For persistent fibroids, a less invasive option

A procedure that stops the blood supply to fibroids could be a safe and effective alternative to hysterectomy for women whose fibroid symptoms won't go away, according to a new study.

But some who get uterine artery embolization - which is less invasive, cheaper, and easier to recover from than a hysterectomy - might still eventually need a hysterectomy to relieve their symptoms, the results of the study in 150 women show.

Uterine fibroids are generally benign tumors that grow in the walls of the uterus. In an embolization procedure, a catheter filled with small particles is used to block off the vessels that supply blood to the fibroids. In a hysterectomy, fibroids are surgically removed from the body - along with the rest of the uterus. Embolization is performed by a radiologist, while hysterectomy is done by a patient's gynecologist.

"Hysterectomy has the major advantage of really getting rid of the fibroids forever without any doubt, whereas embolization sometimes gets rid of the fibroids," Dr. Klim McPherson, an obstetrician at the University of Oxford in the UK who was not involved with the study, told Reuters Health.

But, "hysterectomy interferes with sexual function, urinary function, ovarian function ... if you really want to treat the fibroids, hysterectomy is going to do that but much more as well," McPherson said.

About 40 percent of women will get uterine fibroids, said Dr. Jim Reekers, a radiologist at Amsterdam's Academic Medical Center and one of the study's authors. About half of women with fibroids have symptoms, often including pain and heavy menstrual bleeding. And about half of those will not be helped with medication and other non-invasive treatments and will turn to surgery, Reekers said.

In the current study, published in the American Journal of Obstetrics & Gynecology, Reekers and his colleagues followed about 150 women, most in their forties, who had uterine fibroids that hadn't responded to medication.

The women were divided up randomly - half got a hysterectomy, and the other half had embolization done.

Over the five years following the procedures, the authors tracked the women in the study with questionnaires, asking about their quality of life, any continuing symptoms from their fibroids, and whether they had any follow-up treatments after the original hysterectomy or embolization.

At the end of the five years, there was no difference in the physical or mental quality of life reported by the two groups, and more than 4 out of 5 women in both groups were very satisfied with the treatment they had received. The majority of women also reported that their fibroid symptoms were gone or much improved.

But some women who had undergone embolization continued to struggle with heavy bleeding, and about a quarter of them went back for a hysterectomy, most in the two years after their embolization. About 10 percent of women in the hysterectomy group went back for another procedure, often because they still had abdominal pain.