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Fibroid Embolization: Good Outcomes

85% of Women Still Better 3 Years After Uterine Fibroid Embolization

Fibroid Symptoms, Fibroid Treatments continued...

Surgery is not the only option. The most commonly chosen nonsurgical treatment for fibroids is UFE. Other options under development include destroying fibroids via freezing, microwaves, or focused ultrasound.

During UFE, an interventional radiologist inserts a small tube into a leg artery and guides it into the blood vessels feeding the uterus. Small plastic beads released through the tube go inside the uterus and block off the blood supply feeding the fibroids. This kills the fibroids, which usually are absorbed back into the body after they die.

"The important thing is that people tend to recover more quickly after UFE than after surgery," Goodwin says. "You are talking two weeks; that is a big plus for UFE. And some studies show fewer complications than surgical alternatives."

Some women appear to do better than others. In the Goodwin study, patients who reported the best outcomes:

  • Had heavy bleeding as their main fibroid symptom
  • Had fewer symptoms
  • Had smaller fibroids
  • Were older
  • Weighed less


Fibroids and Pregnancy

What if a woman needs relief from fibroid symptoms but still wants to become pregnant?

Cowan says there's only one option: myomectomy.

"If a patient with fibroids wants a pregnancy, I recommend myomectomy," Cowan says. "And not laparoscopic [minimally invasive] myomectomy, either. There might be six to 10 doctors who can do it and secure the uterus intact, but I am not one of them. And I am not willing to compromise the ultimate outcome for the patient, which is to carry a pregnancy to term."

What about UFE? Goodwin notes that UFE can lead to failure of the ovaries. In women in their late 40s, he says, this happens about a third of the time. But Goodwin says that only 1% of women under age 35 have ovarian failure after UFE.

"For younger women, UFE would be a reasonable alternative to myomectomy for preserving fertility," Goodwin says. "But a woman in her mid 40s -- who will have a lot of fertility problems anyway -- may wish to consider myomectomy."

In its most current policy statement, written in February 2004, the American College of Obstetricians and Gynecologists argues against UFE for women who wish to remain fertile. That advice still stands, Cowan says.

Cowan argues that women suffering fibroid symptoms should be under the care of a gynecologist.

"Yes, I would recommend UFE to patients," he says. "But I sit down with my patients and discuss all the options. If they want UFE, I back them 100%. I get them an interventional radiologist, and we will make this happen."

Goodwin agrees that doctors should discuss all fibroid treatment alternatives with patients. But he says patients often don't learn all the facts about UFE from their doctors.

That may be changing. Goodwin notes that his report -- and earlier reports on this study -- appears in Obstetrics & Gynecology, published by the American College of Obstetricians and Gynecologists.


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