New Procedures Offer Alternatives to Hysterectomy

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June 26, 2000 -- Doctors say new alternatives to hysterectomy are emerging that can, in some cases, treat noncancerous tumors of the uterus without sacrificing the women's chances to have a baby.

One procedure, known as uterine arterial embolization, works by decreasing blood supply to the tumors, called fibroids, causing them to shrink.

Until recently the effect of arterial embolization on future fertility and pregnancy was unknown. Now, a new study by the French team that pioneered the technique 10 years ago reports that patients studied had no regrowth of fibroids during their pregnancies. Typically, fibroids grow during pregnancy in response to the high levels of hormones.

The study, which appears in a recent issue of the journal Fertility and Sterility, included nine women who had 12 pregnancies. One woman had three pregnancies, and one woman had twins. The women's average age at the time of the procedure was 40.

The researchers found that growth of the baby was normal in all pregnancies; the blood flow of the baby, mother, and placenta, which nourishes the baby, was normal as well. No abnormal bleeding was observed during labor, delivery, or immediately after delivery, even in the woman who had had a cesarean section.

"This is probably the largest group of women who have become pregnant after embolization," Robert Worthington-Kirsch, MD, tells WebMD. Worthington-Kirsch, who was not involved in the study, is an interventional radiologist in Philadelphia who says he has performed more than 700 embolizations.

He speculates that researchers will eventually find that fertility after embolization is about the same as it is after another procedure, called myomectomy, which involves scooping out the tumors.

Anne Roberts, MD, chief of vascular and interventional radiology at Thornton Hospital, at the University of California, San Diego, says she is optimistic but cautious about the results of the study.

"At this point, I think that I'm encouraged by the fact that there have been normal deliveries following embolization," she tells WebMD. "We still don't know whether embolization is the first option in women who are candidates for myomectomy. Some say embolization is the best procedure because you're not making an incision in the uterus, but no one has done that study."


In a related development, a Dutch gynecologist announced Monday that he has developed another method to treat fibroids.

Mark Emanuel, MD, from Spaarne Hospital in the Netherlands, said at the European Society of Human Reproduction and Embryology that he has successfully treated 30 women by using a special wand. The device is inserted through the cervix and then cuts and removes the tumors.

Emmanuel said the technique is useful in treating fibroids that appear on areas of the uterus that the wand can reach. He estimated one in four women with fibroids would be eligible for this treatment.

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