Is There an Alternative to Hysterectomy for Treating Fibroids

Friday, November 26, 2004

When national security adviser Condoleezza Rice had minor surgery recently, she brought to light a common problem faced by millions of women—uterine fibroids. About one in five American women over age 35 has fibroids, which are solid lumps of muscle and connective tissue that grow in and around the uterus. Fibroids aren’t cancerous.

Usually first diagnosed during a woman’s 30s or 40s, fibroids are often small and cause no problems. But 20 to 40 percent of women with fibroids experience symptoms such as prolonged menstrual bleeding (leading to anemia), pelvic pain, and leg and back pain. In some cases, fibroids also may interfere with a woman’s ability to conceive.

Drug therapy often is the first step in treating fibroids. If this is ineffective, a gynecologist may recommend major surgery—either a myomectomy (removing only the fibroids), or a hysterectomy, which involves removing the uterus and possibly the ovaries and fallopian tubes. About 20 percent of the more than 600,000 hysterectomies performed in the U.S. each year are due to uterine fibroids.

Dr. Rice underwent a newer procedure called uterine fibroid embolization or UFE. Today, more women are discovering UFE—a less invasive treatment—as an alternative to major surgery for treating uterine fibroids.

During the UFE procedure, a woman is conscious but sedated. Using local anesthesia, small cuts are made in the groin to insert a catheter, which is threaded into the arteries that supply blood to the fibroids. An x-ray is taken after injecting dye to see the arteries.

Once the catheter is in place, tiny plastic particles are injected into the arteries through the catheter. The particles cut off the blood flow to the fibroids, causing them to gradually shrink. In three to six months, the blood-starved fibroids will shrink about 50 percent and will slowly disappear within two to four years. As the fibroids shrink, a woman’s symptoms are reduced or stop completely.

A UFE procedure usually requires a hospital stay of one night. It controls bleeding in 80 to 90 percent of cases, and the bleeding is controlled immediately. Compared to a hysterectomy, UFE results in a faster recovery, is less invasive, and has fewer complications. Plus, the woman retains her uterus.

For about 10 to 20 percent of women who undergo UFE, the procedure does not control their bleeding. These women may then need other treatments.

Not every woman with fibroids is a candidate for UFE. Appropriate treatment depends on the size and location of the fibroids, the severity of the symptoms, and any other health problems a woman may have. Most women seeking treatment are beyond their childbearing years.

If fibroids interfere with a woman’s ability to conceive, UFE is not the initial treatment and is reserved only for cases in which surgical treatment for infertility is ineffective.

Dr. Michael Braun is one of many interventional radiologists at Columbia St. Mary’s that offer this procedure. For more information on UFE at Columbia St. Mary’s, call (414) 291-1160.


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