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Embolization Effective for Fibroids

Embolization Effective for Fibroids Most Patients Satisfied With Treatment WebMD Health News By Salynn Boyles Reviewed by Louise Chang, MD More from WebMD New Drug Treats Fibroids With Fewer Side...

Feb. 26, 2008 -- A relatively new treatment for uterine fibroids is a reasonable alternative to hysterectomy for women who want to avoid surgery, new research shows.

Outcomes among patients who had the treatment, known as uterine artery embolization (UAE) or uterine fibroid embolization (UFE), were compared to those of hysterectomy patients in the trial from the Netherlands.

Both groups reported significantly improved health-related quality of life two years after treatment, but nearly one out of four women initially treated with UAE ended up having hysterectomies because of treatment failure.

"For those women seeking absolute certainty of being asymptomatic after treatment, I would recommend a hysterectomy," study researcher Jim A. Reekers, MD, PhD, says in a news release. "But for women who wish to retain their uterus and who desire a fast recovery, I would definitely recommend UAE." 

Fibroid Treatment Options

As many as one in four women have symptoms from uterine fibroids, which are benign tumors of the uterus.

Symptoms of uterine fibroids can include heavy, painful menstrual bleeding, pelvic pain or pressure, and frequent urination.

According to the National Women's Health Information Center, uterine fibroids are the reason for about one-third of the 600,000 hysterectomies performed in the U.S. each year.

Introduced just over a decade ago, uterine artery embolization is a minimally invasive catheterization treatment designed to choke off uterine fibroids.

A small tube is inserted into a leg artery and guided into the blood vessels feeding the uterus. Tiny particles are then strategically injected to block the blood supply that feeds the fibroids.

In most cases, the fibroid tissue shrinks or dies, leading to relief of symptoms. Recovery time after UAE is typically around a week, compared to six weeks with hysterectomy.

This is also far shorter than recovery times for another surgical fibroid treatment known as myomectomy, in which the fibroids are removed but not the uterus.

The EMMY Findings

Reekers and colleagues report two-year follow-up from their Embolization versus Hysterectomy (EMMY) trial in the March issue of the journal Radiology.

The study included 177 women with uterine fibroids and heavy menstrual bleeding, half of whom were initially randomly assigned to treatment with UAE and the other half to hysterectomy.

During two years of follow-up, no significant differences in health-related quality of life were reported among the two treatment groups. Nine out of 10 patients in both groups reported being at least moderately satisfied with the treatment they received.

However, 24% of women who had undergone embolization did end up having hysterectomies.

Georgetown University interventional radiologist James B. Spies, MD, tells WebMD that the UAE failure rate was higher in the EMMY study than in many others.

In Spies' own UAE study involving 200 patients, the symptom-recurrence rate was still 20% with the nonsurgical treatment five years after treatment.

Spies says UAE has proven to be as effective as any uterus-sparing treatment, including myomectomy, for the long-term relief of symptoms related to fibroids.

"Women now have a choice, and they can weigh the factors that are most important to them before making a decision about treatment," he says.

Another UAE researcher tells WebMD that myomectomy offers the best chance of preserving fertility, while hysterectomy is the best choice for patients who aren't concerned about fertility, recovery time, or surgical complications and want to make sure their fibroids don't come back.

"Obviously, there is no re-treatment after hysterectomy because once the uterus is gone, it's gone," Scott C. Goodwin, MD, of the University of California, Irvine, tells WebMD. "But UAE has been proven very effective for women who want a shorter recovery time with fewer treatment-related complications."

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