OB/GYN Practice Preferences Signal Need for Cross-Specialty Collaboration in the Treatment of Uterine Fibroids

Purpose: Uterine fibroids (UF) are neoplasms of the uterus that commonly present with heavy menstrual bleeding and pain. Uterine artery embolization (UAE), an effective treatment option, is believed to be under-referred in practice despite efforts by the Society of Interventional Radiology (SIR) to increase awareness of UAE among patients. This study aims to understand OB/GYN physician reasoning behind the underutilization of UAE in the treatment of UF.

Methods/Materials: A 22-question survey consisting of multiple choice, Likert scale, and free response questions was created using Qualtrics XM software and distributed via OB/GYN-specific social media and messaging platforms. Respondents needed to be resident or attending OB/GYNs practicing in the US. Free response data was analyzed for response trends.

Results: 112 responses met inclusion criteria. For patients with symptomatic UF, UAE was offered as a first choice option less than 2% of the time. For patients with symptomatic UF seeking to maintain fertility, UAE was recommended only 1% of time, behind medical therapy (54%) and myomectomy (42%). Free response data on UAE’s downsides was notable for postoperative pain (65%), unclear fertility outcomes (49%), non-definitive treatment (26%), efficacy concerns (23%), issues with access (19%), and need for post-UAE management by OB/GYNs (12%). In addition, respondents reported lower rates of confidence (selecting "strongly agree” or “agree”) regarding risks and benefits of UAE (77%) in comparison to myomectomy (99%) or hysterectomy (100%).

Conclusions: UAE is offered for symptomatic UF considerably less than other therapies. This can be attributed to both the perceived downsides and also to the relative lack of OB/GYN understanding and confidence regarding UAE as a viable option. This signals a need to assess UAE’s place in gynecologic training and practice. Prompt collaboration between the American College of Radiology, SIR, and the American College of Obstetricians and Gynecologists is needed to redefine treatment protocols for the betterment of patient care.