12 Jul Fibroid Awareness Month: Choosing Wisely Part 1
July is Fibroid Awareness month. And what better way to spread the word, than to share information.
At Froedtert & The Medical College of Wisconsin since April 2018, the departments of Obstetrics & Gynecology and Radiology have collaborated to offer women affected by uterine fibroids a joint consultation with a fellowship-trained Minimally-Invasive Gynecologic Surgeon (Dr. Benjamin Beran) and an Interventional Radiologist (Dr. Alexandra Fairchild). The focus of this visit has always been treatment options that are alternatives to hysterectomy, but discussions of hysterectomy also occur.
Since 2012, the Choosing Wisely® campaign’s mission has been to promote conversations between clinicians and patients by helping patients choose care that is:
- Supported by evidence
- Not duplicative of other tests or procedures already received
- Free from harm
- Truly necessary
The Choosing Wisely® campaign asked leading medical organizations to come up with lists of tests or procedures commonly used in their field whose necessity should be questioned and discussed. A complete list of recommendations can be found at their website www.choosingwisely.org.
In this post, we will explore how our Fibroid Clinic at Froedtert & MCW addresses and utilizes Choosing Wisely® recommendations that can be applied to uterine fibroids.
The American College of Obstetricians and Gynecologists (ACOG) is a national medical specialty society for obstetricians and gynecologists with approximately 56,000 members. ACOG strongly advocates for quality health care for women, maintains the highest standards of clinical practice and continuing education of its members, promotes patient education, and increases awareness among its members and the public of the changing issues facing women’s health care.
Recommendation #6 – Avoid using robotic assisted laparoscopic surgery for benign gynecologic disease when it is feasible to use a conventional laparoscopic or vaginal approach.
Robotic-assisted laparoscopic surgery has been shown to reduce surgical risks to patients when compared to laparotomy (large incisions). The benefit compared to conventional laparoscopy or vaginal surgery is less clarified, and there is concern about surgical costs when using robotic-assisted surgery in non-cancerous surgery. While Dr. Beran holds credentials to perform robotic-assisted laparoscopic surgery, his fellowship training focused on conventional laparoscopy and therefore he solely performs conventional laparoscopic surgery in his current practice.
Recommendation #8 – Don’t routinely transfuse stable, asymptomatic hospitalized patients with a hemoglobin level greater than 7-8 grams.
Many women affected by uterine fibroids suffer from anemia, or low blood counts. When this process occurs gradually over time, the human body can adapt and many patients may not show symptoms, despite having severe anemia. Untreated anemia can lead to common signs of fatigue and poor exercise tolerance, or even more severe conditions such as congestive heart failure, chest pain, abnormal heart rhythm, and heart attack. Correcting anemia, especially prior to surgeries or procedures, helps reduce the risk of these complications. Options used through the Fibroid Clinic to avoid unnecessary blood transfusion include menstrual suppression, oral iron therapy, and intravenous iron therapy. If surgery is performed, various medications, surgical techniques (especially minimally-invasive surgery), and blood cell salvage systems can reduce need for blood transfusion.
Learn more about our Fibroid Clinic: Alternatives to Hysterectomy.