What often-debilitating condition affects up to 75 percent of women and has long been ignored by the US healthcare system?

The answer is uterine fibroids.

The neglect disproportionately affects black women, who are younger at onset, have more severe symptoms, and are more likely to require surgery and hospital stays. The secret scandal is that, while there is a minimally invasive fibroid treatment option, most doctors only offer their patients complex, invasive surgical procedures such as hysterectomies. These procedures require up to six weeks of recovery time and end the patient’s fertility forever.


Image: UCLA

The alternative to the surgical knife is called focused ultrasound and women treated with it return to work and daily activities in just a few day, their fertility undisturbed. Almost 20 years ago the FDA-approved its use to treat uterine fibroids.

Since the early 2000s, this advanced technology has been successfully used to treat over 175,000 fibroid patients globally. During a procedure, the physician uses imaging guidance to aim thousands of ultrasound energy beams precisely at the fibroid tumor. Where the beams converge, they heat and destroy the fibroid, leaving surrounding healthy tissue untouched. Complications are rare.

A 2013 survey published in the American Journal of Obstetrics and Gynecology and the Journal of Women's Health reported that when 1,000 US women with fibroids were presented with treatment descriptions, the majority (60%) rated focused ultrasound as their top choice.

But focused ultrasound awareness in the US is low and too few physicians inform their patients about it.

Few private insurers cover this procedure, and Medicare and Medicaid rarely do. Most insurance companies would rather pay for hysterectomies. They claim that not enough physicians practice the procedure to warrant coverage. And doctors shy away from recommending this non-reimbursed treatment when there are reimbursable options. So, lack of coverage leads to lack of physician experience that leads to lack of coverage. It’s a Catch-22 in which women always lose.

The result is that only those who can afford to pay out of pocket can receive this life altering procedure, and usually they must first learn about it – and then find a treatment center – completely on their own.

Expanding both insurance and Medicare and Medicaid coverage of focused ultrasound would provide an additional treatment option for all women, no matter what their socioeconomic status might be.

Major insurers such as Blue Cross/Blue Shield, AETNA and United Healthcare have all approved cases on an individual basis, but no major US insurance company provides consistent coverage and reimbursement. Medicaid, Medicare, the VA healthcare system, and the Military Health System are no better. Fibroid treatments are a prime example of insurers determining treatment practices despite the expressed needs and best interests of the patient.

All women should be able to choose a safe, effective, and noninvasive treatment option that ends pain and suffering, allows a quick return to work and normal life, and safeguards their ability to have children. Women everywhere should be aware of focused ultrasound – and then we should let our doctors and insurance companies hear from us.

As women, our diverse and persistent voices may be our best tools to bring about equitable and comprehensive treatment for this otherwise frightening and painful condition. The secret scandal must end.