Symptomatic uterine fibroids: hysterectomy is not the only option — an interview with Eric Hardee, MD

If you’re diagnosed with uterine fibroids, your doctor may recommend getting a hysterectomy. While there’s no single best treatment option for uterine fibroids, there is a better method out there for candidates who qualify—Uterine Fibroid Embolization. To explain, we reached out to Eric Hardee, MD, a Uterine Fibroid Embolization (UFE) specialist. 

DO YOU ENDO: What is a uterine fibroid? 

“Uterine fibroids are benign tumors that arise from smooth muscle cells of the uterus,” says Hardee. “They are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas or myomas, uterine fibroids aren’t associated with an increased risk of uterine cancer and almost never develop into cancer,” Hardee continues. “Uterine fibroids range in size from under a centimeter, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus,” Hardee adds. “You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can cause significant abdominal distention.”

DO YOU ENDO: What are the symptoms of uterine fibroids? 

“The most common symptoms of uterine fibroids include heavy menstrual bleeding, which can be severe enough to cause anemia and can lead to iron-replacement therapy or even blood transfusions,” says Hardee. “We have treated many women who had to endure several blood transfusions every year due to heavy bleeding. Women can suffer from such heavy menstrual cycles that they are forced to miss time from work every month.”

Additional symptoms of uterine fibroids include:

• severe pelvic pain or pressure during menstruation 
• bulk-related symptoms related to the size of the uterus and fibroids
• urinary frequency 
• pressure/heaviness 
• painful sexual intercourse 
• urinary frequency 
• lower back pain 
•  leg pain, swelling, heaviness 

“Peri-menopausal women and women who are spotting between menstrual cycles may also need an endometrial biopsy,” adds Hardee. “Fibroids are initially diagnosed clinically based on a patient’s history and physical exam. Once suspected, the diagnosis of fibroids is usually confirmed with imaging such as pelvic ultrasound,” says Hardee.
“However, MRI is the best way to accurately visualize fibroids prior to deciding which treatment option is best for a patient.”

DO YOU ENDO: Are uterine fibroids dangerous?

“In many cases, women with uterine fibroids never experience symptoms, and it’s not necessary to treat fibroids in such cases,” says Hardee. “However, in other cases, fibroids can cause distressing symptoms such as pain during menstrual cycles, pain during sex, and heavy menstrual bleeding,” Hardee continues. “Uterine fibroids can be uncomfortable, but in most cases, there are no serious complications. Nevertheless, in some cases, uterine fibroids may cause one or more significant health and/or fertility issues.” 

Uterine fibroids may cause one or more of the following: 

• anemia (due to excessive blood loss)
• decreased fertility (due to prevention of implantation of an embryo)
• recurrent spontaneous miscarriages (loss of pregnancy)
• blocked fallopian tubes (due to the location of a fibroid at the entrance to the   fallopian tubes leading to decreased fertility) 

DO YOU ENDO: What are the treatment options available for uterine fibroids? 

 “My partner, Dr. William C. Fox, and I have more than 35 years of combined experience performing Uterine Fibroid Embolization (UFE) and are very passionate about this non-surgical, uterine-sparing therapy,” says Hardee. “Unfortunately, most women are not presented with the option of UFE, and instead are usually steered primarily toward surgical options like hysterectomy. The majority of my patients are told that hysterectomy is their only option and find out about UFE via internet searches or talking with friends or family members who either had the procedure or had heard about it elsewhere,” Hardee continues. 

“Dr. Fox and I have pioneered the outpatient treatment of fibroids in Texas with revolutionary techniques including radial artery access and innovative pain management techniques,” adds Hardee. “We perform more UFE procedures in a single day than most practitioners do in one year.”

Hardee outlines additional treatment options below, including both non-invasive procedures as well as surgical options, including a hysterectomy. 

Non-invasive treatment options

• Medical therapy is usually the first thing tried in patients and can include oral contraceptive pills or other agents that can be used temporarily to decrease fibroid symptoms or size.
• Intrauterine devices are sometimes tried which may decrease bleeding in some patients.
• MR-guided focused ultrasound can treat fibroids in a limited number of patients, although most do not qualify due to uterine fibroid anatomy or lack of insurance coverage.
• Uterine Fibroid Embolization (UFE) is an outpatient, minimally-invasive option that eliminates fibroid symptoms without surgery or the prolonged four- to six-week recovery period required. A tiny catheter is inserted into the body and used to inject particles that shut down the blood flow to the fibroids forcing them to shrink, become dormant, and ultimately eliminate all of their inherent symptoms.

The advantages of UFE include no incision or scar, and no need to remove body parts. The procedure is done on an outpatient basis with no hospitalization required. There’s a very short recovery period, with most women resuming normal activity and returning to work in seven to 10 days.

The overwhelming majority of women with symptomatic uterine fibroids are candidates for UFE. This procedure is a well-established treatment option whose efficacy has been established through randomized controlled trials comparing hysterectomy to UFE.

Surgical treatment options 

• Myomectomy is a surgical procedure to remove uterine fibroids. The surgeon’s goal during myomectomy is to take out symptom-causing fibroids and reconstruct the uterus. Unlike a hysterectomy, which removes your entire uterus, a myomectomy removes only the fibroids and leaves your uterus.
• Radiofrequency ablation is a less invasive procedure where probes are inserted into individual fibroids which then use extreme heat to treat the fibroid. This can be performed by inserting a probe through the skin or cervix. In spite of its less invasive nature, it is difficult to treat all of the fibroids in many patients since you have to target each fibroid one at a time.
• Hysterectomy removes the entire uterus completely. There are many other reasons besides fibroids that may lead to hysterectomy. Disease processes such as uterine prolapse, endometriosis, and cancer are commonly treated with hysterectomy. In patients with symptomatic fibroids who no longer desire pregnancy, uterine fibroid embolization is an excellent option and should be considered as a viable alternative when considering a hysterectomy.

DO YOU ENDO: Why are so many women having hysterectomies to treat uterine fibroids when it may not be necessary?

“One of the most commonly recommended treatments for uterine fibroids is hysterectomy, a major surgical procedure to remove the uterus and sometimes, the ovaries,” says Hardee. “Uterine fibroids are one of the leading causes of hysterectomies in the United States, with an estimated 200,000 performed annually for this reason,” adds Hardee. “Hysterectomies require a recovery time of four to six weeks, leave surgical scars, and involve the risk of potential complications including blood clots, infection, the need for additional surgeries, and increased risk of cardiovascular disease,” Hardee continues. “However, what you — or your grandmother, mother, sister, friend, or cousin — may not know is that hysterectomy is not the only option. And you’re in good company: one in five women in the U.S. believe that the only treatment for fibroids is hysterectomy, according to an online survey conducted by The Harris Poll.”

DO YOU ENDO: What should a patient do if their doctor recommends a hysterectomy? 

According to Hardee, a patient who is told that they should get a hysterectomy for their fibroid(s) should get a second opinion in addition to doing one or more of the following tasks: 

• Research. Visit reputable medical websites for the latest information, including the National Uterine Fibroid Foundation, the American College of Obstetricians and Gynecologists, and the Society of Interventional Radiology.
• Talk to others about their experiences with uterine fibroids. What treatment option did they choose? What were the results? How did they feel about their experience, before and after?
• Talk to your OB-GYN. Ask plenty of questions, including: Do I need treatment? What are my options, surgical and non-surgical? What are the risks? Am I a potential candidate for UFE? What if I want to become pregnant? What is the likelihood fibroids will return after treatment?
• If you’re considering UFE, talk to an interventional radiologist. Interventional radiologists specialize in minimally invasive, image-guided treatment of medical conditions, such as fibroids, that previously required open surgery. An interventional radiologist who specializes in UFE can evaluate whether you are a good candidate for the procedure.

DO YOU ENDO: Do you have any tips for how our readers can become advocates for their own health? 

“I actually direct patients to social media groups,” says Hardee. “We get a lot of patients who come to us through these independent Facebook groups. There are Facebook groups in the local area, women with fibroids and women with endometriosis and adenomyosis,” Hardee continues. “And once you have a few patients who are very active in social media have the procedure, they use their prior experience to really help out their community members. Social media groups are a great way for that, and that’s really helped get the word out for us. Members of those groups typically will have recommendations of who to go to and sometimes recommendations of who not to go to.”

DO YOU ENDO: Why aren’t patients given alternative options to a hysterectomy? 

“Medicine has evolved into a highly sub-specialized field. Most people have all they can handle keeping up with their own specialty and oftentimes don’t have the time to keep up with all of the new technologies and developments in other medical subspecialties. When a patient comes to a doctor with a problem, the doctor wants to solve that problem. In most cases, a doctor is going to look inside their own toolbox and try to solve the patient’s problem with the tools they have which essentially are the treatment options they were trained to use for these patients. This is one of the reasons we take a lot of time to educate other physicians as well as patients and the general public about newer treatment options such as uterine fibroid embolization. Patients with symptomatic fibroids need to know that hysterectomy is not their only option. 

DO YOU ENDO: In your opinion, is the medical community failing to better educate patients and potential patients?

“Despite all the possible benefits, many women are not being told that UFE is an option when it comes time to discuss all of the available fibroid treatments,” says Hardee. “In fact, 77% of women who know about UFE didn’t first learn about it from their gynecologists. This lack of giving information about all of the available options is a major problem,” Hardee continues. “We strongly believe that women deserve to know all their options particularly when they have a desire to preserve their fertility and avoid hysterectomies when possible.” 

About Eric Hardee, MD:  Dr. Hardee has been performing Uterine Fibroid Embolization (UFE) in the Houston Metropolitan area for 20 years. He brings an incredible amount of experience in highly advanced, minimally invasive procedures treating a wide variety of disease processes. He is the co-founder of Houston Fibroids and is board-certified by the American College of Radiology, with added qualifications in Vascular and Interventional Radiology.