Outpatient Fibroid Treatment Beats Open Surgery

From the WebMD Archives

March 6, 2001 (San Antonio) -- An outpatient procedure not only stops the heavy menstrual bleeding caused by benign fibroid tumors in the uterus, but also does it with less pain and faster recovery than open surgery. It also improves sexual function in some women, according to studies reported here at a meeting of interventional radiologists.

Fibroids are benign, noncancerous growths in the uterus. They are very common -- as many as 40% of women 35 and older get them. When fibroids become large, they can cause pain, heavy and prolonged menstrual bleeding, and a feeling of pressure or fullness in the abdomen.

When weighing what treatment to choose for fibroids, though, one expert says more patients learn about the outpatient technique from the Internet than from their gynecologists. If their gynecologists won't support them in seeking the treatment, many women are finding new doctors.

The technique is called uterine fibroid embolization, or UFE. During UFE, a radiologist guides a small tube through a small cut in the groin up into the artery feeding the uterus. The tube is used to deliver tiny beads that block the enlarged blood vessels feeding the fibroids, causing them to shrink.

"What we found is that in terms of control of bleeding, the embolization group did much better than the [abdominal surgery] group," Mahmood K. Razavi, MD, tells WebMD. "My feeling is it shouldn't be a second alternative, it should be the first alternative for bleeding patients."

The findings come from the first direct comparison of UFE to open surgery to remove fibroids without removing the uterus. The study did not look at patients who underwent a less-invasive form of surgery called laparoscopy.

The comparison of UFE and removal of fibroids via traditional, open surgery -- abdominal myomectomy -- is a collaborative study between Razavi and gynecologist Bertha H. Chen, MD, at Stanford University Medical Center. Over a three-year period, Razavi and Chen compared data from UFEs and abdominal myomectomies they performed.

The 76 UFE patients tended to be older, about age 45 vs. 38, and better informed than the 36 myomectomy patients available for follow-up. There was no significant difference between the two groups in terms of fibroid symptoms.

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Myomectomy patients did tend to report better improvement in the sensation of uterine pressure, while UFE patients tended to report less pain after the procedure. Consequently, UFE patients reported using pain medication for only three to four days, compared to a week for myomectomy patients. UFE patients also returned to normal activity in about seven days instead of 35 days for those who underwent open surgery, and about 4% of UFE patients reported complications compared to more than 19% of the myomectomy patients.

"In myomectomy, they can't get all the fibroids, but with embolization, all of the fibroids are treated at the same time," Razavi says. "The key is that for appropriately selected patients, embolization performed better than myomectomy."

Most of the experts consulted by WebMD were quick to note that while normal pregnancies have been reported in women who have undergone UFE, the procedure is not currently recommended for women who intend to become pregnant.

Symptoms aren't the only thing that improves after UFE, according to a small study by Jackeline Gomez-Jorge, MD, assistant professor of interventional radiology at the University of Miami in Florida.

"It was very interesting to find out that this procedure does not adversely affect patients' sex lives, and, in fact, may improve them," Gomez-Jorge tells WebMD.

Gomez-Jorge and colleagues at Georgetown University gave a brief, nine-item questionnaire to 115 premenopausal patients who underwent UFE. Half the women responded to the explicit questions. The results:

  • 64% of patients had no change in strength of orgasms
  • 6% of patients reported stronger orgasms; 6% reported no orgasms
  • 56% of patients reported internal orgasms with uterine contractions
  • 80% of patients reported continued sexual desire more than once per week, vs. 8% who had no interest in sex
  • 34% of patients reported sex more than five times in the last month

"It is my impression that by keeping the anatomy intact -- the nerve endings, the organs, and tissues -- to my mind it seems that would be an advantage to UFE," Gomez-Jorge says. "Of course, sexual response is more than anatomy -- but as far as the physical part, keeping your uterus, keeping your vagina, keeping the aspects that have to do with the sexual response may be an advantage. This is particularly true for those women who experience uterine contractions as part of their sexual response."

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Yale interventional radiologist Michael G. Wysoki also studied sexual function in women who underwent UFE. In a telephone survey to which 21 premenopausal patients responded, his team found that 43% of patients had increased sexual desire. There was decreased pain during intercourse in 60% of women, and 27% reported increased frequency of orgasms.

Wysoki also asked the women about their gynecologists. Nineteen of the 21 women said it was they -- and not their doctor -- who initiated discussion of UFE. Most of these women learned of the technique on the Internet. All of the women said their gynecologist initially recommended hysterectomy for their fibroids -- and only one of these physicians ultimately offered UFE. This is not surprising, as only five of the 21 gynecologists had a positive opinion of UFE and more than three-quarters of them were strongly opposed to the procedure.

Eight of the nine women whose gynecologists remained opposed to UFE said they now had a new gynecologist.

"Women are taking charge of their healthcare," Wysoki says. "They are investigating options, especially on the Internet, and they are going to the gynecologist who offers them what they think are the best available treatment options. If their gynecologist is opposed to that option, they are going to switch doctors rather than fight with them."

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