AJ Gunn, MD, Assistant Professor of Radiology, University of Alabama at Birmingham, talks about fibroids and a treatment option called the fibroid embolization procedure.
Interview conducted by Ivanhoe Broadcast News in January 2018
Can you tell me a little bit about the issues that come up with fibroids?
Dr. Gunn: Fibroids are non-cancerous growths inside the uterus. They’re very common problems; about twenty five to fifty percent of women will have fibroids at some point in their lifetime. But only a smaller percentage of women will ever have symptoms from those fibroids. Symptoms can be pain, prolonged bleeding during their cycle or bleeding in between cycles. And when that happens it causes quite a bit of disruption to a woman’s life.
Are there any other symptoms that women might not consider it to be a fibroid but actually is?
Dr. Gunn: Yes. When fibroids grow to a certain size they can compress on the bladder and make it so that women feel like they have to urinate more frequently. Sometimes they can push behind and push up against the colon so it will make it hard for people to have bowel movements. And sometimes pain during sex can be a symptom of fibroids as well.
What are some current options for it?
Dr. Gunn: The current treatment options range from medicines all the way up to invasive surgery. Medicines work well but when you stop taking the medicines the fibroids can come back and the symptoms of fibroids can come back. On the other end with surgery there’s a treatment called a myomectomy where a surgeon will go in and remove just parts of the fibroid or the fibroid itself and then there’s a hysterectomy where the surgeon goes in and actually takes out the whole uterus. I like to think of ourselves in interventional radiology as in between those two treatments. Because we are a minimally-invasive treatment option where we go through a pinhole in either the wrist or through the groin and find the arteries that are feeding the fibroid and we block those arteries off with tiny particles and that makes it so that the fibroids starve from not having a blood supply.
How can a doctor determine which treatment option is best for the patient?
Dr. Gunn: I think it goes on a case by case basis because some fibroids are so large that a minimally-invasive procedure from interventional radiology might not be the best option. Sometimes someone may not want to go through surgery no matter what. I think actually sitting down with your OB/GYN and your interventional radiologist and discussing all of those options is the best way to approach that problem.
Talk a little bit about the fibroid embolization procedure.
Dr. Gunn: Uterine fibroid embolization or UFE for short is something that was first described in France back 1995. We’ve been doing them in the United States since 1997. We’ve got well over a hundred thousand procedures performed, it’s been approved by the FDA. It’s part of the practice guidelines for the American College for Obstetrics and Gynecology. What we do is we use just a pinhole in the skin to either go through a blood vessel in the wrist or a blood vessel in the groin. And using X-ray guidance we find the blood vessels that are feeding that fibroid. Once we find those vessels we block them off with tiny little particles and those particles stay there and they starve the fibroid from blood supply. When it doesn’t have any more blood supply it starts to die off; so the size starts to shrink, the bleeding symptoms start to go away and people find a lot of relief from that.
I was reading that this is not commonly used, why is that?
Dr. Gunn: I think it’s mostly a lack of education, either for patients not knowing about the procedure or for referring physicians not knowing about the procedure. That’s why I think it’s so important that we’re out there talking about this so that women are aware. A lot of the women that we see in our clinic are women that have searched about problems with fibroids either through the internet or patient forums and they find us directly through those means. I think once women hear about it they’re very interested in it and excited about it because our recovery time is much less than a traditional open surgery and obviously they’re out of work a lot less and they’re able to get back to their normal lives a lot quicker.
Are there any further benefits besides less invasive, shorter recovery time, are there any other benefits besides that?
Dr. Gunn: Well it’s successful; I think that’s probably the other benefit. We’re about 85 to 90 percent successful in controlling the symptoms within the first year. And if you look out to about five to ten years we’re about 75 percent successful in keeping them from ever having to get a hysterectomy in the future. So the fact that it’s minimally invasive, it’s an outpatient procedure; we can do it in 45 minutes to an hour and we’ll get that woman back to her normal life in three to five days is a huge advantage.
And who would be a good candidate for this?
Dr. Gunn: It’s a complicated question and I think the best answer is that it should be evaluated on a case to case basis, but we know that it’s best when women have symptoms of bleeding. We also know that once the fibroids grow to a certain size it may not do well with uterine fibroid embolization. I think if you’re having any of those symptoms it’s really easiest to come in and talk to your interventional radiologist and they can look at images, go over your history, discuss what your wishes and your expectations are really and then come up with treatment plan that’s best for you.
What’s the size limit that you guys could do this procedure on?
Dr. Gunn: People talk about having a uterine size of eighteen or twenty weeks gestation of being potentially too large for uterine fibroid embolization or potentially a single dominant fibroid that’s greater than twelve or thirteen centimeters. That being said if a woman really wants to avoid surgery, I still think it’s a potential treatment option to go ahead with uterine fibroid embolization.
Talk to me a little bit about Venita’s case.
Dr. Gunn: So Ms. Gowdy is an excellent case example of uterine fibroid embolization. She went to a couple of different doctors with her problem, which was heavy bleeding, and they recommended surgery, they recommended medications. She did her own research on the internet and found her way to us here in interventional radiology at UAB to discuss uterine fibroid embolization. She came to us and we looked at her images, discussed her symptoms, what her wishes and desires were for her case. And we really thought uterine fibroid embolization was a great treatment option for her. So she came in and we were able to treat her through just a small pinhole in her wrist. When we saw her for her post procedural visit in two to three weeks her symptoms had completely resolved. She was a great candidate for this because it was really disrupting her life, both the bleeding that she was having during her cycles and in between her cycles.
Why in particular through the wrist?
Dr. Gunn: When you go through the wrist it allows the patient to be able get up after the procedure and walk around earlier. When we go through the artery in the groin they usually have to lay flat for two or three hours after the procedure just to make sure that there’s no extra bleeding or bruising that would form there. When you go through the wrist you’re able to put a compression device on the wrist which allows that patient to get up and go to the bathroom and walk around. It allows them to be a little bit more comfortable after the procedure.
What are some risk factors for fibroids?
Dr. Gunn: There are a few risk factors for fibroids. That would include age, as women get older but before menopause they’re more likely to have fibroids. Women of African American heritage are more likely to get fibroids. If you have a mother or sister that’s has fibroids you’re more likely to get fibroids. And also being overweight is a risk factor for fibroids.
Do you have anything else that you would like to add about this procedure?
Dr. Gunn: I think the biggest message is if you’re having these issues and you’ve been found to have uterine fibroids it’s worth discussing this with either your OB/GYN or find an interventional radiologist near you to discuss your case. Because actually sitting down discussing all of your treatment options and knowing all of your options is the best way to make any decision about your health.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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AJ Gunn
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