Transcription:
Uterine fibroid Embolization and the UK HealthCare Uterine Fibroid Clinic

Intro: Another informational resource from UK HealthCare. This is UK HealthCast, featuring conversations with our physicians and other healthcare providers.

Cheryl Martin: It's not unusual for women to have uterine fibroids at some time in their lives. They may not know because often there are no symptoms. The fibroids might remain the same size or grow slowly or quickly. On this episode of UK HealthCast, a podcast sponsored by University of Kentucky HealthCare, we discuss uterine fibroids and a procedure to shrink them.

I'm Cheryl Martin. Our guest is Dr. Merve Ozen, a UK HealthCare interventional radiologist. Dr. Ozen, so glad you're on to discuss this important topic related to women's health.

Merve Ozen: Thank you very much. Very happy to be here.

Cheryl Martin: First of all, what are uterine fibroids?

Merve Ozen: Uterine fibroids are non-cancerous tumors of the uterus. They're not as bad, but they can grow over time and cause problems due to compression or they can cause pain and other problems.

Cheryl Martin: What causes these fibroids?

Merve Ozen: We exactly don't know what causes these fibroids, but we know that they grow from the smooth muscle cells of the uterus.

Cheryl Martin: Now, are there risk factors that put certain women more at risk?

Merve Ozen: Yes. It's been found that the African-American women have more tendency to have uterine fibroids. But overall, there are a lot of studies going on to find out the actual risk factors.

Cheryl Martin: And do we know why it's more common among African-American women?

Merve Ozen: We do not know.

Cheryl Martin: Now, do fibroids require a treatment? And if so, how do you treat them?

Merve Ozen: The fibroid require treatment when they cause symptoms. If people find out that they have fibroids on a imaging incidentally, we do not have to treat them. But if they start causing problems like bleeding or bulk symptoms like urinary problems or constipation, then we will consider a different treatment.

Cheryl Martin: Do the fibroids prevent a woman from getting pregnant?

Merve Ozen: They can, because of the space-occupying issues and the fibroids can push the endometrial cavity and it may make the uterus not have a space to have a baby.

Cheryl Martin: So let's talk about uterine fibroid embolization. What is that?

Merve Ozen: Uterine fibroid embolization is a minimally invasive procedure. It's not a surgery. And we do this procedure under image guidance, meaning we use ultrasound and x-ray to localize the vessels of the uterus. And the uterine fibroids are the part of the uterus. And we inject very tiny beads through a very small catheter. The catheter is almost as the size of the tip of a pen. And by using x-ray, we find the uterine artery and we inject these very tiny beads under x-ray.

Cheryl Martin: So who's a good candidate for UFE, uterine fibroid embilization?

Merve Ozen: For uterine fibroid embolization, the patients who are having bleeding problems and bulk symptoms, like a urinary problems or constipation, can be a good candidate. But we always start offering the minimal invasive options like medical treatments first. And then, if that doesn't work, we continue with more invasive options like surgery or procedures.; The uterine fibroid embolization procedure kills the fibroids, but it doesn't kill the uterus. This is a good alternative for patients who would like to keep their uterus and who would like to have less downtime compared to surgery like myomectomy or hysterectomy. Myomectomy means removing the myoma, meaning removing the fibroids. We have a very good teamwork with gynecology, Dr. Hoffman from University of Kentucky Gynecology Department. We work together and we look through every patient's imaging together and we decide which patient a good candidate for surgery or minimally invasive intervention, like uterine fibroid embolization.

Cheryl Martin: So we talked about who would be a good candidate, who would not be a good candidate?

Merve Ozen: If patients have a very, very large uterus and if their main problem is bulk symptoms. There are patients who suffer from fibroids for a very long time. And over time, the fibroids grow more and more. And the uterine fibroid embolization let's our bodies take care of shrinking the fibroids. And it may take some time to shrink the fibroids. For instance, if you have a 30-centimeter or 40-centimeter uterus, it's going to take some time for your body to decrease the size and you may continue to have bulk symptoms. So we always offer different options, but for patients who have very big fibroids and they can consider hysterectomy over a uterine fibroid embolization. But we can still do the uterine fibroid embolization for these patients. Sometimes they suffer from severe anemia and they can't go through a surgery. So we do the uterine fibroid embolization prior to the surgery, so their blood levels come to a normal levels so they can tolerate the surgery.

Cheryl Martin: Anything else you wanted to add about the procedure for patients?

Merve Ozen: The procedure itself is a short procedure, it takes approximately two hours. We do it in an outpatient setting, but we keep our patients overnight just to support them for their pain and nausea. The procedure is minimally invasive, meaning we go through a tiny hole from the groin from the wrist. And the patients get some twilight medication, and they will be relaxed on the procedure table. And we talk to our patients and give comforting medications throughout the procedure. And after the procedure, we observe them over night just to control their pain and nausea.

Cheryl Martin: You've talked about some of the benefits. Any others that you want to talk about, benefits as well as risks?

Merve Ozen: The benefits of the procedures are decreasing the bleeding. Most patients suffer from bleeding due to fibroids because when there is a space-occupying tumor in the uterus, the uterus can't contract as well and it can't stop the menstrual bleeding. So the patients who go through this procedure, usually have very heavy, very prolonged bleeding. And after this procedure, their bleeding normalizes. And they feel great because the bleeding related, bloating, pain goes away, and this is the biggest benefit. And overtime, the fibroids start shrinking and they become almost like this cysts-like structures and they become very soft and the bulk symptoms disappear. And this is one of the most important benefits of the uterine fibroid embolization.

And the most important risk that we talk about is the pain after the procedure. Even though it's not a bad thing, because the uterus is going through a procedure, the pain may be very intense. So we get some precautions, like we ask our pain team to help us to control the patient's pain. And we give our patients send prescriptions in case they have this painful episodes after the procedure.

One of the risks that we always talk about is when you're in a vessel, there's always a risk of vessel injury, when you're doing any type of vessel-related procedure. And we always explain that prior to the procedure.

Cheryl Martin: So on average, how soon can a patient resume normal activities, like going back to work let's say?

Merve Ozen: So, the actual recovery time is usually 24 hours, but we give a couple of weeks to our patients just to get back to their normal life. Not because of having a wound to heal, but because of the pain and that comes with the embolization.

Cheryl Martin: Now, are the results of their procedure lasting?

Merve Ozen: The results of the procedure lasts. And the first thing that they realize is the bleeding symptoms disappear. The lasting, the time changes depending on patient's age and how big their fibroids were. And usually, around the menopause, their fibroids continue to shrink and they don't come back again. But for younger patients, there are studies showing that the uterine fibroid embolization can help patients around five to ten years. But most important part is at what age or what stage they get the treatment.

Cheryl Martin: So there is a likelihood they could grow back depending on your age?

Merve Ozen: Depending on their age, yes. And they can always get another procedure done or the can get a myomectomy done or hysterectomy. So this is a procedure that helps with the patients in long-term, but it doesn't cause any contraindications for future procedures or surgery,

Cheryl Martin: Talk about how UK HealthCare's uterine fibroid program, how it helps women who are living with uterine fibroids.

Merve Ozen: I love our program. We are very passionate about treating fibroids. And as a uterine fibroid program, we work together with gynecologists and interventional radiologists together. And we decide with the patients and we explain the different options and we let our patients pick the best treatment for themselves. And it's very, very patient centered. So, we have a clinic that we see patients together side-by-side. This allows us to discuss the patients right on the site. And this helps the patients just to go to only one place instead of going to two different clinics to in two different buildings. And there's also an MRI nearby. And just before their clinic appointment, they can get their MRI and they can come and see me and Dr. Hoffman on the same day. It's very convenient. And there are some patients who have complex histories or a complex problems, then we all sit down together and we discuss every case. Sometimes we do procedures in conjunction, like Dr. Hoffman does the myomectomy and interventional does the uterine fibroid embolization. So every patient is very different. It's very important to consider every different treatment for every patient. So I think it's very, very powerful to have this collaboration at the University of Kentucky.

Cheryl Martin: That's great. And in closing, anything else you'd like to add, doctor?

Merve Ozen: Yes. We are very passionate about treating with uterine fibroid embolization, because we know that uterine fibroid embolization works. And I saw in multiple patients that it can change lives. I recommend our patients to do their research about the different treatment options and ask questions. What are my options? And what can you offer? Hysterectomy is not the only choice and not the only treatment for fibroids. So my recommendation for our patients is asking questions to their doctors about different treatment options for fibroids. And they can always contact us and we're always open to answer questions if they have.

Cheryl Martin: Very informative. Thanks so much for educating women on this life-changing topic. Dr. Merve Ozen, interventional radiologist at UK HealthCare. If you'd like more information, please visit our website, ukhealthcare.uky.edu. That's ukhealthcare.uky.edu. This wraps up this edition of UK HealthCast from University of Kentucky HealthCare.

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