Treating fibroids without surgery

Women who had less invasive treatment for painful uterine fibroids did about as well as those who had surgery, including a hysterectomy, a new study suggests.

Uterine fibroids are common among women of childbearing age. Nearly 40 percent develop these noncancerous tumors in the uterus that often don't cause any symptoms. Although the most common treatment for fibroids that cause extreme pain is surgery, some women choose a gentler procedure known as uterine artery embolization.

However, the study found there were some trade-offs to the popular procedure. While embolization patients spent far less time in the hospital, they also were more likely to need a repeat treatment.

Fibroids are growths of muscle fibers inside the uterus that can range from a quarter-inch in size to as large as a cantaloupe. In serious cases, they can cause heavy menstrual bleeding, pelvic soreness and pain during sex.

For decades, hysterectomy — removal of the uterus — was the only option. A more recent option is a myomectomy, surgery that removes the fibroids and keeps the uterus intact, allowing for a future pregnancy. However, there's a chance the fibroids will return.

The American College of Obstetricians and Gynecologists says that while embolization is an option for women with fibroids, there's not enough evidence to show that it's safe for women who want to get pregnant.

The procedure involves making a small incision in the groin and inserting a catheter into the artery. Doctors then blast tiny pellets into the uterine artery to cut off the blood supply that feeds the fibroids. Over time, the tumors shrink and die.

The new study, published in today's New England Journal of Medicine, randomly assigned 106 women to embolization and 51 to surgery. Most in the surgery group had hysterectomies; a few had myomectomies.

After a year of follow-up, researchers found no significant difference in the quality of life for either group. However, the embolization group recovered faster. Despite the faster recovery, 13 percent in the embolization group were readmitted to the hospital after a year, including 10 percent who needed a repeat procedure or hysterectomy because of recurrent symptoms.

"The results of our study make clear that the choice between surgery and uterine artery embolization ... involves trade-offs," wrote lead author Richard Edwards of Gartnavel Hospital in Glasgow, Scotland.

Since the safety of pregnancy after embolization is still unknown, the first "line of treatment" for women who plan to have children should be myomectomy, Dr. Togas Tulandi, a professor of obstetrics and gynecology at McGill University in Canada, wrote in an editorial accompanying the study.