Prakash Chandran (Host): Welcome to BayCare HealthChat. I'm Prakash Chandran, and in this episode we'll be talking about treating and recovering from uterine fibroid embolization. Joining us to discuss is Dr. Clifford J. Raymond, an Interventional Radiologist with BayCare Health System. Dr. Raymond, thank you so much for joining us today. Really appreciate your time. I wanted to get started with actually the basics. Can you just tell us what fibroids are?

Clifford J. Raymond, MD: Absolutely. And, thank you for having me. So uterine fibroids are a benign or non-cancerous mass that grows within the uterus itself. Many women have these and they don't cause symptoms at all. But some women, the fibroids grow large enough where they can cause dysfunctional uterine bleeding. They can cause severe or moderate pelvic pain, and then other symptoms can occur, if the fibroids get large enough, such as constipation and other bulk type symptoms.

Host: And just expanding on that a little bit. I know you say that they're benign and a lot of women have them. Do they manifest at a certain age, and do they grow larger with time?

Clifford J. Raymond, MD: Yes, they often do grow larger in time, particularly the patients that we see. So the original or the early treatment of these fibroids is often with conservative measures such as oral contraceptive pills, other hormonal treatments and usually those can be very effective at reducing the symptoms related to fibroids, but occasionally they don't work or they don't work well enough.

And in those patients, the fibroids can tend to grow very large to where the uterus actually grows to the same size that it would be during pregnancy. So these fibroids can indeed get very large and they are responsive to the hormonal systems in the female reproductive cycle. So, women that typically we treat are in their thirties and forties. So these are premenopausal women that are symptomatic from their fibroids.

Host: Okay, so let's get into that a little bit. Talk to us about what symptomatic means, and also let's lead into when a uterine fibroid embolization is needed.

Clifford J. Raymond, MD: Sure thing. So what symptomatic uterine fibroids means really, is that the fibroid, as I said previously, grows large enough and starts to cause bleeding that really you can't control that well. Women will often complain of vaginal spotting throughout their menstrual cycle. They'll complain of a prolonged menstrual cycle. When they were younger, in their twenties, it would be three to five days, but now they're in their thirties and forties and their menstrual cycle is lasting two weeks. They're having to go through several tampons or pads a day, and it really becomes a burden on their lifestyle, not only in the workplace, but also at home when they're taking care of their children or other loved ones in the family. So that's really what symptomatic means in the sense that these fibroids are causing issues to the point where it's affecting the woman's individual life.

Host: So if it is affecting them, is the uterine fibroid embolization the gold standard procedure, or are there others to consider?

Clifford J. Raymond, MD: So, no the gold standard for fibroids that have not responded to conservative measures, such as hormonal therapies, oral contraceptive pills; a hysterectomy is really the gold standard in the sense that the entire uterus is removed, but the procedure that we offer is essentially an alternative to this, and it has a much lower risk than a hysterectomy or a myomectomy, which is just partial removal of the uterus.

Host: Okay. Understood. And so when is it considered versus a hysterectomy or a myomectomy, for example? Like how do you make the consideration that the fibroid embolization is the right approach?

Clifford J. Raymond, MD: So really it comes down to patient choice. Historically gynecologists have treated symptomatic uterine fibroids that don't respond to conservative measures with either hysterectomy or myomectomy. Now that is an effective treatment and it's well documented, but some women don't want to take their uterus out, they want to maintain their uterus and they also don't want to have to deal with any potential complications or being out of work for a long time that you would experience with a hysterectomy or a myomectomy.

So, it really comes down to patient choice. It's a safe alternative to these procedures, and like I said, it gets patients back to work much quicker. And it has a lower side effect profile than a major operation.

Host: Yeah, that makes sense. So let's get into the procedure itself. Can you talk us through it?

Clifford J. Raymond, MD: Absolutely. So the procedure itself start to finish takes about an hour to an hour and 20 minutes. Patients are admitted for observation overnight at one of our BayCare hospital facilities. During the procedure, they are in our IR suites. They're lying on a table and they're given moderate sedation, and this is basically medications through the IV that put you in a twilight state, and most patients actually sleep through most of the procedure. So how I technically perform the procedure is I put a tiny catheter into the artery in the groin. And that artery connects up to the arteries that feed the uterine fibroids.

And what I do is I inject little particles that block blood supply to the fibroids. And like everything else in the body, if there's a lack of blood supply to an organ, that organ or the mass will actually shrink over time. And that's the basis of the embolization; blocking blood supply to these masses that are in the uterus in order to reduce the volume, reduce the size of them, in order to reduce the symptoms that the woman is suffering from. So I actually perform a nerve block as well during the procedure that helps reduce pelvic pain that patients can have after the procedure and then we give them other medications to treat any nausea that could occur. They will stay overnight in one of our facilities and the majority of women leave the next morning.

And are able to go home, they'll take another one to two days off of work and then can get back to light activity thereafter.

Host: Yeah, that is a very quick turnaround. You know, you mentioned that you use a nerve block to reduce the pelvic pain. Can you tell us more about that?

Clifford J. Raymond, MD: Absolutely. So, the nerve block is called a superior hypogastric nerve block. So this procedure has been developed over the last 20 to 30 years, and there's various different ways to treat post-procedural pain, right? You can give people medications through an IV. They can take medications by mouth.

This is a block that actually blocks the nerves to the uterus, and patients that have pain following the procedure, the most severe pain is usually in about the six to eight hour range. And this nerve block, blocks the pain for up to 12 hours. So it's been scientifically proven to reduce pain following the procedure.

And in many centers that these nerve blocks are being performed, women can often go home the same day. We choose to keep our patients overnight for observations to be conservative. But it's really a game changer in the sense that it greatly reduces women's post-procedural pain and allows them to get out of the hospital sooner.

Host: So let's talk about the procedure's efficacy. How effective is it in treating the related bleeding and pelvic pain that you spoke about earlier?

Clifford J. Raymond, MD: So the procedure is very effective at treating symptoms from uterine fibroids. In studies that have been performed, upwards of 90 to 95% of patients report improvement of their symptoms. Repeat intervention is needed in these women in less than 5%. So only one out of about 20 patients will require another fibroid embolization procedure or a hysterectomy after our procedure, which is pretty remarkable.

Host: Yeah, that's incredible. Are there any risks associated with the procedure that people should know about?

Clifford J. Raymond, MD: That's a good question. So although the nature of my field, we have low risk side effect profiles for all the procedures that we do. There's always a risk in anything when a therapy is administered. So the major complication rate in a study of this procedure that was done back in 2012, basically found that under 5 to 6% of the time, a major complication occurs.

And really the major complication rate is probably lower than that, a full decade later after our technologies have improved. So the most common things that can occur, we've kind of addressed. You can have some post-procedural pain, but we can treat that effectively. Occasionally people can get a little bit of a hematoma or a small amount of bleeding in their groin.

But that's easily treated and the side effect profile is definitely lower than a major operation in terms of potential risks and so forth. So overall the risks are very low for the procedure, but there's always a risk in anything we do. But fortunately, the things that can occur are very minor.

Host: If someone is experiencing some of the symptoms that we talked about, that bleeding that is really impeding on their lifestyle, and some of that pelvic pain, what should they do? Like, do they need to go to their OBGYN and get a referral, or do you recommend something else?

Clifford J. Raymond, MD: Yes, we always recommend patients speaking with their gynecologist regarding the procedure. The gynecologists are a fundamental part of this process in the sense that I will perform the procedure and I will take care of this patient to the extent that I can. But really, it's always great for the gynecologist to be involved with the patient care before and after. So a referral from them is recommended, but it's not necessary all the time. I'm happy to see any woman in my clinic that has any questions about the procedure, and so forth.

Host: So, Dr. Raymond, just before we close, I'm sure that you've helped many women with this procedure, the uterine fibroid embolization. If there's one thing that you know to be true, that you wanted to leave with our audience or with women as they consider this procedure, what might that be?

Clifford J. Raymond, MD: So I've spoken to many women that have suffered from uterine fibroids over the years and it can cause a lot of distress in their lives. The women that we take care of are usually in their thirties and forties, and they've been dealing with severe menstrual bleeding for years, and it affects every facet of their life; not only personally when it comes to intimacy with their partner, it can affect their ability to provide childcare and care for other loved ones. It can affect their work performance when they're dealing with heavy menstrual cycles. And it's really a burden for women. I guess the goal of my talk today is really so that women understand there is an alternative to having their uterus taken out in these situations. And that is the procedure that we provide, which is uterine fibroid embolization. So this procedure is safe, it's effective, and it's a minimally invasive alternative to a major operation.

Host: Well, Dr. Raymond, I think that is the perfect place to end. Thank you so much for your time today.

Clifford J. Raymond, MD: Thank you. It was great talking with you. And, I hope to see some of these patients in my clinic soon.

Host: And that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information. Please remember to subscribe, rate, and review this podcast and all of the other BayCare podcasts. For more health tips and updates, follow us on your social channels.

My name's Prakash Chandran. Thank you for listening. Stay well.