Uterine Fibroid Treatment Raises Questions About Hysterectomy Over-prescription

For nearly a decade, Josette Santiago sought relief from uterine fibroids, a condition affecting millions of women. Despite experiencing debilitating symptoms from a grapefruit-sized fibroid, she was repeatedly offered only one treatment: a hysterectomy. Santiago's journey has brought to light concerns that less invasive alternatives to removing the uterus may not be consistently presented to patients.

A 2024 survey indicated that 53 percent of women diagnosed with fibroids were offered a hysterectomy, while only 17 percent were offered procedures aimed at shrinking the growths without removing the uterus. While hysterectomy can be the most appropriate solution for severe cases or when other treatments fail, it is an irreversible procedure that ends a woman's ability to bear children and carries surgical risks.

Santiago, a physical therapist in New Jersey, was first diagnosed with a fibroid in 2016 when it measured about 4cm. Despite its initial small size, it caused heavy bleeding and bloating, impacting her active lifestyle. Doctors initially suggested waiting for menopause, but her symptoms persisted. A 2019 ablation procedure offered only temporary relief.

By 2020, when she consulted new doctors, the recommendation shifted to hysterectomy, with warnings that the fibroid could continue growing and potentially press on surrounding organs. When Santiago expressed reluctance, she claims one doctor dismissed her case, stating there was nothing more they could do.

By 2025, the fibroid had grown to 16cm, causing significant discomfort, early satiety, and a swollen abdomen that led others to believe she was pregnant. Her work as a physical therapist also became more challenging due to the size of the growth.

Determined to avoid major surgery, Santiago began her own research and discovered uterine fibroid embolization (UFE). This minimally invasive procedure blocks the blood supply to fibroids, causing them to shrink over time without requiring the removal of the uterus. The procedure involves inserting a thin tube through a small puncture, typically in the wrist or groin, to deliver microscopic particles that cut off blood flow to the fibroid. UFE usually takes about an hour, and many patients can return home the same day.

Santiago was surprised that none of her doctors had mentioned UFE. After initially identifying a clinic in Dallas, she found her New Jersey insurance would not cover out-of-state treatment. She was then referred to Dr. Tate Kirk, an interventional radiologist in Westchester County, New York, a specialist offering the procedure closer to home than she realized.

One potential reason for the lack of awareness surrounding UFE is that it is typically performed by interventional radiologists, a different specialty than gynecologists who commonly diagnose and treat fibroids. This often requires a referral to a different type of specialist.

UFE is not a universal solution; the best treatment depends on factors such as fibroid size, location, symptoms, a woman's medical history, and her desire to have children. Other options include medication to manage bleeding or myomectomy, a surgery to remove fibroids while preserving the uterus.

Dr. Kirk explained that UFE not only shrinks fibroids but also alters their tissue consistency, making them less likely to cause pressure on surrounding organs. He estimates that fibroids can shrink by approximately 50 percent over six months, though individual results vary.

Santiago underwent UFE in April 2026. The procedure, performed under sedation, took about an hour, followed by a two-hour recovery period. She reported minimal pain, experiencing only a mild fever and fatigue for about a week. She has since returned to her active lifestyle, experiencing no further heavy bleeding or bloating.

While Santiago experienced a relatively smooth recovery, UFE can cause significant pain, nausea, and fever. Less common complications can include infection, damage to ovarian function, or the need for further treatment. Fibroids themselves are common, with estimates suggesting up to 80 percent of women may develop them by age 50, though many remain asymptomatic.

Santiago hopes her experience will encourage other women to explore all available treatment options and to seek multiple opinions before deciding on surgery. She is awaiting an MRI scan to confirm the extent of her fibroid's shrinkage.