Published: Oct. 17, 2006
Updated: Oct. 22, 2007
Their politics are poles apart. But not too long ago, staunch Democrat Judy Whisnant, a Durham-based family attorney, and U.S. Secretary of State Condoleeza Rice had something in common: uterine fibroids, a medical problem prevalent among middle-aged women.
The similarities didn't stop there, as both women chose the same treatment for the condition -- a relatively new procedure known as uterine artery embolization, or UAE.
Like many women, Whisnant had anticipated menopause with mixed emotions. Still, she figured she at least knew what to expect. But as she hit her mid 40s, Whisnant was startled to find that, rather than taper off, her menstrual cycle was, as she puts it, "building to a crescendo."
Over the next year, Whisnant began to bleed so heavily that her periods began to disrupt her work. When they merged into a 47-day marathon, Whisnant became severely anemic. Because the years leading up to menopause are sometimes marked by heavy and irregular menstrual periods, Whisnant's physician didn't initially recommend any additional tests. But as her periods continued to get heavier, she was given a diagnostic ultrasound, which clearly revealed the fibroids.
What to do about them was less clear. Whisnant was offered a limited list of options: wait for the fibroids to go away on their own after menopause (which doesn't always happen), or have one of a variety of surgeries, among them hysterectomy. None of these prospects thrilled her. As a result, Whisnant lived with the debilitation and discomfort of her excessive bleeding for another 18 months before finding a treatment she considered acceptable -- UAE.
Uterine fibroids are noncancerous growths that can develop within the uterine cavity, within the wall, or on its outer surface. They can grow from microscopic seedlings to a weight of several pounds. They can be found within the uterine cavity or replace an entire uterine wall, sometimes altering its shape or even protruding beyond it.
The most common type of pelvic tumor, fibroids are not malignant. Yet they can cause a constellation of troublesome symptoms such as heavy or prolonged bleeding, anemia, menstrual pain, urinary frequency, stress incontinence, pain during sex, and lower back pain.
Fibroids are very common, with estimates that they affect three in every four women of childbearing age. Because uterine fibroids don't always cause symptoms, the exact number of women who have them is unknown. Although one in four women with fibroids will have symptoms, the condition is particularly prevalent among African-American women, whose risk for developing fibroids is estimated to be three to nine times that of Caucasian women.
While the cause of uterine fibroids is unknown, it's possible that their growth is linked to the presence of estrogen -- which would explain why they rarely affect women younger than 20 or those past menopause. Estrogen therapy, oral contraceptives, or pregnancy can stimulate fibroids. Whatever their cause, fibroids remain the leading reason for the approximately 600,000 hysterectomies performed in the U.S. each year.
UAE offers many women with fibroids an appealing alternative. First developed in the mid 1990s, UAE involves placing a catheter into the arteries that supply the uterus and fibroids through a small incision in the groin. By injecting tiny spheres into those arteries, the blood flow to the fibroids is blocked. This deprives nourishment to the fibroids, which will gradually shrink, relieving symptoms.
Duke interventional radiologist Michael Miller, MD, has performed more than 250 uterine artery embolization procedures over the past five years. According to Miller, women seeking UAE for troublesome fibroids should first explore non-operative and uterine-sparing treatment options such as various types of medication and surgeries that remove isolated fibroids or the uterine lining. (Whisnant had been prescribed a pill that she took for several months, with negative side effects and no improvement to her symptoms.)
Since the procedure poses a small risk of ovarian damage, Miller says, "we do consider a patient's wishes to maintain fertility given that the impact of UAE on the chances of getting pregnant is unknown. However, the majority of women with symptomatic fibroids are in their late 30s to 40s, when they've completed their childbearing."
The UAE procedure takes about an hour, and is followed by an overnight observation period during which patients receive medication to relieve pain and cramping. Women generally return to normal activity within the first week, compared to six weeks following hysterectomy. "The short recovery period for UAE is a real advantage for women who can't afford to be out of commission for a long time," Miller says.
In the months after the procedure, fibroids typically shrink an average of 40-70 percent, alleviating symptoms for more than 95 percent of patients. "The rapid recovery and high likelihood of symptomatic relief results in a high rate of patient satisfaction with their choice of UAE." reflects Miller.
Miller describes the UAE services offered by Duke's interventional radiology team as "one-stop shopping.” It is carefully orchestrated through his nurse practitioner Joanna Hiller. “This begins with an MRI that reveals the woman's anatomy and the location, size, and number of her fibroids, in addition to screening for other potential causes of her symptoms," he says.
"We sit down with our patients to review the diagnostic images and plan the process together. We work closely with gynecologists to offer the best multidisciplinary care to meet the patients' needs.
The team's approach gets top marks from Whisnant, who underwent UAE in August of 2004 (Condoleeza Rice had the procedure a few months later). "My experience was top notch every step of the way," Whisnant says. "The team at Duke provided me with lots of material about UAE to make sure I was thoroughly informed. They went over my imaging in great detail at my pre-op visit. I was really impressed by the time and care they took."
In the months following her UAE, says Whisnant, her periods have become more regular, shorter, and lighter. "I couldn't imagine a better outcome -- I'd say it's a 90-percent improvement," she says. "I'm a happy camper."