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Uterine fibroid embolization reduces pain, may enhance women's sex lives
As many as 40 percent of women 35 and older develop nonmalignant fibroid tumors. Most of them don't experience any serious symptoms from these uterine growths, but about 25 percent have fibroids that become large and cause pain, heavy and prolonged menstrual bleeding and an uncomfortable bloated feeling in the abdomen.
Large fibroids can cause pain, heavy and prolonged menstrual bleeding and an uncomfortable bloated feeling in the abdomen.
A variety of treatments are available to these women, including hysterectomy, surgical removal of the uterus; myomectomy, surgical removal of the fibroids; hormone therapy; and uterine fibroid embolization (UFE), a technique that shrinks fibroids by blocking their blood supply.
According to studies reported at the 26th Annual Scientific Meeting of the Society of Cardiovascular & Interventional Radiology (SCVIR), UFE not only stops the heavy menstrual bleeding caused by fibroids, it also does so with less pain and faster recovery than more invasive surgery. It might also improve sexual function in some women.
Comparing UFE to myomectomies
In the collaborative study, the researchers compared data from 76 UFEs and 36 myomectomies they performed over a three-year period.
Effect of treatment on sexual experience
Gomez-Jorge gave a nine-item questionnaire to 115 premenopausal patients who underwent UFE. About 50 percent of the women responded as follows:
“Keeping the anatomy involved in sexual response intact may be an advantage,” Gomez-Jorge said. “This is particularly true for women who experience uterine contractions as part of their sexual response.”
Michael G. Wysoki, MD, assistant professor of radiology, Yale University School of Medicine, also studied sexual function in women who underwent UFE. In a telephone survey to which 21 premenopausal patients responded, his team found that after UFE, 43 percent had increased sexual desire. There was decreased pain during intercourse in 60 percent of women, and 27 percent reported increased frequency of orgasms after having UFE. “No patients reported a deterioration in sexual function,” he said.
UFE is a good option for many women suffering from fibroids
More than 180,000 American women undergo hysterectomies each year to treat excessive bleeding and pain resulting from uterine fibroids. According to a 1999 survey conducted by the Society for Women's Health Research, as many as one-third of the women who have this surgery do so without discussing potential alternatives with their doctors.
“As many as one-third of the women who have [hysterectomies for fibroids] do so without discussing potential alternatives.”
What are fibroids?
Most women with fibroids do not experience significant discomfort, but if the fibroids are very enlarged, they can press on the bladder and cause obstruction of the kidneys, which can be painful. They may also result in heavy bleeding, painful intercourse and an enlarged uterus similar to a four- to five-month pregnancy or larger.
This major surgery requires general anesthesia, a six-week recovery period and may have psychological and sexual consequences as well. There is about a 20-40 percent risk of complication following hysterectomies—most of them minor, such as bladder infections and fever, but more major ones include risk of injury to the bladder, bowel or ureter, as well as bleeding.
UFE: less invasive, shorter recovery
A small incision (less than 1/8 of an inch) is made in the groin and a thin tube called a catheter is then guided through an artery to the uterus while the interventional radiologist watches the progress of the procedure using X-ray imaging. The patient is sedated and feels no pain. Small particles are then inserted into the artery that is supplying blood to the fibroid tumor (or tumors) to cut off the blood flow. Cutting off the blood flow to fibroids causes them to shrink or die.
“Between 85 and 95 percent of women who have UFE will not need any other treatment.”
Fibroid embolization usually requires a hospital stay of one night. Many women return to normal activity in three to seven days, compared to more than 35 days for myomectomy patients and six weeks or more for hysterectomy patients.
The success rate is very high. Between 85 and 95 percent of women who have UFE will not need any other treatment. For bleeding, it is 95 percent effective. There is also less pain following UFE, as the study presented at the SCVIR annual meeting indicated.
Who is not a good candidate for UFE?
Another contraindication for UFE is renal insufficiency or underfunctioning kidneys. Also, very large fibroid tumors outside of the uterus may not shrink sufficiently with UFE and women with these kinds of fibroids might be better candidates for a myomectomy.
What should you do if you have painful fibroids?
Dr. Wysoki is an interventional radiologist at Yale-New Haven Hospital and assistant professor of diagnostic radiology at the Yale University School of Medicine.