July 29, 2003 -- There are few nonsurgical options for the treatment of uterine fibroids, but that could soon change. A procedure that destroys the noncancerous tumors with guided ultrasound waves was found to be safe and well tolerated in a recent study from Boston's Brigham and Women's Hospital.
The hope is that the technique will become the first completely noninvasive treatment for uterine fibroids, which are the leading cause of hysterectomies. Unlike surgical options, the ultrasound procedure does not require hospitalization, and most of the patients in the Boston study rated pain following the procedure as mild.
"Annually, about 200,000 hysterectomies are the result of uterine fibroids," lead researcher Elizabeth Stewart, MD, says in a news release. "A hysterectomy is by no means a perfect solution to this problem. As women are seeking minimally invasive alternatives, we are encouraged by these results."
Roughly a quarter of all women have uterine fibroids, which develop in the muscle layer of the uterus. The benign tumors may cause no problems for some women, but in others they can lead to excessive abdominal swelling, intense pain, abnormal bleeding and infertility.
Women who want to preserve their fertility can opt for surgical removal of their uterine fibroids (myomectomy) instead of hysterectomy, but fibroids often return. Hormonal treatments are also used to shrink the tumors, but they can cause menopausal symptoms.
A relatively new treatment option called uterine fibroid embolization involves the injection of materials into the arteries to cut off the blood supply to the fibroid and shrink the tumors. It is not clear, however, whether embolization is a good option for women who want to remain fertile.
With the new experimental technique, which was developed in Israel, clinicians first pinpoint the exact location of the fibroid using magnetic resonance imaging (MRI) and then target a high-temperature, ultrasound beam directly at it to destroy the tumor.
In the Brigham and Women's study, published in the July issue of the American Journal of Obstetrics and Gynecology, 55 women who were already scheduled for hysterectomies had the MRI/ultrasound therapy. Treatments lasted approximately two hours, and real-time MRI visualization allowed clinicians to ensure that the correct amount of heat was being delivered and that the targeted fibroid tissue was being precisely treated.
Overall, the women reported that discomfort was low, and only 10% needed pain medication after the procedure. Fertility preservation could not be assessed in the study, however, because none of the patients intended future childbearing.
Ob-gyn Susan Haas, MD, MSc, says it is too early to tell whether the MRI/ultrasound procedure will offer advantages over existing fibroid treatments. She says that doing nothing may be the best treatment option for many women. Haas is an assistant professor of obstetrics and gynecology at Harvard Medical School. She is also with Brigham and Women's Hospital but was not involved with this study.
"This is elective treatment, and women need to understand that observation is also an option," she says. "The decision about whether to treat and how to treat depends on a number of things, including fibroid size, number, and location and the symptoms."