Survey: Women Are Unaware of Uterine Fibroids and Their Treatment Options

Findings from a survey conducted by The Harris Poll on behalf of the Society of Interventional Radiology found that among women who were diagnosed with uterine fibroids, over half (53%) were recommended to get a hysterectomy, whereas fewer than 20% of women were presented with other less invasive options.¹ These other options included OTC nonsteroidal anti-inflammatory drugs (19%), uterine fibroid embolization (UFE; 17%), oral contraceptives (17%), and endometrial ablation (17%).¹

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A uterine fibroid, according to the survey, is a type of tumor that occurs in the muscle cells of the uterus. Most women will be affected by uterine fibroids by the time they are 50 years of age, and although the growths are not always dangerous and do not spread to other regions of the body, the symptoms—such as uterine pressure or pain, heavy bleeding during menstruation, and abdominal enlargement—can be difficult for patients to deal with. Additionally, survey takers reported never hearing of uterine fibroids (20%), not knowing anyone who has been diagnosed (52%), not believing they are at risk (72%), and the belief that fibroids can increase the risk for uterine cancer (29%).²

This poll was conducted online by Harris Poll between May 30 and June 3, 2024, and gathered responses from 1122 US women 18 years and older. According to the experts, the overall survey results were surprising because they represented a lack of awareness among women regarding uterine fibroids.^1,2

“The survey findings, coupled with the low number of women who were offered a minimally invasive treatment like UFE, indicate that women are not being given all of the information they need to make their own health care decisions,” John C. Lipman, MD, FSIR, founder and medical director of the Atlanta Fibroid Center and adviser for the report, said in a news release. “Not offering minimally invasive treatments like UFE in addition to the surgical treatment options is a significant oversight. Women need to be informed about the complete range of options available for treating their uterine fibroids; not just the surgical options as is [which are] most commonly done by gynecologists.”¹

Additionally, the experts also emphasized concern that approximately 17% of women, including 27% of women aged 18 to 34 years, believed that a hysterectomy is the only treatment option for uterine fibroids.^1,2 UFE is a minimally invasive treatment for uterine fibroids that has been proven to reduce heavy menstrual bleeding, relieve uterine pain, and improve energy levels. For this procedure, an interventional radiologist uses a catheter through a small incision in the wrist or thigh to block nonessential blood vessels that lead to the fibroids, causing them to shrink or disappear. Nearly 4 in 5 women who reported knowing about UFE did not hear about the procedure from their obstetrician gynecologist (OBGYN).²

Black women, according to the Society of Interventional Radiology, are also more likely to need additional follow-up treatment following UFE, in addition to those who have a history of smoking or have a body mass index greater than 25. Further, it is important to note that Black women who are over the age of 40 with high blood pressure, overweight, or who have immediate family members are at an increased risk for uterine fibroids.²

“The survey noted deep disparities in awareness and access regarding fibroids and fibroid treatments among Black and Hispanic women, who have a higher risk factor for developing uterine fibroids,” Robert J Lewandowski, MD, president of the Society of Interventional Radiology and professor at Northwestern Medicine Feinberg School of Medicine, said in the news release. “The data serve as a guiding light for improving physician and patient educational efforts on various treatments to ensure all women, regardless of background, are informed about their risks and the full range of treatment options available.”¹

Because of the disproportionate symptomatic burden of uterine fibroids in Black and Hispanic women, a June 2024 retrospective study published in The Journal of Racial and Ethic Health Disparities evaluated if racial disparities seen in disease severity in regards to bleeding symptoms and surgical management had also applied to presurgical medical management.³ For this study, women aged 18 to 50 years with a uterine fibroid diagnosis who underwent a myomectomy or hysterectomy between 2012 and 2021 were enrolled.³

The study found that minor procedures were infrequently utilized without statistically significant variations among races. Further, there were no preferential uses of gonadotropin-releasing hormone analogues, intrauterine devices, or oral hormonal therapies between different races.³ The authors emphasize that, in this study, previous evidence that Black and Hispanic women are more severely affected by uterine fibroids is confirmed. In addition, Black women were observed to use the highest number of medications before excisional procedures, followed by Hispanic women. The authors note that further research is necessary to identify factors that prevent these patient populations from achieving better symptom control preoperatively.³

Further, authors of a 2013 study published in Seminars in Reproductive Medicine also speculate, based on growing evidence, that molecular mechanisms in disease development are also a contributing factor.⁴ Notably, variations in the expression levels or function of estrogen and progesterone receptors, polymorphism of genes that are involved in estrogen synthesis and/or metabolism (COMT, CYP17), retinoic acid nuclear receptors (retinoid acid receptor-α, retinoid X receptor-α), and aberrant expression of micro-RNAs (miRNAs) are some of the molecular mechanisms that may be involved.⁴

Additionally, the authors also observed that nutritional factors, such as vitamin D deficiency, may also be a contributing factor to the incidence of uterine fibroids in Black women, who are more likely to have hypovitaminosis D. The authors acknowledge that further analyses and a better understanding of these mechanisms will provide additional insight into the molecular basis of racial disparities that are present in uterine fibrosis formulation, as well as develop new innovations in treatment.⁴

According to the Society of Interventional Radiology, nearly 600,000 hysterectomies are performed each year in the US, but some may not be necessary. About 1 in 5 women who had a hysterectomy for a noncancerous condition did not have any evidence to support the need for surgery, according to a study published in the American Journal of Obstetrics and Gynecology.² Because OBGYNs do not perform UFEs, they are often unaware of the benefits of the treatment, such as the success rate and who may be candidates for treatment. Instead, an interventional radiologist who specializes in UFE would be the best source of information on the treatment.^1,2 Research demonstrates that nearly 9 out of 10 patients who undergo UFE experience significant or complete resolution of their symptoms.¹ The experts emphasize that it is a disservice for women, especially women of color, to not have this information and have the inability to make appropriate health care choices that are most suitable for them.^1,2

“Women suffering from fibroids are often given only 1 treatment option by their gynecologist, hysterectomy, without being informed of less invasive treatments, like UFE,” said Lipman in the news release. “Many patients don’t want a hysterectomy and they’re left to suffer in silence, even though their lives could be transformed back to normal if they only knew about UFE.”¹

REFERENCES

1. The REIS Group. Survey finds most women with uterine fibroids are offered hysterectomies over minimally invasive treatments. News release. July 9, 2024. Accessed October 8, 2024. https://www.eurekalert.org/news-releases/1050624

2. Society of Interventional Radiology. The Fibroid Fix: What Women Need to Know. July 8, 2024. Accessed October 8, 2024. https://www.sirweb.org/globalassets/aasociety-of-interventional-radiology-home-page/patient-center/fibroid/sir_2024_fibroid_fix_report_fnl.pdf

3. Martinez, C., Olig, E., Pachalla, S. et al. Racial Disparities in Medical Management of Uterine Fibroids Prior to Myomectomy or Hysterectomy. J. Racial Ethn Health Disparities (2024). doi:10.1007/s40615-024-02048-3

4. Catherino WH, Eltoukhi HM, Al-Hendy A. Racial and ethnic differences in the pathogenesis and clinical manifestations of uterine leiomyoma. Semin Reprod Med. 2013;31(5):370-379. doi:10.1055/s-0033-1348896