Kim Fenoglia didn’t know what to expect when she went to her doctor to deal with her painful and unusually heavy bleeding during menstruation. An ultrasound revealed that small uterine fibroids, noncancerous growths, were the cause of her discomfort. Her physician prescribed a hormone, which alleviated Fenoglia’s symptoms for a couple of years.
But the pain returned, worse than before. So did the bleeding during menstruation; it was so heavy that some days Fenoglia had to run to the bathroom every 10 minutes to change feminine products. It got to the point that Fenoglia was bleeding three out of every four weeks, and she became anemic. Fenoglia’s gynecologist recommended a hysterectomy — surgery to remove her uterus. She thought that option was drastic, given that it would entail weeks and maybe months of potentially painful recuperation, and risks of complications like early menopause, the need for hormone replacement treatments and infection. So, she sought a second, third, fourth and fifth opinion. “It was really frustrating,” she says. “Everyone wanted to do a hysterectomy.”
Fenoglia conducted online research and found a physician, Dr. John Lipman, at the Atlanta Fibroid Center, who suggested doing a uterine fibroid embolization. That’s a procedure in which an interventional radiologist inserts a catheter through a tiny incision in the skin to deliver particles that block the blood vessels leading to the fibroids, causing them to shrink or even disappear. None of the five OB-GYNs she’d previously consulted had mentioned UFE, she says. Fenoglia agreed to the UFE, which lasted about 45 minutes — and which quickly alleviated her pain. “It was incredible,” Fenoglia, 46, says. “I had the procedure on a Friday and was back to work on Monday. I feel like I got my life back.”
Like many women, Fenoglia knew next to nothing about uterine fibroids when she first sought treatment. In addition to heavy bleeding during menstruation, they can cause pelvic and lower back pain and painful sex. While Fenoglia conducted enough research to find an alternative to surgery, a collective lack of knowledge leads to countless unnecessary hysterectomies, some physicians say. More than 400,000 hysterectomies are performed annually in the United States, according to research published in the American Journal of Obstetrics and Gynecology in March 2015. Overutilization of hysterectomy has been estimated to range from 16 to 70 percent, according to the study. The research found that alternatives to hysterectomy, such as UFE, are underutilized.
[See: Tampons, Pads or Menstrual Cups? A Woman’s Guide to Period Products.]
“The antiquated concept that the uterus is a disposable organ needs to be put to bed,” says Dr. Robert Vogelzang, professor of radiology at Northwestern Feinberg School of Medicine in Chicago. “Women who undergo hysterectomies face a number of problems, from early menopause to pelvic floor disorders [which affect a person’s ability to control the muscles in their pelvic floor to have a bowel movement] and sexual dysfunction.” Research has shown that hysterectomy increases the long-term risk of cardiovascular and metabolic conditions, even when the ovaries are conserved, he says.
Fenoglia and some physicians believe a widespread lack of knowledge and mistaken beliefs among many women about fibroids and alternative treatments are major reasons why many women get a hysterectomy unnecessarily. A 2017 survey commissioned by the Society of Interventional Radiology found that 28 percent of the women surveyed had never heard of uterine fibroids, 20 percent believe hysterectomy is the only treatment for uterine fibroids and 19 percent believe fibroids are cancerous and require the removal of the uterus. Overall, 57 percent of the respondents said they didn’t believe they were at risk of getting fibroids — even though 57 percent of women in the U.S. will develop fibroids by age 50. The survey was conducted by the Harris Poll online in June 2017. Pollsters surveyed 1,176 women in the U.S. age 18 and older to gain a better understanding of the awareness of uterine fibroids and treatment options.
The widespread lack of understanding of fibroids and treatment options contribute to unnecessary hysterectomies, says Dr. Gerardo Bustillo, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “Historically, too many hysterectomies have been performed for fibroids,” Bustillo says. “It’s important to know that fibroids are extremely common, occurring in 70 to 80 percent of women, and that the majority of women will never need treatment. Also, symptoms from fibroids will resolve in many patients once menopause is reached. In addition, the risk of malignancy is very low.”
[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]
If you’re diagnosed with fibroids, you have an array of options other than a hysterectomy. Here are five strategies that can help you find the right approach:
Talk to your doctor. Women who are diagnosed with fibroids should talk to their gynecological care provider about whether they are causing symptoms, says Dr. James B. Spies, a professor of radiology at MedStar Georgetown University Medical Center in the District of Columbia. “Most women will not have symptoms initially and will need no therapy,” he says.
Consider watchful waiting. If symptoms are present but mild, consider their severity and whether they impact your day-to-day life, Spies advises. “If there is little impact, watchful waiting may be the best option,” Spies says. Watchful waiting entails monitoring a patient’s condition but not providing treatment unless symptoms change or appear.
Be prepared to get a second opinion. If your symptoms become bothersome, discuss your options with your gynecologist. “If the first or only option offered is hysterectomy, then the patient clearly should seek a second opinion,” Spies says. If the gynecologist doesn’t mention UFE as an option, ask about it, he says. Patients interested in the procedure should ask for a referral to an interventional radiologist for consideration for UFE.
Become educated on other treatment options. Ask your physician about other minimally invasive treatment options. These include laparoscopic ultrasound-guided radio frequency ablation, in which radio frequency energy is applied through a small needle, destroying fibroids and leaving the surrounding tissue unaffected. Myomectomy is another alternative to hysterectomy. This procedure involves surgically removing just the fibroids. A surgeon can do this by entering through the navel. Another option is a hysteroscopy, which involves the insertion of a thin instrument through the vagina. This is typically an option for women who have fibroids within the lining of the uterine cavity.
[See: 7 Reasons to Call Off a Surgery.]
Weigh whether a hysterectomy is right for you. The ideal candidate for hysterectomy is a woman who has completed her child-bearing and has no major contraindications to surgery, Bustillo says. “With today’s technology, the majority of hysterectomies can be performed in a minimally invasive way, and patients benefit greatly from the increased safety, decreased pain and much faster recovery that these techniques offer,” he says. “A patient considering hysterectomy should make sure that the gynecologic surgeon she chooses is experienced in these newer techniques.”
More from U.S. News
10 Ways to Prepare for Surgery
11 Ways to Cope With Back Pain
What to Eat and Drink During Menopause
Why Many Women Unnecessarily Get a Hysterectomy originally appeared on usnews.com
