Satisfaction After Fibroid Embolization Similar to Hysterectomy
WEDNESDAY Feb. 27, 2008 -- Women with fibroids face a myriad of choices for treatment, each with its own benefits and drawbacks, which can make it difficult to choose the right procedure.
Now, a new study helps define the choice between at least two options -- uterine artery embolization (UAE) and hysterectomy. After two years of follow-up, the study, published in the March issue of Radiology, found that women who had UAE reported an equal quality of life compared to women who'd had a hysterectomy.
"Both UAE and hysterectomy improved health-related quality of life," wrote the Dutch researchers, who added that they believe UAE is a good alternative to hysterectomy.
"UAE does offer a decreased hospital stay, quicker recovery and less morbidity," added Dr. William Romano, an interventional radiologist at Beaumont Hospital in Royal Oak, Mich.
As many as one in four women have fibroids that cause symptoms, such as heavy menstrual bleeding, pelvic pain and reproductive problems, according to the National Institute of Child Health and Human Development.
Common treatment options include hysterectomy, myomectomy (surgical removal of individual fibroids), UAE, and endometrial ablation, a procedure in which the endometrial lining of the uterus is destroyed. In UAE, two catheters are placed in the uterine arteries, and small particles are injected that block the flow of blood supply to the fibroids. Women who wish to retain their fertility cannot choose hysterectomy, UAE or endometrial ablation.
For the study, 177 women with fibroids and troubling symptoms who had originally planned to have hysterectomies agreed to participate in a randomized trial comparing UAE to hysterectomy.
The researchers then followed the women's health for two years and assessed health-related quality of life at six different times. Twenty percent of the women in the UAE group went on to have hysterectomy, which offers a permanent end to symptoms, because the uterus is removed.
Six weeks after treatment, people in the UAE group had higher satisfaction scores for physical function than those who underwent hysterectomy.
Quality-of-life scores improved significantly for people in both groups six months after treatment. The only difference at six months was in a measure called the defecation distress inventory that related to bowel symptoms, and these scores improved in the first six months for the UAE group but not for the hysterectomy group.
After two years, more than 90 percent of the women in each group reported being satisfied with their treatment, according to the study.
"UAE is an excellent addition to women's options," said Dr. Erika Banks, director of the Fibroid Center at Montefiore Medical Center in New York City. However, she added that 24 months is the longest follow-up available on UAE, and the procedure can cause premature ovarian failure and hasten menopause.
"There are many options, and women with fibroids should see a gynecologist who specializes in all of the options and who works with a radiologist. Not every single option is right for every woman. With your doctor, weigh the risks and benefits of each option, considering your own situation," Banks advised.
"Fibroids significantly impact on women's mental and physical health, and any treatment can improve their overall outlook. In this study, patients with fibroids had a significant improvement in quality of life with either treatment. Having a choice and the proper knowledge to make the decision can lead to a better outcome overall," Romano said.
To learn more about fibroids and the available treatment options, visit the National Women's Health Information Center.
Posted: February 2008
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