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Medical Intel

Jul 19, 2018

Uterine fibroids affect millions of U.S. women. Dr. Saher Sabri, Director of Interventional Radiology, discusses uterine fibroid embolization, a minimally invasive procedure that can relieve painful symptoms without removing a woman’s uterus. 



Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.


Host: Thanks for joining us today. We’re talking with Dr. Saher Sabri, Director of Interventional Radiology at MedStar Washington Hospital Center. Today we’re talking about uterine fibroid embolization as an alternative to hysterectomy. More than a third of all hysterectomies are performed due to fibroids. A recent study found that almost half of women diagnosed with uterine fibroids have never heard of uterine fibroid embolization, which has been around for a couple of decades. So, Dr. Sabri, why do think so few women have heard of this procedure?


Dr Sabri: When we saw the statistic that 50% of women have not been offered or heard about uterine fibroid embolization prior to being offered hysterectomy, it was somewhat surprising that uh, a procedure that has been so effective and popular for the last two decades have not reached all women. This is, uh, an effort that we should, as physicians, do a better job at. The health system should as well try to reach out to as many women, as many families as possible, to let them know about a procedure that can provide a minimally invasive way to treat the fibroid and by improving quality of life with minimal interruption of your daily routine with a lower complication rate and, actually, from a cost perspective, it actually costs less. So, this is an effort that we’re gonna work on to improve awareness of this procedure.  There’s a lot of national campaigns trying to improve the awareness of this procedure, and locally in our community, that’s something that we’re gonna be working on to improve awareness for this procedure. And know that all women who have fibroids need to know their options.


Host: So, how does uterine fibroid embolization work?


Dr Sabri: So, uterine fibroid embolization is a minimally invasive, image-guided procedure. The procedure starts by placing a catheter, which is a small plastic tube, in the artery at the top of the thigh, or through the wrist. Through any of these arteries in the wrist or the thigh, we advance this catheter, which is a small plastic tube, using image guidance under x-ray guidance into the arteries that supply the fibroid. Once that catheter is there, then we inject through it small beads, that are like sand grains, into the arteries that supply the fibroids. The fibroids will then shrink and the symptoms that accompany the fibroids and the enlarged uterus will improve. The procedure is done as an outpatient procedure. At the most, the patient will have a one-night hospital stay, but less than 24 hours, and usually the women that have..undergo this procedure can go back to their daily routine a week after the procedure. We see them, evaluate them, before the procedure, discuss all the options that they have, talk about hysterectomy, talk about the fibroid embolization, and talk about some of the other minimally invasive surgeries that they can have. And then, from this point on, if they decide to go with a uterine fibroid embolization, we counsel them on the process, and the symptoms that they would have afterwards, and the side effects and how they cope with it, and the time frame when they can go back to work.


Host: What is a uterine fibroid and what would some of the symptoms be that would spur a woman to come in for treatment?


Dr Sabri: Uterine fibroids are benign growths inside the uterus. The uterus will enlarge and the fibroids can be anywhere from one to more than a dozen. And, the symptoms that happen are mostly bleeding, heavy periods, and, uh, pain and cramping. They can also have what we call bulk symptoms, which is increase in urination, frequency, waking up at night to go to the bathroom, constipation at times. It affects around a third of women above age 35. African-American women, per se, they’re.. have a higher incidence--they have a threefold increase in incidence of fibroids, so..and can affect them at an earlier age of life. After the age of menopause, which is, you know, in the 50s and 60s of their age, the fibroids tend to shrink and the symptoms will go away for most women. So, you know, it affects women at this age, in their 30s and 40s and early 50s, and can cause significant interruption to their daily activities. They cannot have an interruption for two or three weeks for a hysterectomy and they’re seeking a minimally invasive procedure that can help them get back to their daily routine faster, and this is what this procedure offers. It’s very effective. Around 90% of women show significant improvement in their symptoms and that success rate is what drove this procedure to be that widely adopted as an alternative to hysterectomy.


Host: These women are potentially dealing with these pretty awful-sounding side effects for, you know, 15 up to 20 years sometimes. What would drive a woman to say, “I’d rather keep my uterus and have this embolization procedure” as opposed to just remove it and be done with it?   


Dr Sabri: It’s a personal preference and I truly believe in individualized medicine. I think not two patients are the same and each patient needs to hear about all their options. And then it’s up to them, once they’re fully informed, to make the decision that best suits their life. Some women do not want to deal with hysterectomy and, to them, they would not seek medical advice because they think that their only option is hysterectomy, and if they’re not informed about this procedure, they can live with some, you know, awful symptoms that affect their daily life.  On the other hand, there are some women, once they hear that their uterus has fibroids in it and causing them issues, they would just rather have hysterectomy and not have to deal with any other option or any other considerations that the fibroids may come back, you know, down the road. So, that’s something that we inform women about. We talk in detail about the science behind each of these procedures and they can decide. On the note that would..can fibroids come back after uterine fibroid embolization, the incidence of that is around one in five, but that’s after five years, so most women, by the time that this time frame comes back, they are already getting close to menopause and they rarely need additional procedures to address their fibroids. From the women that we’ve seen, 90% of them have success and they don’t have to actually have a second procedure or have to deal with it afterwards. The ten percent that the procedures does not work, then they can still undergo hysterectomy or other procedures to deal with it. I would like to add that there’s some other minimally invasive options other than hysterectomy, other than uterine fibroid embolization, that are performed by our colleagues in Gynecology here at the Washington Hospital Center, so we have a comprehensive approach to this. We have a fibroid center, where specialists from OB/GYN and Interventional Radiology meet and discuss every patient, and we offer all the options for the patient, including uterine fibroid embolization, hysterectomy and minimally invasive procedures performed by the gynecologists. After offering these options the woman can decide what works best for her out of these options.


Host: So, at your fibroid center, what are some of the..the specialists that you work with and..and how did they help women come to these determinations?


Dr Sabri: The specialists are.. there are GYN specialists, gynecologists and interventional radiologists. We have advanced care practitioners who have a lot of experience in this field, who help us counsel the patients. We discuss all these options, and present it to them, and then they would decide what works best for them based on our counseling. The fact that this procedure is popular and we perform a large number of it, we’ve had many, many patients who come to us and they’re giving hugs to everybody of our team because of the impact it had on their life and how much it improved their symptoms with minimal interruption. I remember a woman who was offered a hysterectomy because of a large uterus. She had around 20 fibroids and, um, she did not want to have a hysterectomy. And she came to us in tears at how much it’s affecting her life. She had her kids with her at the time and she was saying how she’s not been able to take care of them the way she wanted to and the interruption she’s had to her work. So, we performed the procedure for her and after a week she managed to get back to her work and go back to her daily activities. And when I saw her three months afterwards, her symptoms were completely gone and she was..she could not be happier with her decision to undergo the uterine fibroid embolization. And she was saying that “I would volunteer to talk to any woman who would like to hear about this because I can’t believe that some women don’t even hear about this procedure and don’t get offered this option, and I’m so glad that I, you know, saw you and saw that you offered this procedure and came to talk to you, and it was a life changing for me.” So, this is one of the examples of what we see for a lot of these women, the impact it can have on their lives.


Host: So this is a very common condition among women of a pretty wide age range. For women that are younger, maybe in their 30s or even early 40s, is there hope for fertility still after a procedure like this?


Dr Sabri: Yes. There’ve been studies done that showed that fertility is not significantly affected by this procedure. Initially, when the procedure started, this was an issue, and women seeking fertility, they were hesitant to undergo this procedure, but since the wide adoption of the procedure there’s no significant effect on fertility after the procedure, and there’ve been many, many successful stories. Patients of mine and many other colleagues have had successful pregnancies and healthy babies after the procedure, So, we, again, counsel the women about their options, and talk about the science and the evidence behind it. Women who seek fertility, there’s some other excellent options and minimally invasive surgeries that our gynecologists do that can fit them as well, and these are options that we present to them to hear about it, and then they can choose which of the two they prefer and which evidence they feel more comfortable with.


Host: So, you mentioned also, that as women get up to that menopause age, the fibroids tend to shrink in many of these women. So if you have a woman who comes in presenting with these symptoms, close to that menopause age, would you ever, at some point, counsel them maybe just wait?


Dr Sabri: That’s a very good question. This happens frequently. And we talk about the severity of symptoms, their lifestyle. We discuss the risks with them. We’ve had many women close to menopause come to us and they say their symptoms are so lifestyle limiting that could not wait two or three years or so to wait for the symptoms to eventually improve on their own. And again, it’s not like menopause shows up one day and then the symptoms are completely gone. It takes a while to get to it. It depends on the severity of  symptoms, the type of symptoms. The bulk symptoms that I mentioned, like the having to go to the bathroom a lot, and constipation, and things like that--they are the last to actually improve with menopause. The bleeding symptoms tend to improve sooner because, you know, the patient does not have a period anymore. So, we counsel them and we discuss with them. We’ve seen it both ways. Some will just say, “Let’s wait it out and not get a procedure done.” For some others, since it’s a minimally invasive procedure with minimal interruption, that way we would go ahead with the procedure and they’re happy that they’ve had it done. On an average, it’s around a week to 10 days, and they’re back to their normal activity. Generally speaking, the most symptoms that they feel after the procedure is pain and it’s moderate to severe pain. And, there’s a regimen of pain medications that we provide to the patients to help them through this process. Again, everything is done through a pinhole in the upper thigh or a pinhole in the wrist, so there’s no incision to deal with. There’s no..the risk of infection is much lower and the risk of complications is much lower. The recovery time for uterine fibroid embolization is somewhere between five days and up to three weeks. The majority of patients, seven to 10 days they go back to their normal activities. And this can be compared to around two to three weeks for hysterectomy. For some of the minimally invasive surgical options, the recovery can be shorter; it can be closer to the uterine fibroid embolization. But, not all patients are candidates for such a procedure.


Host: Are there any work restrictions like lifting or anything that women would need to be aware of?


Dr Sabri: So, for the first week we tell them to take it easy, don’t lift anything more than five to 10 pounds the first week and just to not to do a lot of activities around the house or at work, so we just tell..ask them to take it easy. Most women, because of the, you know, some degree of pain, they also feel like as if they’re coming down with the flu. They don’t feel like doing much. We just say because it’s just a pinhole through the groin or through the wrist, it looks like they should be more active, but what’s going inside the body with the fibroids can have an effect on them. So, usually these are the restrictions. Definitely, they can walk around the house and do activities and do some trips outside the house, but as long as they don’t exhaust themselves. Then, after a week time, it’s OK to get back to work and resume your normal activities gradually. Again, for a hysterectomy this can be two to three weeks. There’s a high risk of infection, such as wound infection, longer hospital stay compared to uterine fibroid embolization, so definitely the recovery time and going back to work is shorter with uterine fibroid embolization.


Host: Why should a woman choose MedStar Washington Hospital Center?


Dr Sabri: At MedStar Washington Hospital Center we have a lot of experience with treating women with fibroid. We have a dedicated fibroid center, where you’re gonna meet several specialists to talk about your options. We offer all the options for..for fibroids. Considering uterine fibroid embolization, we have a lot of experienced interventional radiologists who have done hundreds of these procedures with excellent outcomes. I think if you have these symptoms and you were not offered uterine fibroid embolization by your gynecologist, you owe it to yourself to explore the options and we’re here to help you.


Host: Thank you for joining us today.


Dr Sabri: Thanks for having me.


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