Penn Center for Integrated Fibroid Care: A team approach to disparities in uterine fibroid care.
The specialists of the Penn Center for Integrated Fibroid Care offer patient-centered, culturally competent care for women with uterine fibroids.
A majority of women in the United States experience uterine fibroids (leiomyomas or myomas): About 80 percent of Black women and 70 percent of white women will develop one or more fibroids before age 50.
Despite the high prevalence of fibroids, diagnosis and treatment are often delayed. On average, women wait about 3.6 years before seeking treatment.
Of those who do seek treatment, including those who sought treatment without delay, 41 percent consult two or more health care providers when seeking diagnosis. About 5 percent of women see five or more providers before receiving a fibroid diagnosis. Among Black women, the delay in treatment is more pronounced: Black women report living with fibroid symptoms for 4.45 years before seeking treatment.
Not all patients with fibroids experience symptoms. Those who do may have heavy bleeding, anemia, and pelvic pain.
When symptoms aren’t controlled with medication, patients should be referred to uterine fibroid experts, says Florencia Greer Polite, MD, Chief of the Division of Academic Specialists in Obstetrics and Gynecology at Penn Medicine and Vice Chair of operations who led the implementation of the Penn Center for Integrated Fibroid Care.
Specialists at the Center are dedicated to providing comprehensive, patient-centered, and culturally competent care for all women.
Not every patient who experiences uterine fibroids needs a referral to the Center for Integrated Fibroid Care, according to Dr. Polite. But for patients with complex or uncontrolled fibroid symptoms, team members design customized care plans that deliver optimal uterine myoma treatment outcomes aligned with patients’ personal health goals.
An integrated, patient-centered approach to diagnosing and treating fibroids
Many women with fibroid symptoms seek initial care from their gynecologist or primary care provider. While many women are treated successfully by these providers, some experience more complex fibroid symptoms. Yet specialist referral for fibroid care has often been inconsistent. The Penn Center for Integrated Fibroid Care streamlines this process, allowing providers to seamlessly refer patients to an expert fibroid management team.
The Center’s collaborative approach provides women who need specialty care with prompt, tailored uterine fibroid treatment. It is the priority of Penn Medicine’s team of highly trained specialists to ensure that all women are heard, acknowledged, and receive care that fits their needs.
“Patients who have fibroids have often suffered for years and have been offered standard treatments, regardless of whether those treatments have worked for their specific symptoms,” notes Center for Integrated Fibroid Care Director Monique R. Farrow, MD, a fellowship-trained minimally invasive gynecologic surgeon and fibroid specialist at Penn Medicine.
“Often, these are patients who are presenting with years of bleeding or pain symptoms. At the Center, we are working to ensure that patients who need specialty fibroid care can get that care expeditiously.”
Clinical expertise in uterine fibroid management
Upon referral to the Center, every patient meets with a nurse practitioner (NP) who serves as the main point of contact. The NP gathers needed information and counsels the patient through the next care step.
All patients receive a standardized evaluation that provides equitable data and information. “The infrastructure of the Center includes guidelines and standardized evaluations to help eliminate unconscious bias,” Dr. Farrow says. This evaluation includes anemia testing, as well as imaging for patients who wish to preserve their uterus.
The Center’s multidisciplinary team then consults on care pathways for each patient. Patients are connected with the specialist who can best serve their needs. Whenever possible, specialists use approaches that preserve the uterus for patients who wish to maintain the possibility of future pregnancies.
Medication management
Center experts use a range of medications to reduce fibroid size and decrease blood loss:
- Gonadotropin-releasing hormone agonists
- Hormonal birth control medications
- Hormone-modulating therapies
- Progestin-releasing intrauterine device (IUD)
Minimally invasive fibroid surgery
Penn Medicine gynecologic surgeons use the least invasive surgery options possible to treat large and complex fibroids. Specialists use robot-assisted surgical techniques to perform myomectomy with reduced scarring.
Minimally invasive techniques such as laparoscopy can help preserve the uterus while allowing patients to return to their daily activities more quickly.
Uterus-sparing procedures
Expert interventional radiologists perform minimally invasive uterine fibroid embolization (UFE) to reduce fibroid size and prevent fibroids from growing. These specialists also use hysteroscopy and other nonsurgical treatments for uterine fibroids to protect the uterus.
Fertility preservation
Penn fertility care specialists work with Center patients who wish to preserve the possibility of pregnancy.
Team members offer minimally invasive gynecologic surgery and reproductive endocrinology services such as intrauterine insemination (IUI), in vitro fertilization (IVF), and ovulation induction.
Disparities in uterine fibroid diagnosis and management affect health outcomes
While fibroids are common in all women, Black women face an increased burden of disease. Symptoms including heavy menstrual bleeding, pain, pelvic pressure, and anemia, are typically more severe in Black women. Fibroids in Black women are also more likely to grow quickly and increase in size.
Black women are more likely to be treated with hysterectomy than white women (16.3 percent versus 15.6 percent), particularly before they’ve completed their families. Hysterectomy also occurs more frequently in Black women who develop anemia resulting from heavy bleeding.
It’s not clear why Black women experience fibroids more intensely. “It was once thought there was mainly a genetic component, but that hasn’t been demonstrated in the science,” says Dr. Farrow. What is clear is that Black women face diagnosis and treatment disparities that lead to worsening symptoms, delayed treatment, and poorer health outcomes.
“What is clear is that Black women face diagnosis and treatment disparities that lead to worsening symptoms, delayed treatment, and poorer health outcomes.”
What’s also clear, says Dr. Polite, is that fibroid symptoms are normalized in Black culture—and by medical providers.
“There is this notion that things that are common are normal,” she says. “If you’re in a family where everyone has heavy menstrual cycles that soak through clothes or onto sheets, that becomes normalized. Patients may say, ‘I’ve had a transfusion’ or ‘I’ve been told I’m anemic’ without any alarms going off. We need to make sure that when patients tell us about their symptoms, we acknowledge those symptoms as abnormal and worthy of examination.”
“We want to make sure we are creating a Center that is intentional in trying to address the disparities that we know exist.”
While not every provider in the Center is Black, every provider is committed to eliminating disparities in fibroid care. “All of our providers understand and are sensitive to these issues,” says Dr. Farrow. “We want to make sure we are creating a Center that is intentional in trying to address the disparities that we know exist.”
Care for patients with complex fibroids
Referral should be considered for symptomatic patients with documented fibroids whose symptoms have progressed after first or second-line treatment. Referring providers receive communications regarding all uterine fibroid care provided to their patients and continue to provide routine gynecologic care to their patients.
“If a patient has a two-centimeter fibroid, is taking birth control pills, and their period is controlled, keep doing what you’re doing,” she says. But when fibroids are a chronic issue, take note: Anemia and required blood transfusions indicate a need for specialized care.
To refer your patient to the Penn Center for Integrated Fibroid Care, call 618-902-4989, extension 8.