Uterine Fibroid Treatment Innovations at Paoli Hospital

Though doctors aren't sure what causes the painful masses to grow, physicians on the Main Line have a solution to the mysterious problem.



See also Phyllis Bucci's non-surgical options for uterine fibroids.

Illustration by Chris McAllister.The asteroid. That’s what Kimberly Schaffer called the mass on her uterus.

“It was the size of a softball,” she says. “It put so much pressure on my bladder that I was getting up seven times every night to pee. Most of my life centered around finding bathrooms.”

Schaffer lived like that for a long time before she said anything to her doctor. “I didn’t know there was treatment for it,” she says. “I thought I had a small bladder.”

It wasn’t that simple. “My doctor did an ultrasound,” she says. “My uterus was swollen to the size of a woman who was five months pregnant.”

Fourteen days. That’s how long Amanda Hatch’s period lasted. “If I got lucky, it would last only 10 days, which is still double the normal length of a period,” says Hatch. “Basically, I was bleeding for half of every month. And the periods were so heavy that I’d stay home from work on the first day to avoid accidents and try to manage the blood flow.”

Worse than that were the cramps. “‘Doubled over in pain’ is how I’d describe myself,” Hatch says. “I was taking ibuprofen liberally, and it was barely taking the edge off.”
 

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For both Schaffer and Hatch, uterine fibroids were the cause of their problems. Elongated periods, heavy bleeding, severe cramps and frequent urination are but a few of the symptoms of an affliction that affects millions of women. As many as one in five have fibroids during their childbearing years, and half of all women have them by age 50.

Fibroids are benign tumors that grow in the uterus or its lining. The medical community has yet to discover why certain women get fibroids or what causes them to grow. But doctors can see the fibroids on an ultrasound. “They can be the size of a pea or a watermelon,” says Dr. Shari Senzon of Main Line OB/GYN Associates. “The tumors themselves are not a health issue. The problems are the symptoms they cause if they grow and put pressure on different areas. Those symptoms can be merely inconvenient, or downright horrible.”

It’s often a numbers game. “Women can have one or many, but most have more than one—and even one can be debilitating, depending on its location,” says Dr. Atul Gupta, director of interventional radiology at Paoli Hospital. “A fibroid as small as a grain of sand, if it’s on the endometrium (the inner lining of the uterus), can cause a lot of bleeding. If the fibroid is larger—like the size of a cantaloupe—it will put pressure on organs near the uterus. That results in frequent urination, back pain and other problems.”

To assist in the surgical treatment of fibroids, Gupta has developed an innovative new imaging technology called MRA Fusion. But surgery isn’t the first phase in treating fibroids.

“Fibroids feed on estrogen, so when menopause reduces the amount of estrogen in the body, it also reduces the size of fibroids,” Senzon says. “If women can wait it out, we advise them to do so.”
 

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Schaffer was 43, and Hatch 34, when their symptoms became unbearable. Both explored medical treatment. Of the three surgical options—hysterectomy, myomectomy and uterine fibroid embolization—the first is the most extreme and also the most effective. Still, hysterectomy erases any chance of having children and initiates menopause, something most women want to stave off. And while technological advances like Springfield Hospital’s da Vinci Robotic Surgical System are making hysterectomies more precise, they still require a six-week recovery period.

Myomectomy removes the fibroids from the uterus—though Gupta discounts its efficacy. “Often, a surgeon gets in there and finds many more fibroids than were imaged,” he says. “Some may be so small that removing them makes the surgery longer and more involved.”

But the surgeon may not get them all. “And there’s also the chance that they will regrow,” Gupta says. “The uterus is still there, and so are estrogen and blood.”

The goal of uterine fibroid embolization is cutting off the blood supply. Gupta created his MRA Fusion imaging technology for this third option, using data from MRIs and CT scans to create a 3-D image he calls “a human GPS.”

MRA Fusion shortens the length of the UFE procedure from 90 to 45 minutes, while reducing the radiation needed by 70 percent and iodine dye amounts by 50 percent.

Gupta explains the operation: “We thread a tiny catheter through the arteries to the uterine artery, which supplies the uterus with blood. Then, we inject microscopic particles to choke off the blood supply to the fibroid; whether there are one or 20, the uterus is treated globally.”
 

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There are long-term implications to such global treatment. UFE leaves the uterus intact and menopause is averted. But embolizing the artery that provides blood to the uterus can significantly increase the risk of miscarriage. A 2001 study also showed that post-procedural gynecologic interventions were required in 10-11 percent of patients.

Regardless, UFE is fast becoming the treatment of choice for women with fibroids. “That technology has advanced in the past decade, and there is more public awareness,” says Senzon. “Women are realizing that their symptoms may add up to a medical condition—and they’re learning that they have options other than hysterectomy.”

UFEs are performed at area hospitals, including Lankenau, Bryn Mawr, Paoli, Riddle, Delaware County Memorial and Crozer-Chester Medical Center. The surgery requires a one-night stay in the hospital and a week to recover at home.

And recovery wasn’t a walk in the park for Hatch and Schaffer, who both underwent the procedure with Gupta at Paoli Hospital. “The first 24 hours were a real pain—and no amount of narcotics or pain relievers made it go away,” says Schaffer, who had surgery in April of this year. “It was like the worst menstrual camps I’ve ever had, times 100.”

The next morning, Schaffer’s pain had subsided significantly. “But I didn’t leave the house for a week,” she admits.

Schaffer was told that it would take three months to see any relief from the fibroid symptoms. “There was incredible fatigue, and I felt like I had the flu, which I was told to expect,” she says. “They said it is from the fibroid dying and releasing toxins into my bloodstream.”

As for Hatch, she had her UFE surgery in February of last year. And while her recovery was similar to that of Schaffer’s, she’s now completely symptom-free.

“My periods last five or six days; the flow is light, and I don’t have cramps or frequent urination,” says Hatch. “Finally, I have a normal person’s period. I can’t quite explain how different my life is without fibroids. It’s a whole new world for me.”
 

See page 5 for Phyllis Bucci's non-surgical options for uterine fibroids.
 

Nature Over Knives

Phyllis Bucci’s nonsurgical options for uterine fibroids.

Bucci is a practitioner of naturopathic medicine and co-owner of Holistic Apothecary in Ambler.

Good fats
Eat more fish, nuts and other things with Omega-3 fatty acids. “No-fat and low-fat diets might be good for some things, but not fibroids. They starve the body of lipids it needs to balance hormones.”

Wild yam cream
Bucci and other homeopathic professionals believe it provides an all-natural boost of progesterone that balances estrogen and other hormones.

Dong guai
Often called “female ginseng,” it has been a staple of Chinese medicine for centuries. Bucci uses it to relieve symptoms of PMS and fibroids.

Jin shin jyutsu and reiki
Bucci uses both forms of massage to reduce stress, which stimulates fibroid growth. “When you’re stressed, your body uses its hormones differently. Massage reduces the stress, allowing those hormones to go back into balance.”

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