In this MD Newsline exclusive interview with obstetrician and gynecologist Dr. Wendy Goodall McDonald, we discuss surgical treatment for fibroids, including hysterectomy, which is used at higher rates in Black women.
What is your surgical treatment strategy for fibroids?
Dr. Wendy McDonald:
“Surgical management for fibroids is also extensive. If a person is noted to have submucosal fibroids, fibroids that are inside the uterine cavity, a hysteroscopic myomectomy can often significantly improve symptoms without putting a person into a major surgical recovery space. Recovery from hysteroscopy can be days to a week at most. So it’s a great management option for a person who has small submucosal fibroids, usually smaller than 4 centimeters.
A person who has intramural or larger fibroids may benefit from laparoscopic myomectomy or even open myomectomy or hysterectomy. Also, uterine artery embolization is very often used in a person who is past their childbearing years but still not menopausal, as well as endometrial ablation, if a person has submucosal fibroids and has also completed childbearing.
You should also know that laparoscopic fibroid ablation is achievable with the Acessa procedure. Acessa is a treatment option that is performed with ultrasound guidance laparoscopically, where a radiofrequency ablation probe is put into the fibroid, and it actually ablates the fibroid from the inside. Fibroid size is reduced by 30 to 40%, and bleeding is reduced as well substantially. And this is also considered a minimally invasive procedure because it’s not an open myomectomy or hysterectomy.
So knowing that there are multiple surgical options is important. The hysterectomy is often the [last resort] unless a person has really gone through enough treatment options where they’re not wanting to try them all. I don’t think a person needs to try every management option before they get to hysterectomy.
But knowing that there are health disparities when it comes to management of fibroids in ethnic populations, I think that providers should know that there are a wide variety of treatment options that are available for fibroids before hysterectomy.
And also, certain people of color may have reservations about having a hysterectomy because the uterus can be associated with their femininity. So again, ask questions. Know what a person’s background is. Know what their concerns are when you present certain treatment options to them.
Also, know that you may need to take a few extra minutes out of your day to really sit down and delve into those questions that they have. And you may have to have the person come back if you don’t have extra time in their visit, have them return for an additional visit, or do a telehealth visit in order to be able to explain more what their options are.
And remind them that your primary goal is their safety and their health. We are not paternalistic doctors. We are doctors who participate in patient care with our patients. We want this to be shared decision-making, and we want our patients to understand the risks, benefits, and alternatives of every option that we present to them.”
Do Black women undergo hysterectomy at higher rates for the treatment of fibroids?
Dr. Wendy McDonald:
“Fibroids affect 70 to 80% of women by the age of 50. However, symptomatic fibroids affect [fewer] women but can lead to multiple medical treatments as well as surgeries.
The thing that’s important to know in a cultural competency awareness space is that the prevalence of surgery for the treatment of fibroids is different depending on the ethnicity of the patient. 60% of African American patients will undergo hysterectomy for fibroids, while 29% of white Americans will undergo hysterectomy for fibroids.
So it’s important to understand the differences with regard to ethnicity as well as the variety of treatments that can be provided to all patient populations in order to reduce the need for invasive surgeries.”
Responses have been condensed and lightly edited.