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During a routine exam five or six years ago, a gynecologist found fibroids in Elizabeth Fechtmann-Crippen’s uterus. As the benign tumors grew in number and size throughout the years, the gynecologist recommended a hysterectomy.
Fechtmann-Crippen didn’t want to have her uterus removed, but after the fibroids caused heavy bleeding and pain, she felt she didn’t have any other choice. The Lancaster County resident scheduled a hysterectomy for summer 2001.
Then, a month before the surgery, Fechtmann-Crippen saw a television news report on a less-invasive option for women with fibroids. The option, uterine fibroid embolization, cuts off the fibroids’ blood supply and causes them to shrink. After doing some research on the procedure, Fechtmann-Crippen canceled her hysterectomy and underwent the fibroid embolization procedure in September.
It’s a story that is becoming more common, according to doctors with Lancaster Radiology Associates Ltd. Doctors at the Lancaster-based medical practice said more women who have fibroids but don’t want hysterectomies are expressing interest in uterine fibroid embolization.
“It gives us an alternative,” Fechtmann-Crippen, 52, said. “It gives women a greater say in how they find a solution to their medical problems.”
Another option
Uterine fibroids are common and don’t cause problems for many women. However, sometimes fibroids can cause a number of symptoms, including heavy menstrual bleeding, pelvic pain and digestive problems. The growths can vary in size from a couple of millimeters in diameter to the size of a grapefruit, said Dr. Leigh Shuman of Lancaster Radiology Associates.
“Nobody knows why they happen; they just happen,” Shuman said.
Dr. John Briguglio, another doctor with the practice, said the traditional ways to treat fibroids are through a hysterectomy or myomectomy, which is a surgical procedure to remove the fibroids.
About one-third of the more than 500,000 hysterectomies done each year nationwide are performed to treat fibroids, according the Society of Interventional Radiology in Fairfax, Va.
Briguglio said uterine fibroid embolization does not involve cutting out any tissue, but instead kills the fibroids by blocking off the small blood vessels that feed the fibroids’ growth. During the procedure, a catheter is inserted into a groin artery and guided to the uterus. Plastic particles about the size of grains of sand are injected into the blood vessels, and the fibroids’ blood supply is eliminated.
Lancaster Radiology Associates’ doctors perform the two-hour procedure at Lancaster General Hospital. The procedure is done under local anesthesia and sedation so the patient is conscious but feels little, if any, pain, Briguglio said.
Patients may return home the same day or may spend a night at the hospital. Most recover completely within a week, Shuman said. In most cases, the size of the fibroids will decrease by about 80 percent within a year, he added.
Shuman estimated the uterine fibroid embolization procedure itself costs a couple of thousand dollars, although he said the total cost will vary depending on hospital charges and length of stay. Most health insurers cover the cost, he said.
Doctors have injected plastic particles into blood vessels to reduce bleeding during surgery for many years, Shuman said. Uterine fibroid embolization is a new application for an old technology, he said.
Initially practiced in France, uterine fibroid embolization was introduced in the United States in the mid-1990s. Between 15,000 and 20,000 procedures have been performed worldwide, said Patti Lucas, communications manager for the Society of Interventional Radiology.
Lancaster Radiology Associates doctors started performing the procedure in 1999 and have done about 27 so far.
Two or three procedures were done in the first year, but now the practice does two or three every month, Shuman said. More women are also expressing interest in the procedure, Briguglio said.
“It’s definitely something that more women are considering,” Lucas said. “It’s giving women a great alternative.”
Doctors at Penn State Milton S. Hershey Medical Center also perform the procedure. The center did not return calls for comment by press time.
Making women aware
The most appealing thing about uterine fibroid embolization is that it gives women an alternative to hysterectomy, Shuman and Briguglio said.
Women have a variety of reactions to hysterectomy, Shuman said. Some don’t have a problem with having their uterus removed, while others want to keep their uterus because they want to continue to have children or feel that it is connected to their sense of femininity.
“It just didn’t feel right to have a hysterectomy,” said Fechtmann-Crippen. “A hysterectomy is major surgery, and it wasn’t something that I wanted to jump into.”
Uterine fibroid embolization is also less invasive and requires much less recovery time than does a hysterectomy, Shuman said. A typical hysterectomy patient spends two or three days in the hospital following surgery and cannot go back to work for four to six weeks, he said.
However, Shuman added, fibroid embolization is not for everyone. Because the treatment can cause infertility, myomectomy may be best for women who want to continue having children, he said.
There is also a chance that fibroids could reoccur, according to the Society of Interventional Radiology. That’s why hysterectomies remain popular among women as a treatment for fibroids, said Dr. Jean Hauser, a gynecologist/
obstetrician with PinnacleHealth System in Harrisburg. Many women who do not want to continue having children want a permanent cure for their fibroids, Hauser said.
“Hysterectomy is a definitive treatment,” she said. “It’s a final solution.”
Briguglio agreed that uterine fibroid embolization would not replace hysterectomies, but said embolization would become more popular as more women became aware of it.
“The word is getting out, and people are interested in it,” he said. “The growth of this procedure has been patient-driven.”
