Treating fibroids without surgery

Women with uterine fibroids who do not want to have hysterectomies now have an effective, non-surgical option. And new research suggests that fertility can be maintained in many patients who have the procedure, known as uterine fibroid embolisation (UFE).

Several teams of researchers who’d compared the non-surgical treatment with hysterectomy and uterus-sparing surgery presented their findings this week at a medical meeting in Baltimore.

Uterine fibroids are common among women in their 30s and 40s, and they often cause severe pain and excessive bleeding. Fibroids are a leading reason why women undergo hysterectomy, or surgical removal of the uterus. Until recently, myomectomy — in which fibroids are surgically removed — was the only treatment option for women hoping to remain fertile.

Fibroid embolisation is performed by interventional radiologists, who specialise in targeted, image-guided treatments. From a small incision in the groin, special sand-sized plastic particles are placed in the artery that feeds blood to the fibroid, effectively choking off its blood supply. Fibroids often shrink dramatically within six weeks, but relief of symptoms usually occurs much earlier.

Atlanta interventional radiologist, John Lipman, MD, who has performed more than 500 fibroid embolisations, says most of his patients go home the same day, and 90% are soon symptom-free, without further interventions.

“I believe that in the near future, when more studies have been done, fibroid embolisation will replace myomectomy as the treatment of choice for a large number of women,” he tells WebMD.

Women with several fibroids or fibroids that are difficult to remove surgically may be good candidates for embolisation, he says. While those with just a few fibroids that are easily accessible by surgery might have a better outcome with a myomectomy.

In one study presented at the Baltimore conference, researchers reported that a variation on the fibroid embolisation procedure may help women in their 20s and 30s with fibroids maintain fertility. The researchers replaced the plastic particles widely used in UFE with particles made from a gel-foam sponge material. The gel-foam materials dissolved soon after treatment and allowed uterine arteries to reopen.

Over 90% of the 65 treated patients reported relief of fibroid-related symptoms. And within one year after treatment, six pregnancies were achieved among 12 patients who said they were actively trying to conceive following the procedure.

“This is a very promising procedure in patients with symptomatic uterine fibroids who desire future fertility,” lead researcher Keith M Sterling, MD, tells WebMD. “We are obviously going to continue to follow these patients to see how many more of them get pregnant, and what those pregnancy outcomes are.” Sterling is an interventional radiologist at Inova Alexandria Hospital in Washington.

In a separate study, researchers from Georgetown University compared what happened to 102 women who had UFE and 47 who had a hysterectomy. James B Spies, MD, and colleagues, found that the embolisation patients were as satisfied with their procedures as those who had hysterectomies, and the two groups had similar scores on tests of health status and mental wellbeing.

The researchers also compared the average cost of UFE with that of myomectomy, and found the non-surgical procedure to be slightly cheaper — $6,861 per procedure vs $7,486. Although embolisation patients have more extensive imaging exams, their hospitalisation costs tend to be lower because recovery time is quicker.

Spies, who is vice chairman of radiology at Georgetown University Medical Centre, tells WebMD that there is no one best treatment option for all women with uterine fibroids. Although some women are better candidates for one procedure than another, the decision is ultimately that of the patient, he says.

“I would never tell a patient that they had to have a hysterectomy,” he says. “Women who face this decision are generally in their 30s and 40s, and there is not a more educated, capable group of people out there. Our job is to present them with all of the options.”