More than five years ago, Maxine Green learned she had uterine fibroids. As many as three out of four women develop the benign growths in their wombs during childbearing years.
Often, they're harmless, but Green's fibroids developed painful symptoms in the last year and a half.
"There's so much bleeding and pain," Green said. "It drains you." Ultrasound revealed three tumors that had grown into the sizes of a grapefruit, orange and lemon, crowding her abdomen.
About a decade ago, a woman with tumors that size would likely have undergone a hysterectomy to remove her womb. Instead, Green opted for uterine artery embolization, a nonsurgical procedure once considered experimental but gaining in popularity as it has proved to be successful.
This approach blocks the arteries that feed fibroids with blood, causing them to wither away.
More patients may soon benefit from the procedure after the Centers for Medicare and Medicaid Services decided to increase its reimbursement for fibroid artery embolization from $2,642 to $5,639, beginning in January.
"In this day and age, for Medicaid to increase reimbursement speaks volumes," said Dr. Joseph Mullaney, chief of staff for Trident Health System and director of interventional radiology.
The procedure's cost can vary widely based on the number and location of the tumors. Also, hospital time and the type of equipment involved can add to the price.
For a typical treatment, however, patients can expect to pay between $6,000 and $7,000, according to area health providers and the Radiological Society of North America.
Nationally, the success rate of the procedure for women who have symptoms associated with bleeding is 90 percent, Mullaney said. For women who experience pressure in the lower abdomen, the rate is slightly lower at 85 percent.
Fibroid artery embolization has been available in the United States since the late 1990s, but public awareness of the procedure is increasing. "Part of it is through word of mouth," Mullaney said. "You treat one patient, and they bring their sister in."
That's how Green heard about the option. Co-workers at East Cooper Regional Medical Center, where she works as a nuclear medicine technologist, told her about the procedure. "Here I am, connected to radiology, and didn't even know about it," she said.
Recovery time is about a week, while traditional abdominal hysterectomies take six to eight weeks. Patients are usually kept overnight to ensure pain is managed properly.
The procedure is not recommended for women who want to become pregnant. While it is not a form of birth control, pregnancy is more difficult after an embolization.
If women have painful fibroids and still want to have children, they may try hormonal treatment or a myomectomy, which removes the tumors and leaves the uterus intact.
Green underwent embolization in August and was back at work within a couple of weeks. Her symptoms subsided, and she has no scar. "I feel like a whole new person since I had it done," she said.
In 2005, nearly 600,000 U.S. women had hysterectomies, according to the Centers for Disease Control and Prevention. Uterine fibroids led to about a third of those surgeries.
Dr. Bridget Williamson, an obstetrician/gynecologist with East Cooper Women's Center, said embolization is not the right procedure for everyone, but it's an alternative for women who have fibroids.
The pros are that it's less-invasive, creates less blood loss and has less risk of infection, she said. On the other hand, it can be painful, and the fibroids can come back.
"For a long time, embolization was considered experimental by insurance companies," she said. But those days seem to be over. She has recommended several of her patients for the procedure, which is performed by an interventional radiologist, a physician who specializes in minimally invasive procedures.
Mullaney said most insurance companies cover the procedure. And the Centers for Medicare and Medicaid Services' decision to increase its reimbursement by 113 percent is a testament to the treatment's low risk and good outcome.