Dr. Parker,

I am 49 yrs. old in good physical health. I walk or run several times a week, and am slim(5ft.115 lbs) and look youthful. However, I have a lot of stress-6 children, 2 with drug addictions, a difficult marriage, etc. I have a 10 cm fibroid that is putting pressure on my rectum. I had bleeding and huge clots but taking progesterone 10 days of my cycle has alleviated that. My gyn recommends hysterectomy. I am scheduled for this Thursday, Dec.16, but have a lot of anxiety about it, because I am depressed and worried about how it will affect my emotional state which is already terrible. When I called my gyn he was in his other office further away, and could not call me back. He told his office manager that he already went over everything with me, and to tell me a hysterectomy was the best course of action. He said a myomectomy would thin the lining of my uterus too much. He never mentioned UFE. He seems perturbed that I did go to another gyn for a second opinion. The other gyn said hysterectomy also, not mentioning UFE. I called an interventional radiologist and they said they could see me. Have I broken the doctor-patient trust factor? Will he treat me differently now?

L,

Doctors should welcome a second opinion. You need to do what is best for you and getting a second opinion when surgery is recommended is always a good idea. UAE works very well for heavy bleeding and shrinks fibroids about 40%, so if this would help you, you should see the interventional radiologist to see what they recommend. Myomectomy is always possible and it will not thin the uterine lining no matter what the size of your fibroid. A 10 cm fibroid can be removed laparoscopically as an outpatient by a skilled laparoscopic surgeon.

If the doctor does treat you badly because you got a second opinion, you should consider getting another doctor.

Bill Parker, MD

Study: Among 240 women who had UAE, 16 women had fibroids on a stalk on the outside of the uterus. The average size of the fibroid was about 7 cm (3 inches) in diameter. The average width of the stalk was 2.7 cm (1 inch) and 6 fibroids had a stalk less than 2 cm in width.

Results: None of the 16 women had a pedunculated fibroid detach as a result of UAE. The average reduction in size of the fibroid was 39%, the same results that have been published for other types of fibroids.

Dr. Parker’s Comments: These results are very encouraging and will allow more women to have UAE. The only problem with the study is that it is possible, in fact likely, that some women with large fibroids on long or thin stalks were not recommended for UAE in the first place. So, the recommendation for UAE will depend on the interpretation of the MRI by the interventional radiologist.  More about UAE can be found here: http://www.fibroidsecondopinion.com/uterine-artery-embolization/

Authors: Popovic M, Berzaczy D, Puchner S, Zadina A, Lammer J, Bucek RA.
Journal: American J Roentgenology. 2009;193:267-71.
Study from: Department of Cardiovascular and Interventional Radiology, Medical University of Vienna

Problem: The first use of embolization to treat women with fibroids was performed in France in 1997, so the long-term effectiveness of the procedure is still being investigated. These authors wanted to see how patients they treated over the past 10 years have done with regards to their quality-of-life following UFE.

Study: All 53 women from an earlier publication of UFE were questioned about their quality-of-life and symptoms following the procedure. Thirty-nine women (75%) responded to the questionnaire.

Results: The average time since treatment was 7 years. Reduced bleeding was reported in 90% of the women, reduced pain in 79%, reduced bulk-related symptoms in 90%, reduced fatigue in 77%, reduced limitations of social life in 93%, and reduced depression in 79%. The general quality-of-life for these women improved significantly.

Six women (15.4%) had a hysterectomy at an average of 32 months after UFE. Thirty-two women (82%) were satisfied with UFE, and 30 patients (77%) said they would recommend uterine fibroid embolization to other women. The authors concluded that UFE seems to lead to significant long-term relief of fibroid-associated symptoms.

Dr. Parker’s Comments: Although this is a small number of women, and 14 of the original study patients did not respond to the survey, the long-term results are very reassuring. There was a high satisfaction rate reported by the women over the long follow-up period of 7 years. Only 15% of the women needed to have a hysterectomy after UFE (myomectomy following UFE was apparently not considered). One of the early questions about UFE was whether the results would last over time. I agree with the article that the answer is yes.