University of Virginia Health System

U.VA. OFFERS NON-SURGICAL TREATMENT FOR UTERINE FIBROIDS

Uterine fibroids occur in about 25 percent of women of childbearing age and create symptoms in 10 to 20 percent. Occasionally, they can grow large enough to make a woman look as though she is six months pregnant, said Dr. Alan H. Matsumoto, chief of the division of angiography, U.Va. Department of Radiology.

The resulting health problems can include cause excessive menstrual bleeding and pain, low back pain, constipation and bladder pressure, he said.

Matsumoto said as many as 200,000 hysterectomies -- surgical removal of a woman's uterus -- are performed in the U.S. each year because of uterine fibroids. Hysterectomies require general anesthesia, two to three days of hospitalization and two to six weeks of healing time.

The newer treatment, called uterine fibroid embolization (UFE), is less invasive and requires only local anesthesia, one night in the hospital and approximately one week of recovery. An interventional radiologist makes a very small nick in the patient's skin and inserts a tiny tube through the femoral artery to the uterus. Guided by X-ray, the radiologist injects gelatin sponge or plastic particles through the tube to block blood vessels that feed the tumors. The starved tumors shrink by an average of 60 percent in six months, and 90 percent of patients state that they are satisfied with the results of UFE.

Being in my mid-30s, I was not terribly happy about the possibility of a hysterectomy, said Liza Shotwell, a Charlottesville UFE patient. After doing research on the Internet and consulting my gynecologist at U.Va., I found out about UFE. I spent one night in the hospital and was back to work within a week. Ten months after surgery, the fibroids were two-thirds smaller. I feel lucky that I found out about this option.

Uterine artery embolization has been used for approximately 20 years to stop heavy bleeding after childbirth, according to the Society of Cardiovascular and Interventional Radiology (SCVIR). In 1991, physicians at the Service de Gynecologie, Centre Hospitalier Universitaire Lariboisiere in Paris, France discovered that embolization also caused fibroids to shrink.

Fibroid embolization was first studied in the United States at the University of California Los Angeles. The worldwide clinical success rate -- defined as relief from symptoms and no further need for surgery -- is 85 percent, studies show. No regrowth of tumors has occurred in patients tracked for up to six years after having UFE, according to SCVIR.

Matsumoto said some patients who could not conceive because of fibroid blockage became pregnant after the procedure. However, UFE should not be considered a procedure for infertility, he said. Although patients have had normal pregnancies and deliveries after a UFE procedure, researchers do not yet know UFE's overall effects on the ability to conceive and on fetal development.

Side effects from embolization include nausea, vomiting, cramping and fever for 24 to 48 hours after the procedure, Matsumoto said. In rare cases, UFE may cause a loss of menstrual cycles, resulting in infertility, he said.

Studies show that UFE appears to pose less risk than other therapies for fibroid tumors, Matsumoto said. For example, 25 percent of patients who have fibroid tumors surgically removed (a procedure called myomectomy) must return for a hysterectomy because of bleeding problems or unresolved symptoms, he said. By comparison, less than one percent of embolizations result in problems that require a hysterectomy, he said.

Hormone therapy, often used to treat fibroids in women close to menopause, can reduce blood flow to the uterus and shrink tumors, but regrowth can occur when the therapy is stopped, Matsumoto said. Side effects of long term hormone therapy may include osteoporosis, hot flashes, vaginal dryness and mood swings, he said.

A recent study by researchers at the University of California in Los Angeles reported that up to 70 percent of hysterectomies among 500 women were inappropriately recommended, and 60 percent of the hysterectomies were recommended due to fibroid tumors. The study was published in the journal Obstetrics & Gynecology.

August 11, 2000