Uterine Fibroid Embolization May Eliminate Need

Wednesday, August 20, 2003

More women are discovering Uterine Fibroid Embolization (UFE) as an alternative to major surgery to treat uterine fibroid tumors, according to Michael Braun, MD, an interventional radiologist at Columbia St. Mary’s.

Fibroids are solid lumps of muscle and connective tissue (usually benign) that grow in and around the uterus. They are usually first diagnosed during a woman’s 30s or 40s. Symptoms caused by fibroids depend on their size and location. For some women, fibroids may cause no problems; for others, fibroids can be traumatic and cause abnormal bleeding (leading to anemia), pain, and miscarriage.

When a woman has symptoms, she may be able to tolerate them, depending on how severe they are. If treatment is called for, drug therapy often is the first step. This may include:

  • Hormonal treatment (birth control pills)—the data on this treatment is inconclusive. Birth control pills may reduce heavy, prolonged, and painful menstrual periods caused by uterine fibroids, which decreases blood loss and corrects anemia. Studies show no difference in fibroid growth between women who use birth control pills and those who do not. Birth control pills do not eliminate fibroids.
  • Injections of Lupron, an anti-estrogen drug that shuts down ovaries and the bleeding cycle for six to nine months. A side effect is that Lupron puts a woman in artificial menopause.

For some women, an OB/GYN may recommend major surgery as the next step—either a myomectomy or a hysterectomy. A myomectomy involves removing only the fibroids from the uterus. A hysterectomy 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.

“Women who are told that they need a myomectomy or a hysterectomy often seek alternatives to these major surgeries,” Dr. Braun said. “They do research on the Internet or talk to friends and learn about UFE as a less invasive alternative.”

Not every woman is a candidate for a UFE, Dr. Braun said. 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.

During the UFE procedure, a woman is conscious but sedated. Using a local anesthesia, small cuts are made in the groin to insert a catheter, which is threaded into the arteries that supply blood to the fibroid tumors. An x-ray is taken after injecting dye to see the arteries. The x-ray provides a “road map” of the blood supply to the fibroids. Once the catheter is in place, tiny plastic particles are injected into the arteries through the catheter. The particles wedge in the arteries and cut off the blood flow. This causes the fibroid tumors to gradually shrink and decreases or halts the symptoms they cause. The procedure takes 1-2 hours.

“The reason it works is the fibroids are vulnerable to being starved of their blood supply,” Dr. Braun said. “While the uterus can regenerate and regrow if starved of blood, fibroids cannot. In three to six months, the blood-starved fibroids will shrink about 50 percent and will slowly degenerate over the lifetime of the woman.”

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 is less complicated. Plus, the woman retains her uterus.

About 10 to 20 percent of women who undergo a UFE, the procedure does not control their bleeding. These women will then need to have a hysterectomy.

A UFE should be done by a board certified interventional radiologist, a doctor who is trained to diagnose and treat conditions using miniaturized tools while watching their progress on imaging equipment, such as an X-ray unit.

Many women with fibroids can have a successful pregnancy. For some women, however, fibroids may interfere with a woman’s ability to get pregnant. While there’s no guarantee that a woman who undergoes a UFE will able to get pregnant, some women have been successful. However, for many women, this isn’t a concern.

About one in five American women over age 35 has fibroids. Fibroids create problems for about half of women who have them. Fibroids, which tend to run in families, are more common in African-American women than in white, Hispanic, or Asian women. They are also seen often in overweight women.

 

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