Women's Health: A Gentler Way to Treat Fibroids
A technique that treats fibroids without surgery could reduce the need for hysterectomies, according to a study released today in the New England Journal of Medicine. Fibroids, benign uterine growths that can cause heavy menstrual bleeding and pelvic pressure, account for 200,000 hysterectomies each year. An additional 34,000 women undergo myomectomies, in which only the fibroid is surgically removed, preserving the uterus. Far fewer women have embolization, a decade-old procedure that involves the injection of grain-size polyvinyl particles into the uterine artery to block off the fibroid's blood supply.
In the study, Scottish researchers randomly assigned either embolization or abdominal surgery (hysterectomy or myomectomy) to 157 women who had symptomatic fibroids; one year later, they found no significant difference between the two groups in terms of their overall quality of life. What they did find was that those who had the less invasive procedure experienced less pain and recuperation with an average hospital stay of one day compared with five for the surgery group and a return to work in three weeks versus two months for the surgical patients. On the downside, after the first year about 20 percent of the embolization patients needed a repeat procedure or a hysterectomy owing to persistent symptoms.
"Women should certainly be offered the choice of this technique over hysterectomy," says Jon Moss, a staff interventional radiologist at North Glasgow University Hospitals in Scotland. "It may be preferable for those who don't want the long recovery time. Some women, though, might still want surgery since it ensures they won't be plagued by fibroids again."
Future pregnancies should also be factored into a woman's decision, since some research suggests that embolization could, in rare cases, lead later to premature ovarian failure, miscarriage, preterm delivery, or postpartum hemorrhage. Although these occurrences are based largely on anecdotal case reports, women planning to conceive should probably avoid embolization until more studies are completed, says Togas Tulandi, a professor of obstetrics and gynecology at McGill University in Montreal, who wrote an editorial that accompanied the journal article. The American College of Obstetricians and Gynecologists agrees and adds that postmenopausal women experiencing symptomatic fibroids should also avoid embolization. They're at greater risk of having a fibroid that is malignant, according to ACOG spokesman Howard Sharp, an associate professor of obstetrics and gynecology at the University of Utah School of Medicine. Only about 1 in 1,000 symptomatic fibroids is cancerous, but those that don't shrink after menopause are more likely to be malignant.
Some worry that gynecologists who diagnose fibroids and recommend treatment might be reluctant to suggest embolization, since they only perform fibroid surgeries; interventional radiologists perform embolizations. "I've had gynecologists in my local area tell me that this will hurt them in the purse," Tulandi says. He recommends getting a second opinion if your doctor's only answer to fibroids is a hysterectomy.