Nearly a quarter of the female population develops uterine fibroids, non-cancerous growths on the muscular wall of the uterus. For years, the only surgical treatments for the discomfort and heavy bleeding caused by fibroids was hysterectomy or myomectomy — invasive procedures that require lengthy recovery periods and can leave a woman infertile. Today there is a less-invasive procedure that enables a woman to go home the next day — called uterine fibroid embolization or UFE. New research comparing the older and newer procedures shows UFE is as effective and may have fewer side-effects than the older, lengthier procedures.| Take Action |
The risks associated with UFE are minimal, but there are some potential side effects you should know about:
Some women pass small pieces of fibroid tissue after UFE, which can lead to bleeding and infection.
Early-onset menopause may occur in a small percentage of women, especially those over 45.
The particles that cut off blood supply to fibroids may travel to the ovaries, causing them to stop working for a short time – or permanently.
There may be a need for hysterectomy if infection or persistent symptoms exist.
It is not known how UFE affects future fertility, so women wishing to have children should consider surgical removal of individual fibroids. |
Fibroids do not always cause symptoms, but their size and location can lead to problems for some women. They can cause heavy menstrual bleeding, clotting, pelvic pain, and sometimes an abnormally enlarged abdomen. Doctors typically first prescribe medical treatment, such as hormone therapy or anti-inflammatory drugs. When fibroids fail to respond, surgery is the remaining option.
Until 1994, women had their symptomatic fibroids removed one of two ways — either through hysterectomy — which is complete removal of the uterus, or through myomectomy — removal of the fibroids with reconstruction and preservation of the uterus. Both procedures have been successful in treating the symptoms, but they are considered major surgical procedures and require longer hospital stays and longer recovery time.
For a decade now, interventional radiologists have been performing uterine fibroid embolizations on women; the procedure requires that a woman only receive regional anesthesia, and she typically goes home in 24 hours. During the 1-hour UFE procedure, the doctor inserts a long guide wire into the femoral artery, which extends into the uterine arteries. Then the doctor guides a tiny instrument called a microcatheter over the wire until it reaches its destination. It then injects tiny foam particles called polyvinyl alcohol into the bloodstream, which blocks blood flow to the fibroids. Without oxygen and nutrients the fibroids shrink and die, and sometimes shed naturally from the body.
At the recent Society of Interventional Radiology Annual Scientific Meeting, preliminary research was presented by Dr. S.C. Goodwin, of the Greater Los Angeles Veterans Administration Hospital, on the quality of life outcomes for 200 women who had undergone either a UFE procedure or a myomectomy. The myomectomy patients had more fibroids and were more likely to have a miscellaneous pelvic abnormality before the procedure. The presenting symptoms between the two groups were similar; however the UFE group reported longer periods prior to surgery.
Dr. Goodwin found that hospital stays for UFE patients were 1 day, but 2 days for myomectomy. He found that 93.4% of UFE and 88.6% of myomectomy patients had significant improvement in quality of life scores. Both had significant reduction in uterine volume, but bleeding was reduced more in the UFE group. The embolized group returned to normal activities in 15 days and myomectomy patients in 44 days. Significant adverse events were higher in the myomectomy group.
In a similar study comparing the two procedures in a population of women, whose average age was 31-years and were being treated for infertility possibly due to fibroids, the UFE procedure was shown to be as effective as myomectomy, but safer for preserving fertility.
A third research paper, presented at the Society of Interventional Radiology meeting by Dr. G.P. Siskin of Albany Medical Center in upstate New York, showed that the uterine fibroid embolization procedure provided a significant improvement in the majority of the 112 women who were studied. The women, who were between the ages of 35 and 56 years, had symptoms of abnormal bleeding, pelvic pain, and bulk-related symptoms.
Advances in the equipment used to perform the procedure have made UFE even more successful since its introduction 10 years ago. Doctors and medical device companies are continuously improving the procedure by introducing newer and better equipment.
