By: Shelagh McNally for Fibroids1Uterine fibroids are a troublesome health issue for many women. Even though fibroids are benign they often cause pain, pressure, heavy and prolonged bleeding and possible infertility. Traditional surgery normally involves a long recovery period. So, when a minimally-invasive, effective treatment for fibroids was introduced it was greeted with much enthusiasm.
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Treatment Options for Fibroids
UFE (Uterine fibroid embolization) / UAE (Uterine artery embolization) blockage of artery supplying blood to the fibroid(s).
MR-guided focused ultrasound: ultrasound waves are used to destroy fibroid tissue.
Drug therapy: non-steroidal anti-inflammatory drugs (NSAIDs), birth-control pills and hormone therapy.
Myomectomy (surgical removal of the fibroids).
Hysterectomy (surgical removal of the uterus).
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Uterine artery embolization (UAE) is an approach to treating fibroids where the arteries supplying blood to the fibroids are blocked off. UAE uses angiographic techniques (much like those used in heart operations) and is a relatively simple procedure. A catheter is placed into the uterine arteries with X-ray guidance and small particles of polyvinyl alcohol (PVA) are injected slowly into the arteries. The particles wedge into the arteries slowly blocking off the blood supply. Once the blood supply stops, the fibroid shrinks.
A recent study by the University of Birmingham, Birmingham Women’s Hospital in England highlighted the need for continuing research and fibroid patient follow up. The evidence-based findings were published in the Cochrane Library (Issue 2, 2006), an international organization that evaluates medical research and practices. The review, led by Dr. Janesh Gupta at Birmingham Women's Hospital in England, looked at three separate studies.
The first two trials, composed of 234 women, compared UAE against abdominal hysterectomy (surgical removal of the uterus) six months after the procedure. The third trial, made up of 63 women, compared UAE with myomectomy (surgical removal of the fibroids), also with a six-month follow-up. In both groups the women with the UAE procedure show a measured improvement in fibroid-related symptoms with an 85 percent drop in heavy bleeding and a decrease in the largest fibroid between 30 to 46 percent. These women resumed their daily routines much sooner after a shorter hospital stay that those who underwent either a hysterectomy or myomectomy. But there were more complications with the UAE group. Symptoms such as vaginal discharge, post puncture haematoma (collection of blood), pain, fever, nausea and vomiting often resulted in unscheduled visits to their doctor and readmission to the hospital.
Both the Cochrane Library and the University of Birmingham are calling for more long-term research in order to determine UAE’s long-term efficacy. The American College of Obstetrics and Gynecology agrees with the findings as well. Spokesman Howard Sharp, M.D., said, “The important information that this study provides, is that, though UAE appears to be relatively safe compared to hysterectomy and myomectomy, we do not have high-quality, long-term outcome data as to how well UAE holds up over time. How many patients with UAE will have a hysterectomy at five years? How does UAE affect pregnancy and fertility?”
There is an ongoing trial being conducted by the Response Emergency Stress Team United Kingdom (REST, U. K.) and the Uterine Artery Embolization (UAE) Versus Hysterectomy for Uterine Fibroids (Emmy trial) is about to publish the results of their long term follow up study. Both are being awaited with interest.
