From Our 2008 Archives

Embolization a Nonsurgical Way to Treat Fibroids

By Serena Gordon
HealthDay Reporter

TUESDAY, March 18 (HealthDay News) — Uterine artery embolization is an effective, non-surgical therapy for fibroids, even after a woman has had other treatments such as focused ultrasound surgery, a new study says.

But another team of researchers reports that many American women are unaware of embolization as a treatment option.

The two studies were to be presented Tuesday at the Society of Interventional Radiology's annual meeting, in Washington, D.C.

"If you're suffering with symptomatic fibroids, you don't have to have surgery. Uterine artery embolization is an excellent option," said the author of one of the studies, Dr. John Lipman, director of interventional radiology at Emory-Adventist Hospital in Atlanta. "There are some women who are silent sufferers. They basically hemorrhage each month because they know they don't want a hysterectomy and they feel it's the only option. So, they just sit on the sidelines because they don't want the surgery."

Uterine artery embolization (UAE), which is sometimes called uterine fibroid embolization, cuts off the blood supply to fibroids by blocking the uterine arteries. The procedure is minimally invasive, doesn't require general anesthesia, and often allows women to return to normal daily activities within a week, instead of the six weeks or so needed for recovery from a hysterectomy.

The downside to this procedure is that it's not effective for everyone, and in rare cases, the fibroids may recur, according to the Society of Interventional Radiology (SIR).

Other treatment options — such as hysterectomy (surgical removal of the uterus) and myomectomy (surgical removal of individual fibroids) — are available, as is magnetic resonance-guided focused ultrasound. This technique is also known as focused ultrasound surgery (FUS) or ablation, and involves using high-intensity ultrasound waves to destroy (ablate) fibroid tissue, according to SIR.

If ablation fails to relieve fibroid symptoms, uterine artery embolization is still an effective treatment option, according to one of the studies presented. The study evaluated the efficacy of uterine artery embolization after failed ablation, and found that the technique could still provide a reduction in fibroid size and in symptoms.

"FUS is a newer procedure for uterine fibroids and whether it provides sustained symptom relief is still being evaluated. My research shows that when FUS fails, these women could benefit from uterine fibroid embolization," the study's lead author, Dr. Alisa Suzuki, an interventional radiologist at Brigham and Women's Hospital, said in a prepared statement.

But Lipman suspected that — despite the procedure's efficacy — many women aren't being made aware of UAE. In his study, the Emory researcher interviewed 105 women being seen at an Atlanta-area fibroid practice to assess whether or not they had been told by their gynecologists that uterine artery embolization was an option. Lipman pointed out that gynecologists don't perform UAE, interventional radiologists do. So, if women were not informed about the procedure by their gynecologist, Lipman asked how they learned about UAE.

He found that only 33 percent of the women were given uterine artery embolization as an option, and most of these patients were referred from a single health-care organization -- one that requires doctors to present all options. The most common way that the remaining women found out about uterine artery embolization was either from radio advertisements or the Internet.

"While I encourage patients to use the Internet — it's important for patients to empower themselves — it's up to doctors to give their patients all the options. Gynecologists need to take the lead and tell their patients about this option. Patients shouldn't have to direct their own therapy," Lipman said.

Dr. William Romano, an interventional radiologist at William Beaumont Hospital in Royal Oak, Mich., added: "Embolization is a good treatment option and it should at least be considered in all patients with fibroids. It would be nice if the knowledge of it was more widespread."

SOURCES: John Lipman, M.D., medical director, Atlanta Interventional Institute, and director, interventional radiology, Emory-Adventist Hospital, Atlanta; William Romano, M.D., interventional radiologist, William Beaumont Hospital, Royal Oak, Mich.; March 18, 2008, presentations, Society of Interventional Radiology annual meeting, Washington D.C.

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