March 27, 2000 (San Diego) --Younger women with uterine fibroid tumors can have a nonsurgical treatment called uterine fibroid embolization without compromising their fertility, according to researchers who spoke at a meeting of interventional radiologists here. This procedure had been thought to be limited to women 45 and up because it was assumed that embolization impaired the function of the ovaries.
Uterine fibroid embolization is a minimally invasive procedure that consists of blocking the uterine arteries. Doctors have avoided using it for women under 45 who have no perimenopausal symptoms, particularly if they wish to have children, James B. Spies, MD, tells WebMD.
"This procedure should not affect the fertility of women under 45," says Spies, chief of interventional radiology and vice chairman of radiology at Georgetown University Medical Center in Washington, D.C. "Preliminary data [on 66 patients] show that there is no statistically significant change between levels of follicle-stimulating hormone" before beginning the treatment and six months afterward, he says.
Follicle-stimulating hormone regulates ovarian function and is secreted in increasing amounts when a woman begins to enter perimenopause, the period of time preceding menopause. The women in the study who experienced ovarian dysfunction after embolization were all over 44.
He and other researchers are also investigating how long patients' relief from fibroid-related symptoms lasts after embolization. In a study of more than 200 patients, early results show improvement of heavy menstrual flow in 90%, with 75% reporting moderate to marked improvement.
"This [treatment] is at least as effective as myomectomy," Spies tells WebMD. Myomectomy involves removing the tumors from the uterus.
In addition to younger women, women who have adenomyosis may benefit from embolization, Gary Siskin, MD, tells WebMD. Adenomyosis is an overgrowth of tissue between the layers of the uterine wall and causes symptoms similar to fibroids, such as heavy menstrual bleeding, pain, and swelling of the abdomen. But adenomyosis is typically located throughout the uterus, while fibroids are self-contained. For this reason, embolization has been thought to be less successful in treating adenomyosis.
But in a study of patients with adenomyosis, bilateral uterine artery embolization was considered successful and symptoms were considered improved by 12 of the 13 women for whom results were available. Siskin, an assistant professor of radiology at Albany Medical Center in New York, says that adenomyosis is found in 5% to 10% of patients assumed to have fibroids.
"Adenomyosis may be associated with increased failure of embolization, but patients with adenomyosis can still receive significant benefit from this procedure," he tells WebMD. "We need to be certain that they are counseled and have appropriate expectations. Since adenomyosis is conventionally treated by hysterectomy, surgery can be offered to women in whom treatment has failed. However, it's helpful to have a nonsurgical option [available] first."