Nonsurgical Fibroid Treatment Deemed Safe
But Questions Remain About Long-Term Effectiveness
July 13, 2005 -- Complications are rare among fibroid patients treated with
a relatively new nonsurgical procedure known as uterine embolization.
This remains true even in centers that perform only a few of them,
Early findings from the largest study ever of a fibroid treatment suggest
that embolization compares favorably in terms of short-term outcome with
surgical interventions such as hysterectomy and fibroid removal.
Uterine artery embolization was introduced in the United States in 1997 and
is one of the first nonsurgical treatments for fibroids.
The procedure involves introducing small pellets into the arteries that feed
fibroids to choke off their blood supply. Without blood the benign tumors die.
Most fibroids shrink dramatically within six weeks, but relief from symptoms
usually occurs much earlier.
Approximately 3,000 women who had the embolization procedure at 70 centers
throughout the country have been enrolled in a national registry. The women
will be followed for at least three years in an effort to better understand
long-term results with the treatment.
The first published data from the registry showed that less than 1% of women
experienced major complications immediately after having the embolization
procedure and just 4.8% developed major complications within 30 days.
Patient characteristics were not a predictor of whether complications would
occur, nor did the setting (teaching hospital vs. nonteaching hospital) in
which the procedure was performed.
"We found that there was really no significant difference in terms of
complications between sites, whether they did 10 of the procedures or hundreds
of them," radiologist and study co-author James B. Spies, MD, tells WebMD.
"That should reassure everyone that this procedure can be done safely in
all kinds of settings."
Short-Term Benefits Clear
Between 150,000 and 200,000 hysterectomies are performed in the United
States each year to treat heavy menstrual bleeding and pelvic pain caused by
uterine fibroids. Another established treatment option for those who want to
preserve their fertility is surgical fibroid removal, known as myomectomy.
Embolizations are performed by interventional radiologists like Spies, who
specialize in targeted, image-guided treatments. Many ob-gyns have been
reluctant to recommend the procedure to their fibroid patients as an
alternative to surgical treatments, but this is beginning to change, says
In an opinion released in January 2004, the American College of
Obstetricians and Gynecologists (ACOG) acknowledged that nonsurgical
embolization "appears to provide good short-term relief" for women who
are appropriate candidates for the procedure.
And the findings from the registry study were published in the July issue of
the journal Obstetrics and Gynecology.
Long-Term Outcomes Unknown
But ACOG spokesman Bryan Cowan, MD, tells WebMD that the long-term
effectiveness of the procedure has yet to be established.
"We now know that about 25% of women who have myomectomies return for
repeat procedures within five years, and that usually means hysterectomy,"
says Cowan, who is professor and chairman of the University of Mississippi
Medical Center department of gynecology.