A Nonsurgical Alternative to Hysterectomy for Women with Fibroids

Embolization Offers a Nonsurgical Alternative to Hysterectomy for Women with Fibroids

Drs. S. William Stavropoulos and Richard Shlansky-Goldberg of University of Pennsylvania review the current state of the uterine fibroid embolization (UFE) procedure, including recommendations for patient selection.

Fibroids are common, noncancerous tumors of the uterus. Fibroids cause symptoms, most commonly excessive menstrual bleeding (menorrhagia), in about one-half of women. Hysterectomy (surgical removal of the uterus) has been the traditional treatment.

In recent years, however, UFE and other alternative treatments have been developed. UFE is an interventional radiology procedure in which tiny particles are injected through a catheter into the arteries supplying blood to the uterus. The particles "embolize," or block off, the arteries, reducing blood flow to the fibroid tumors. When successful, embolization causes the fibroids to shrink.

Although UFE is a fairly new procedure, research suggests it is effective in most cases. Studies have shown that UFE reduces excessive menstrual bleeding in 81 to 94 percent of patients. Other symptoms and the patient's general health are improved as well.

UFE offers several key advantages over hysterectomy. It can be done without general anesthesia, it causes minimal blood loss, and it permits quick recovery. Most patients go home from the hospital within one day. Serious complications are rare.

Another potential advantage is that UFE preserves the chance of future pregnancy in women with fibroids, which is impossible after hysterectomy. The authors recommend considering other treatments--specifically, a surgical procedure called myomectomy, which removes the fibroids while preserving the uterus--for women with fibroids who wish to become pregnant.

Although long-term follow-up studies are needed, UFE offers a valuable alternative to hysterectomy for women with uterine fibroids, Drs. Stavropoulos and Shlansky-Goldberg conclude. They stress that UFE is not appropriate for all patients with fibroids--the decision concerning the most appropriate treatment should be made in consultation with the gynecologist and the interventional radiologist.

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