March 26, 2004 (Phoenix) -- Many middle-aged women a have bothersome fibroids -- benign tumors that can cause lower pelvic pain or pressure and abnormal uterine bleeding. Most of these women are likely to undergo hysterectomies, but a new study gives hope that a nonsurgical approach may be a better option.
Surgical removal of the fibroids, a procedure called myomectomy, usually requires at least two and half days in the hospital and "a much more significant incision," says John C. Lipman, MD, medical director of the Center for Minimally Invasive Therapy in Atlanta. He presented his findings at the annual meeting of the Society of Interventional Radiology.
In the nonsurgical procedure known as uterine artery embolization, more than 81% of women reported significant improvement in symptoms, he says. Moreover, he notes that this improvement comes with "only one day in the hospital and with only a band-aid size incision."
Uterine artery embolization or uterine fibroid embolization, also called UAE, works by releasing small pellets into blood vessels that lead to the fibroids. "The pellets work like plugs or corks," says Robert Vogelzang, MD, a professor of radiology at Northwestern Medical School, in Chicago and a past president of the Society of Interventional Radiology.
Without blood, the fibroid "becomes liquefied and dies. Once this happens the symptoms usually disappear," says Lipman.
The discomfort that women with fibroids experience can be caused by fibroids pressing on the bladder or other organs in the pelvis. Symptoms can range from lower pelvic pain, urinary incontinence, or heavy menstrual bleeding.
The study compared 149 women who had UFE with 60 women who underwent myomectomy. "Both procedures improved symptoms," he says. The biggest difference was that the women who opted for UFE were back to normal activity in about two weeks, while women who had surgery needed about a month and half to recover. This was particularly interesting, he says, "because the women who chose UFE actually had more fibroids and had more menstrual problems than the women who chose surgery."
Doesn't Work for All Women
Lipman says, however, that UFE doesn't work for all women. "About 10% don't have a good outcome with UFE and for these women surgery is still an option," he says.
But many women don't know about "options" says Carla Dionne, founder of the Uterine Fibroid Foundation. Dionne tells WebMD, "I was diagnosed with uterine fibroids when I was 28." She says that surgery was the only option she was offered, but didn't want surgery because she wanted to have more children. She says her fibroids were diagnosed after the birth of her daughter but she went on to have two more children -- all the while suffering more problems caused by fibroids.
But in 1999, Dionne's mother sent a note, just the corner of an envelope with the word 'embolization' on it. She says her mother watched a television show that reported research by a University of California, Los Angeles radiologist, Scott Goodwin, MD. "He was treating women with uterine fibroids with embolization," she says.
After some false starts, she finally made contact with Goodwin in last 1999. "I underwent the procedure in December and within two weeks, the urinary frequency had disappeared," she says.
A year later Dionne, along with a handful of women she met in an online fibroid support group, founded the UFF, which is headquartered in Colorado Springs, Colo., where she lives.
Yet, as positive as her experience was, Dionne says that she doesn't think UFE is for all women who have fibroid disease. "Many women want surgery," she says. The goal of the foundation is to "educate and support women so that they know the options" and can make truly informed decisions.
In what may be a major advance in educating women, the American College of Obstetricians and Gynecologists (ACOG) is softening its stance on UFE. For years, ACOG maintained that UFE was an experimental procedure, but in January it released a new statement that recognizes that embolization "when performed by experienced physicians, appears to provide good short-term relief among appropriate candidates." But ACOG notes that women should first be evaluated by an ob-gyn.
Lipman, who like Vogelzang is a radiologist, says the new statement from ACOG reflects what he sees happening in his practice. "It used to be that most of my patients came to me by reading about the procedure on the internet, now about three-quarters of my patients are referred by gynecologists."