Guest blog by Laura Marrone and Pratik Shukla, MD, assistant professor of radiology at Rutgers New Jersey Medical School
Uterine fibroids are one of the most common types of gynecologic conditions we see as interventional radiologists (IRs). Uterine fibroids affect 20% to 50% of women of reproductive age, with even higher rates among Black women. Patients with uterine fibroids often have them for many years before symptoms, such as heavy menstrual bleeding, pelvic pain, and infertility, eventually bring them to a physician.
Several options are available to treat uterine fibroids, including surgery, medication, and minimally invasive interventional procedures, such as uterine fibroid embolization (UFE). But unfortunately, many women are effectively denied access to less invasive treatments because the health care system fails to inform them about the full range of options, especially UFE.
To find out more about the lack of awareness of this treatment and why so many women aren’t made aware of UFE as an option, our team at Rutgers New Jersey Medical School conducted a study to understand women’s awareness of treatment options for UFE. We interviewed 24 patients who underwent hysterectomy, including 11 who identified as Black and nine as Hispanic. The unpublished findings were presented at this year’s Society of Interventional Radiology Annual Scientific Meeting, and helped shed light on current gaps in knowledge. With July being Fibroids Awareness Month, there’s no better time to share this knowledge with women who may be living with uterine fibroids and looking for answers.
What is Uterine Fibroid Embolization?
UFE is a minimally invasive treatment option that blocks the blood supply to the fibroid tumors, shrinking or even eliminating them. UFE often helps to avoid surgery, preserve the uterus, control symptoms, and improve quality of life. Approximately nine out of 10 women who undergo UFE will experience significant improvement, or their symptoms will go away completely. With sedation and a small incision in the wrist or groin, IRs use X-ray guidance to thread a spaghetti-thin catheter through the blood vessels to block the specific artery that is supplying blood to the fibroid. UFE requires minimal or no hospital stay and a much shorter recovery time than more invasive procedures.
Black and Hispanic Women Are Offered Different Treatment Options for Fibroids
Black women are three times more likely to be diagnosed with fibroids than white women, and they are also more likely to have more severe symptoms. Some studies have suggested that Hispanic women also have an increased risk compared to white women. At Rutgers University Hospital, the study’s research team saw that many Black and Hispanic women were undergoing hysterectomies to treat their uterine fibroids and sought to find out why.
We interviewed 24 patients who underwent hysterectomy, including 11 who identified as Black and nine as Hispanic. We found that 18 of the 24 women said that hysterectomy was the only option presented to them, and it that they were not aware of the full range of treatment options available to them. In fact, one of the questions on our survey specially asked participants if, during the fibroid treatment option conversation, physicians had discussed “non-surgical, minimally invasive treatments” such as “fibroid embolization”. Eighty-seven percent of surveyed women specifically stated that they had not been made aware of UFE prior to undergoing hysterectomy.
Patient Empowerment and Physician Education Can Help Disparities
More research is needed to understand what can be done to minimize the disparities that exist among women with uterine fibroids. We believe that several actions could help close these gaps. These include:
- Building trust between patients and providers. We believe there is a longstanding mistrust of the medical system among people of color due to historic mistreatment. As a result, communication channels between patients and their providers may be narrowed.
- Raising awareness about the risk for developing fibroids and empowering patients with information to advocate for treatments like UFE. Fibroids have a genetic component, and we frequently saw in the study results and in anecdotal experience that women learn about UFE from other family members and social networks rather than from their physician. Social networks can be influential, so when we empower patients with information, we can help them advocate for treatments like UFE.
- Improving communication among specialists to guide patients more effectively about what treatment is most appropriate, given their symptoms. By taking a team-based approach, OB/GYNs, IRs and primary care providers can come together to recommend the best course of treatment for their health goals. Additionally, with improved interprofessional communication and cooperation, care of symptomatic fibroids may expand to include UFE as a safe, viable option for desiring patients. Overall, the ability to offer patients an additional “good” treatment option to choose from can only improve patient satisfaction with their healthcare, as a whole. We have seen this model work with pulmonary embolism and it could have the same benefits for uterine fibroids.
It is important to address disparities in the treatment of uterine fibroids to ensure that women of color have equitable access to the latest and most effective care for their condition. By educating patients and health care providers, we can improve the lives of countless women.
If you’re living with uterine fibroids and interested in learning more about this or other minimally invasive treatment options, contact an interventional radiologist near you.