Uterine fibroids are non-cancerous tumors that grow on or in the muscles of the uterus (womb). These can be painful and cause heavy bleeding during your periods. At least 25 percent of women in the U.S. have fibroids.
Arun Jagannathan, M.D. discusses Uterine Fibroid Embolization, and how this procedure can help you to have less pain from fibroids and get back to the activities that you enjoy.
Do You Suffer from Pain from Uterine Fibroids? Embolization Might be the Answer You are Looking For
Featured Speaker:
Arun Jagannathan, MD
Arun Jagannathan, M.D. received his medical degree from the University of Illinois College of Medicine in Peoria, Illinois. He completed his Transitional Internship and Diagnostic Radiology Residency at St. Luke's Medical Center in Milwaukee. He went on to complete a fellowship in Vascular Interventional Radiology at Massachusetts General Hospital in Boston. He is a board-certified radiologist who specializes in interventional radiology procedures. Transcription:
Do You Suffer from Pain from Uterine Fibroids? Embolization Might be the Answer You are Looking For
Carl Maronich (Host): And welcome to the podcast. I’m Carl Maronich and today we are joined by Dr. Jagannathan. Doctor, welcome.
Arun Jagannathan, MD (Guest): Thanks for having my Carl.
Carl: We’re glad you are here, and you are an interventional radiologist and today we are going to be talking about uterine fibroid embolization, but before we get into that conversation, we want to get a little background. As an interventional radiologist, tell folks just what it is that you do.
Dr. Jagannathan: So, Carl a vascular and interventional radiologist is a radiologist who has done additional sub-specialization in using image guidance techniques that we have available in order to do minimally invasive procedures. For example, we have been trained in doing minimally invasive procedures using CT scan to guide us, ultrasound, real time x-ray and using combination of these modalities as necessary.
Carl: Well you are a young man still, so you haven’t been in practice that long, but in the time that you have been in practice, have you seen this technology advance? Are you able to do things now that you weren’t able to do when you started?
Dr. Jagannathan: We definitely have. We have seen advancements in the actual imaging technologies themselves as well as advancements in the tools that we use to do our procedures. Advancements in the type of catheters, micro catheters, embolization materials that we have available.
Carl: Yeah, well I know our TVs at home are getting bigger and better definition so if the TVs are doing that, I’m sure the equipment you’re working on, the same thing is happening. So, that’s good for all of us that doctors have this technology. It’s good for watching a ballgame, but it’s even better for looking at parts of the body, right?
Dr. Jagannathan: Absolutely.
Carl: And one part of the body we are going to talk about is the uterus and uterine fibroid embolization. Talk a little bit about what that procedure is.
Dr. Jagannathan: So, uterine artery embolization or uterine fibroid embolization is a minimally invasive method in which we can treat patients that have symptomatic uterine fibroids. Symptomatic uterine fibroids can cause a wide array of symptoms from prolonged, heavy bleeding during a patient’s cycles to mass related symptoms such as pelvic heaviness, fullness, and whole host of other symptoms. So, through uterine artery embolization, we are able to now treat these minimally invasively through a pinhole in either the wrist or the groin as an outpatient and have the patient discharge either the same day or the next day and back to work within a week.
Carl: Are uterine fibroids something most women, many women are going to deal with in their lifetime?
Dr. Jagannathan: Uterine fibroids are very, very common. Anywhere from one third to one half of women will actually have uterine fibroids. Now the number of women that actually have symptomatic fibroids is much smaller than that and it tends to peak around 35 to about 45 years-of-age, more common in African American women, but again, a very, very common disease process. It is a benign tumor, not a pre-malignant tumor that affects and adversely affects a large percentage of our female population.
Carl: And I would guess as with many things, in those patients the severity of those symptoms really varies, I would guess.
Dr. Jagannathan: Definitely. There is a huge range. A number of women may have very large fibroids that are not as symptomatic, and some women have smaller fibroids that are very symptomatic. It can depend on the location, the vascularity of the fibroids. A lot of what we are doing in our evaluation process is determining where the fibroids are, based on our imaging studies and then determining what we think is the most appropriate treatment for those.
Carl: Yeah. And when you talk about fibroids, uterine fibroids, what is the percentage of those that require hysterectomies or is there a link between those and hysterectomies.
Dr. Jagannathan: I would say personally, in my mind, there are not that many patients that are suffering from fibroids that require a hysterectomy. Patients that would require a hysterectomy really would have to have fibroids so large that they cannot be treated effectively through this – through a minimally invasive method. So, a very small percentage I would say.
Carl: So, if a woman in the age range that you said, is having some of the symptoms you talked about, what should their first tactic be, the first thing they should do?
Dr. Jagannathan: I think the first thing they should do is definitely work with their gynecologist. The gynecologist is their expert and is their provider, women’s’ health provider that is going to be able to provide them the full array of options as far as treating these fibroids anywhere from watchful waiting to medications to minimally invasive treatments such as a referral to us for uterine artery embolization or something more definitive and more invasive like a hysterectomy or a myomectomy.
Carl: So, in what you just said, if someone does have a uterine fibroid, embolization isn’t necessarily going to have to happen. It may be kind of a watch and wait situation?
Dr. Jagannathan: Definitely. It depends on the patient. It depends on what they would like to do. If they would like to try a medical treatment, if they would like to move to something more invasive such as a hysterectomy or myomectomy, that’ definitely their choice. I think that it is just most important that they are provided every single option.
Carl: And then the benefit of the embolization versus some of the other more advance procedures would be what?
Dr. Jagannathan: The benefit of the embolization is that it is an outpatient procedure that can be done with conscious sedation. So, no general anesthesia. Done as an outpatient. Through a tiny puncture in either the wrist or the groin which not even a single suture is utilized to close the wound and wuicker recovery in comparison to a hysterectomy or myomectomy and back to work within a week versus potentially four weeks or more.
Carl: If you will, talk a little bit about some of the patients that you have been able to do this procedure on and the difference you have been able to make. I’m sure you have had women who have as you described the condition initially, there can be a lot of pain with that just depending on different circumstances. And you are able to give relief to that. Can you talk a little bit about some of the extreme patients that you have been able to help with this condition?
Dr. Jagannathan: We have had a number of patients that really did not want to consider any other option because they didn’t want to have something very invasive like a hysterectomy or a myomectomy done and until they had learned on their own, of the uterine artery embolization procedure, they had thought that they would just have to live with this until they went through menopause. So, potentially I have had patients that thought they would be dealing with this for another five, six, seven years, they were in their early forties and we were able to then get them to the point where they had marked improvement in their lifestyle within a matter of a couple of months after the procedure.
Carl: Wow and is this – the fibroids are probably not something that a woman can do anything to try to prevent. It is just kind of something that happens in anatomy, is that correct or are there things women can do to try to decrease the likelihood?
Dr. Jagannathan: There isn’t anything they can do. No, there are things that can be done from the standpoint of medical treatments that can potentially reduce the hormone related growth of these fibroids and the symptom related to the fibroids, but there is nothing that you can do that could prevent the growth of this benign tumor.
Carl: So, then it’s more a matter of being in tune with your body, knowing if there are changes, when you notice those kinds of symptoms, react properly, get them checked out?
Dr. Jagannathan: Absolutely. If you are having those symptoms, then you need to have at the very least a pelvic ultrasound in order to determine if you have significant fibroids. And if you have significant large fibroids that are resulting in these type of symptoms; then you need to evaluate all of your options everywhere from anything as minimally invasive as a uterine artery embolization up to a hysterectomy should be evaluated and considered.
Carl: Through a lot of these podcasts, some of the clinicians that we talk to, it oftentimes comes back to regularly getting checkups and making sure – healthy lifestyle and making sure you are in tune with your body and getting regular checkups so when something does start to develop, you can get it early. And that is kind of constant good advice I would think.
Dr. Jagannathan: Absolutely.
Carl: We are talking about fibroid embolization, but in the work that you do, are there – one have you seen more of these? Is this something that over the decades there has been an increase in the number of or is it kind of holding steady and you get the same number of women annually that there has always been?
Dr. Jagannathan: I think there has been a kind of a steady growth probably in the last 30-40 years in women developing symptomatic fibroids. Not a huge change though.
Carl: Now getting away from this specific procedure of fibroid embolization, just talking more generally about the work that you do as an interventional radiologist; what are the top five different procedures that you do if there are some that you do more often and more regularly?
Dr. Jagannathan: So, I would say the procedures that we do embolization wise, the most common ones are the uterine artery embolization for fibroid treatments. We do a large number of liver directed therapies, embolizations to decrease liver tumors. We do a number of venous procedures both deep and superficial venous procedures, patients that have deep venous clots, we will dissolve clots or remove clots, pulmonary embolism.
Carl: Thrombosis?
Dr. Jagannathan: Thrombosis, correct, superficial venous disease, we treat all forms of superficial venous disease. We do biopsies, drainages, we drain fluid basically from everywhere in the body as necessary.
Carl: As I asked a little earlier, are there any – of those conditions and other things that you do, are you seeing anymore of those as time goes on. In the way society has changed eating habits. You mentioned those earlier, are you seeing anymore of a certain kind of procedure than you saw earlier in your career?
Dr. Jagannathan: Definitely. As the population ages, we see a lot more cancer. So, we have a larger population of cancer patients in the area that we do a number of minimally invasive treatments for. We will place long-term venous access with implantable venous access ports for these patients to receive chemotherapy. We will diagnose them with their biopsy, if they develop fluid in their lungs or their abdomen, we may place a drain. If they develop tumors in particular organs, we can treat them minimally invasively either through administering chemotherapy through embolization particles or radiation through embolization particles. So, I would say that the incidence of cancer is definitely rising.
Carl: Well, doctor, you have shared a lot of good information. If someone wants to contact your office, how might they go about doing that?
Dr. Jagannathan: So, we actually see our patients in clinic. So, we have a clinic that we do all of our initial consultations with the patients with so patients can self-refer and call directly to the clinic if they have uterine fibroids and they feel they may be potentially a candidate for the procedure, they could call us directly, or they can be referred by their primary or specialist physician to us.
Carl: Oh, very good. And again, as we talked about earlier, at first sign of anything primary care provider is the route to go and if there is something more that’s needed then the referral would go to you or the appropriate specialist.
Dr. Jagannathan: Definitely. If it’s an emergency, go to the ER, but otherwise go to the primary doc, yeah.
Carl: Very good. Dr. Arun Jagannathan, we appreciate your time and expertise.
Dr. Jagannathan: Alright, thank you Carl.
Do You Suffer from Pain from Uterine Fibroids? Embolization Might be the Answer You are Looking For
Carl Maronich (Host): And welcome to the podcast. I’m Carl Maronich and today we are joined by Dr. Jagannathan. Doctor, welcome.
Arun Jagannathan, MD (Guest): Thanks for having my Carl.
Carl: We’re glad you are here, and you are an interventional radiologist and today we are going to be talking about uterine fibroid embolization, but before we get into that conversation, we want to get a little background. As an interventional radiologist, tell folks just what it is that you do.
Dr. Jagannathan: So, Carl a vascular and interventional radiologist is a radiologist who has done additional sub-specialization in using image guidance techniques that we have available in order to do minimally invasive procedures. For example, we have been trained in doing minimally invasive procedures using CT scan to guide us, ultrasound, real time x-ray and using combination of these modalities as necessary.
Carl: Well you are a young man still, so you haven’t been in practice that long, but in the time that you have been in practice, have you seen this technology advance? Are you able to do things now that you weren’t able to do when you started?
Dr. Jagannathan: We definitely have. We have seen advancements in the actual imaging technologies themselves as well as advancements in the tools that we use to do our procedures. Advancements in the type of catheters, micro catheters, embolization materials that we have available.
Carl: Yeah, well I know our TVs at home are getting bigger and better definition so if the TVs are doing that, I’m sure the equipment you’re working on, the same thing is happening. So, that’s good for all of us that doctors have this technology. It’s good for watching a ballgame, but it’s even better for looking at parts of the body, right?
Dr. Jagannathan: Absolutely.
Carl: And one part of the body we are going to talk about is the uterus and uterine fibroid embolization. Talk a little bit about what that procedure is.
Dr. Jagannathan: So, uterine artery embolization or uterine fibroid embolization is a minimally invasive method in which we can treat patients that have symptomatic uterine fibroids. Symptomatic uterine fibroids can cause a wide array of symptoms from prolonged, heavy bleeding during a patient’s cycles to mass related symptoms such as pelvic heaviness, fullness, and whole host of other symptoms. So, through uterine artery embolization, we are able to now treat these minimally invasively through a pinhole in either the wrist or the groin as an outpatient and have the patient discharge either the same day or the next day and back to work within a week.
Carl: Are uterine fibroids something most women, many women are going to deal with in their lifetime?
Dr. Jagannathan: Uterine fibroids are very, very common. Anywhere from one third to one half of women will actually have uterine fibroids. Now the number of women that actually have symptomatic fibroids is much smaller than that and it tends to peak around 35 to about 45 years-of-age, more common in African American women, but again, a very, very common disease process. It is a benign tumor, not a pre-malignant tumor that affects and adversely affects a large percentage of our female population.
Carl: And I would guess as with many things, in those patients the severity of those symptoms really varies, I would guess.
Dr. Jagannathan: Definitely. There is a huge range. A number of women may have very large fibroids that are not as symptomatic, and some women have smaller fibroids that are very symptomatic. It can depend on the location, the vascularity of the fibroids. A lot of what we are doing in our evaluation process is determining where the fibroids are, based on our imaging studies and then determining what we think is the most appropriate treatment for those.
Carl: Yeah. And when you talk about fibroids, uterine fibroids, what is the percentage of those that require hysterectomies or is there a link between those and hysterectomies.
Dr. Jagannathan: I would say personally, in my mind, there are not that many patients that are suffering from fibroids that require a hysterectomy. Patients that would require a hysterectomy really would have to have fibroids so large that they cannot be treated effectively through this – through a minimally invasive method. So, a very small percentage I would say.
Carl: So, if a woman in the age range that you said, is having some of the symptoms you talked about, what should their first tactic be, the first thing they should do?
Dr. Jagannathan: I think the first thing they should do is definitely work with their gynecologist. The gynecologist is their expert and is their provider, women’s’ health provider that is going to be able to provide them the full array of options as far as treating these fibroids anywhere from watchful waiting to medications to minimally invasive treatments such as a referral to us for uterine artery embolization or something more definitive and more invasive like a hysterectomy or a myomectomy.
Carl: So, in what you just said, if someone does have a uterine fibroid, embolization isn’t necessarily going to have to happen. It may be kind of a watch and wait situation?
Dr. Jagannathan: Definitely. It depends on the patient. It depends on what they would like to do. If they would like to try a medical treatment, if they would like to move to something more invasive such as a hysterectomy or myomectomy, that’ definitely their choice. I think that it is just most important that they are provided every single option.
Carl: And then the benefit of the embolization versus some of the other more advance procedures would be what?
Dr. Jagannathan: The benefit of the embolization is that it is an outpatient procedure that can be done with conscious sedation. So, no general anesthesia. Done as an outpatient. Through a tiny puncture in either the wrist or the groin which not even a single suture is utilized to close the wound and wuicker recovery in comparison to a hysterectomy or myomectomy and back to work within a week versus potentially four weeks or more.
Carl: If you will, talk a little bit about some of the patients that you have been able to do this procedure on and the difference you have been able to make. I’m sure you have had women who have as you described the condition initially, there can be a lot of pain with that just depending on different circumstances. And you are able to give relief to that. Can you talk a little bit about some of the extreme patients that you have been able to help with this condition?
Dr. Jagannathan: We have had a number of patients that really did not want to consider any other option because they didn’t want to have something very invasive like a hysterectomy or a myomectomy done and until they had learned on their own, of the uterine artery embolization procedure, they had thought that they would just have to live with this until they went through menopause. So, potentially I have had patients that thought they would be dealing with this for another five, six, seven years, they were in their early forties and we were able to then get them to the point where they had marked improvement in their lifestyle within a matter of a couple of months after the procedure.
Carl: Wow and is this – the fibroids are probably not something that a woman can do anything to try to prevent. It is just kind of something that happens in anatomy, is that correct or are there things women can do to try to decrease the likelihood?
Dr. Jagannathan: There isn’t anything they can do. No, there are things that can be done from the standpoint of medical treatments that can potentially reduce the hormone related growth of these fibroids and the symptom related to the fibroids, but there is nothing that you can do that could prevent the growth of this benign tumor.
Carl: So, then it’s more a matter of being in tune with your body, knowing if there are changes, when you notice those kinds of symptoms, react properly, get them checked out?
Dr. Jagannathan: Absolutely. If you are having those symptoms, then you need to have at the very least a pelvic ultrasound in order to determine if you have significant fibroids. And if you have significant large fibroids that are resulting in these type of symptoms; then you need to evaluate all of your options everywhere from anything as minimally invasive as a uterine artery embolization up to a hysterectomy should be evaluated and considered.
Carl: Through a lot of these podcasts, some of the clinicians that we talk to, it oftentimes comes back to regularly getting checkups and making sure – healthy lifestyle and making sure you are in tune with your body and getting regular checkups so when something does start to develop, you can get it early. And that is kind of constant good advice I would think.
Dr. Jagannathan: Absolutely.
Carl: We are talking about fibroid embolization, but in the work that you do, are there – one have you seen more of these? Is this something that over the decades there has been an increase in the number of or is it kind of holding steady and you get the same number of women annually that there has always been?
Dr. Jagannathan: I think there has been a kind of a steady growth probably in the last 30-40 years in women developing symptomatic fibroids. Not a huge change though.
Carl: Now getting away from this specific procedure of fibroid embolization, just talking more generally about the work that you do as an interventional radiologist; what are the top five different procedures that you do if there are some that you do more often and more regularly?
Dr. Jagannathan: So, I would say the procedures that we do embolization wise, the most common ones are the uterine artery embolization for fibroid treatments. We do a large number of liver directed therapies, embolizations to decrease liver tumors. We do a number of venous procedures both deep and superficial venous procedures, patients that have deep venous clots, we will dissolve clots or remove clots, pulmonary embolism.
Carl: Thrombosis?
Dr. Jagannathan: Thrombosis, correct, superficial venous disease, we treat all forms of superficial venous disease. We do biopsies, drainages, we drain fluid basically from everywhere in the body as necessary.
Carl: As I asked a little earlier, are there any – of those conditions and other things that you do, are you seeing anymore of those as time goes on. In the way society has changed eating habits. You mentioned those earlier, are you seeing anymore of a certain kind of procedure than you saw earlier in your career?
Dr. Jagannathan: Definitely. As the population ages, we see a lot more cancer. So, we have a larger population of cancer patients in the area that we do a number of minimally invasive treatments for. We will place long-term venous access with implantable venous access ports for these patients to receive chemotherapy. We will diagnose them with their biopsy, if they develop fluid in their lungs or their abdomen, we may place a drain. If they develop tumors in particular organs, we can treat them minimally invasively either through administering chemotherapy through embolization particles or radiation through embolization particles. So, I would say that the incidence of cancer is definitely rising.
Carl: Well, doctor, you have shared a lot of good information. If someone wants to contact your office, how might they go about doing that?
Dr. Jagannathan: So, we actually see our patients in clinic. So, we have a clinic that we do all of our initial consultations with the patients with so patients can self-refer and call directly to the clinic if they have uterine fibroids and they feel they may be potentially a candidate for the procedure, they could call us directly, or they can be referred by their primary or specialist physician to us.
Carl: Oh, very good. And again, as we talked about earlier, at first sign of anything primary care provider is the route to go and if there is something more that’s needed then the referral would go to you or the appropriate specialist.
Dr. Jagannathan: Definitely. If it’s an emergency, go to the ER, but otherwise go to the primary doc, yeah.
Carl: Very good. Dr. Arun Jagannathan, we appreciate your time and expertise.
Dr. Jagannathan: Alright, thank you Carl.