Coping with uterine fibroids
The choices of treatment involve trade-offs, the lead author of the study said.
Women who had less invasive treatment for painful uterine fibroids did about as well as those who had surgery, including hysterectomy, suggests a new study that lays out the options for a troubling condition affecting millions of women.
Uterine fibroids are common among women of child-bearing age. Nearly 40 percent develop these noncancerous growths in the uterus that often don't cause any symptoms. Though the most common treatment is surgery to remove tumors that cause extreme pain, some women choose a gentler procedure.
However, the study found there were some trade-offs to the popular procedure known as uterine artery embolization. Though embolization patients spent far less time in the hospital, they also were more likely to need a repeat treatment.
Although the study did not address whether embolization can preserve fertility, it adds to growing evidence that this less drastic approach is a safe alternative to hysterectomy, the most common type of surgery to deal with painful fibroids.
"For some women, retaining a uterus is much more important than avoiding repeat surgery, particularly for younger women," said Dr. James Spies, a Georgetown University radiologist who had no role in the new research. Spies successfully treated Condoleezza Rice, who was then U.S. national security adviser, with fibroid embolization in 2004.
Fibroids are noncancerous growths of muscle fibers inside the uterus that can range from a quarter-inch to as large as a cantaloupe. In serious cases, uterine fibroids can cause heavy menstrual bleeding, pelvic soreness and pain during sex.
For decades, hysterectomy -- removal of the uterus -- was the only option. Of the roughly 600,000 hysterectomies performed yearly in the United States, about a third are due to fibroids.
A more recent option is a myomectomy, surgery that removes the fibroids and keeps the uterus intact, allowing for a future pregnancy. However, there's a chance the fibroids will return.
Since the 1990s, the popularity of uterine artery embolization has steadily grown. An estimated 13,000 to 14,000 embolizations are done each year in the U.S., according to the Society of Interventional Radiology.
The American College of Obstetricians and Gynecologists says that while embolization is an option for women with fibroids, there's not enough evidence to show that it's safe for women who want to get pregnant.
The procedure involves making a small nick in the groin and inserting a catheter in the artery. Using real-time imaging, doctors then blast tiny pellets into the uterine artery to cut off the blood supply that feeds the fibroids. Over time, these tumors shrink and die.
Patients typically stay overnight in the hospital and are usually sedated or under local anesthesia during the procedure. Embolization, which is covered by most major insurers, tends to be cheaper than surgery at the outset. The costs even out during follow-up care, according to various estimates.
About the study
The new study published in today's New England Journal of Medicine randomly assigned 106 women to embolization and 51 to surgery. The patients were in 27 hospitals across the United Kingdom. Most in the surgery group had hysterectomies, but a few had myomectomies.
Both groups of patients rated pain levels, mental health and recovery process among other factors. After a year of follow-up, researchers found no significant difference in the quality of life for either group.
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