come in different forms. It can be done with a water balloon, microwave, laser, or freezing, but endometrial ablation is directed toward treating the symptoms from the fibroids such as heavy bleeding. It doesn’t treat the fibroid itself.
Hormone therapy or drug therapy can treat the bleeding, but it doesn’t treat the fibroids or get rid of the fibroids.
Q: What are some of the symptoms of uterine fibroids, and who should be concerned about this?
Dr. Dang: There are different symptoms that women can have from uterine fibroids. A lot of it correlates to the size or the location of the fibroids. Since the fibroids occur toward the inside lining of the uterus, women tend to have heavy prolonged bleeding, a lot of gushes, a lot of blood clots.
They can even develop anemia and then the effects of anemia. They could get very tired, feel weak… they may even pass out. It makes their heart work a lot harder. Fibroids that are in the muscle of the uterus or on the outer wall of the uterus can cause pressure, heaviness, and related symptoms. This can cause pain, urinary frequency, and constipation.
Q: If women are not showing any symptoms at all, how are fibroids usually detected?
Dr. Dang: It’s recommended that women see their gynecologists yearly, so during those times a physical exam can discover fibroids. But usually, if fibroids are small and they’re not causing any sort of symptoms, we don’t tend to offer treatment—because the goal here is to improve the patient’s lifestyle or improve their health. If the benefit doesn’t outweigh the risk, we tend not to offer treatment.
Q: What are some of the side-effects of the uterine fibroid embolization?
Dr. Dang: Any effective treatment for uterine fibroids tends to have a recovery phase. So uterine fibroid embolization does have a recovery phase. In relation to this treatment, it is much shorter than hysterectomy. It tends to be around 7-10 days as opposed to 4 to 6 weeks. Where there is pain management, there is a slow recovery or a staged recovery back to normal.
Q: What is the recovery process like for this UFE procedure?
Dr. Dang: The recovery processes usually take between 7-10 days. Patients will be on pain medication for around two to three days. After the first night of rest, they will be up and moving about the next day, and they will gradually increase their activity level, and their diet, until they’re back to normal. From my patient population, by 7 days they tend to be around 90% back to normal.
Q: Is there anything else that’s important for patients to know about uterine fibroid embolization?
Dr. Dang: The embolization procedure and embolization treatment have been around for a very long time. It was initially used to treat patients with GI bleeding or gastrointestinal bleeding, pelvic trauma, or pelvic injury. It can be used to treat vascular malformation or even a tumor. It’s where we block up the blood supply to prevent things from bleeding. So, the procedure itself has been around for a very long time. It was directed toward fibroids in the early 1990s, where a group of physicians in France decided, “What if we embolize the fibroids before the patient undergoes surgery, such as in a myomectomy or hysterectomy?
Would that decrease blood loss, and therefore decrease complications from blood loss during the surgery?” They treated a handful of patients, and what they found out was that a lot of these patients didn’t come back for the surgery because the symptoms went away! So the United States started treating patients with the embolization procedure for fibroids in the mid-1990s—around 1995. And since that time, the procedure has become more common.
Q: So, the procedure has become more popular since then?
Dr. Dang: Definitely, the procedure is becoming more popular because it can be offered as a treatment to women who may not have been a candidate for surgery before. When UFE was developed, it was a challenge to something that has been around for a very long time.
Hysterectomy has been around since the time of Ancient Greece. When you are challenging something like that, you have to have a lot of data and research and clinical trials to back it up. UFE is probably the most documented, most researched treatment option out there for any kind of medical treatment. It has been researched and undergone clinical trials in the United States, in Canada, in Europe, and even in Asia. It’s “tried and true,” and it’s backed by a lot of literature.
Also, our patients tend to like being treated in an outpatient setting. They like to recover at home, in the comfort of their own home—it’s cozier. I don’t know if you have ever been a patient in a hospital, but there’s a lot of noise going on a lot of beeping, and a total lack of privacy.
Our patients can go home. They will have a family member—a sister, a mother, a husband—take care of them as they recover. We keep track of them and call them daily until they meet all of our criteria. They tend to recover very well. We follow up with them a week or two later to make sure they’re on the right track and then thereafter as needed to make sure that they respond appropriately to treatment.
Q: Fantastic. I appreciate you taking the time to have this interview today.
Dr. Dang: Great. Thank you so much.