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A Less-Invasive Treatment for Fibroids
by Roberta Greenwood

Six hundred thousand U.S. women had hysterectomies in 2004. According to a report published in the Wall Street Journal, 200,000 of them had the surgery to correct problems caused by fibroid tumors. Although typically benign, these growths can cause extreme abdominal pain, heavy bleeding and urinary problems. Condoleezza Rice, U.S. secretary of state, was just one of the many American women who faced a tough decision in 2004: What is the most appropriate treatment for my fibroids?

Surgical interventions, either hysterectomies (surgical removal of the uterus) or myomectomies (surgical removal of the fibroids), have been the common approach to problematic fibroids. That changed in 1995, as uterine fibroid embolization (UFE) was introduced by interventional radiolologists as an alternative. Dr. R. Torrance Andrews, chief of vascular and interventional radiology at the University of Washington Medical Center, believes strongly in the procedure and the advantages it offers certain patients. Of the 200,000 hysterectomies performed in 2004 to correct fibroid problems, he estimates nearly half could have been treated successfully with UFE.

Interventional radiologists have been using the embolization of arteries for more than 20 years to treat other uterine problems. The first publication on uterine fibroid embolization in 1997 highlighted the success of the procedure when performed on women with fibroids meeting certain criteria. As described on the Society of Interventional Radiology Web site (www.sirweb.org), UFE “blocks the arteries that supply blood to the fibroids, causing them to shrink. It is a minimally-invasive procedure, which means it requires only a tiny nick in the skin, and is performed while the patient is conscious but sedated – drowsy and feeling no pain.”

According to results that have been published in several major medical journals, UFE is successful in 85 percent of cases, with recurrence of the problems subsequently requiring surgery very rare. A study which tracked patients for six years concluded that there was no re-growth of the treated fibroids. These positive results are what Dr. Andrews terms “significant.”

“If you’re told you need surgery, you should ask if UFE is a reasonable alternative; if the answer is ‘no,’ ask why not?” Dr. Andrews stresses that a team of specialists is necessary to ensure the correct procedure is selected for each patient. “This should be a group effort: patient, gynecologist and the interventional radiologist need to work together. The woman needs to be an advocate for herself and ask if UFE is an option in her case.”

Susan Springer of Portland, Ore., couldn’t agree more. “In 1999 I underwent UFE for my fibroids; my OB-GYN didn’t mention the procedure, suggesting the only method of treatment for me was a myomectomy, which might result in infertility. I wasn’t satisfied and did a huge research project, determining that UFE offered me a chance to solve the problems caused by my fibroids and still have the chance to get pregnant. I had the procedure completed at Oregon Health & Science University (OHSU) and delivered my twins 20 months ago.”

Dr. Andrews had been performing uterine fibroid embolizations for six years while on staff at OHSU. He now heads the interventional radiology department at UWMC with the hopes of treating more patients in the Seattle area with this unique procedure. The University of Washington Medical Center has begun an informational campaign to educate patients and practitioners about UFE, hosting an August 2004 seminar on “Advanced Topics in Uterine Artery Embolization,” in Seattle.

According to Dr. Andrews, a good candidate for UFE is determined by a documented diagnosis of fibroids. Other pathologies can cause similar symptoms, so it’s imperative that women be evaluated for fibroids. Once diagnosed, the fibroids must be causing problems for the patient, as many women have fibroids and never experience any discomfort. If symptoms are present, the tumor should be three to eight centimeters in size, although successful procedures have been performed on larger fibroids. The age of the patient is important and most successful embolizations occur in women near menopause, with the fibroid itself located in the uterine wall. As with many disorders, noninvasive treatments are available; in the case of fibroids, that could be the use of birth control pills or additional strong hormonal therapies.

If it’s determined that surgery is needed, Dr. Andrews suggests that women ask their gynecologists if they’re appropriate candidates for UFE. “Some doctors might see this procedure as a threat, some as an advance, and some aren’t sure. That’s why it’s so important to ask questions and find out if your case could be treated with UFE.”

According to a published report by the Task Force on Uterine Artery Embolization, which Dr. Andrews helped prepare, “Every patient who undergoes uterine embolization should have a complete gynecologic examination by a physician (or other qualified health professional) with training and expertise in gynecologic care. This examination should be performed within 12 months of the procedure.”

Once the decision is made to perform uterine fibroid embolization, it’s necessary to seek the support of an interventional radiologist, of whom there are several in the Seattle area. Additionally, Dr. Andrews suggests inquiring if your practitioner is Board certified, with a Fellowship completed in Interventional Radiology and a Certificate of Added Qualifications (CAQ).

Again, he stresses the importance of working with the patient’s gynecological team.
“It’s so important that this procedure be done in concert with gynecological care; there needs to be an overall management of the patient, with each doctor playing an important role.” Susan Springer interviewed more than a dozen doctors in her research prior to her UFE. “It took phone calls, interviews and lots of work on my part; now, there’s much more information available to women.”

The procedure itself is relatively brief, with most UFEs requiring about an hour to complete. The patient has no need for general anesthesia, usually staying overnight in the hospital. Pain is a highly variable component with most patients requiring a patient-controlled analgesia (PCA) pump in the hospital and pain medication once released.

“Many patients report moderate to severe pain – much the same as a bad menstrual period with heavy cramping – directly after the procedure,” Dr. Andrews says. “Some report extreme pain. We’re not sure of the origin of these differences, but it’s important that women know what to expect. We see improvement in almost all cases within the first 24 hours; my patients report that on a scale of 0 to 10, their pain is around a 5.” Nausea is a common side effect in many patients and is evaluated in the overall plan for pain management on a case-by-case basis.

The size of the fibroids isn’t an indicator of the pain that may occur; it may be related to the amount of material used in the procedure. Uterine fibroid embolization introduces tiny particles into the arteries feeding the tumors, blocking the flow of blood, and resulting in a shrinking or “drying up” of the fibroid. While three different materials are available and FDA-approved for use, Dr. Andrews prefers acrylic micro spheres; these uniform spheres don’t clump as much as other materials and seem to cause less pain.

Although the fibroids are left in the body and not surgically removed as in other interventions, there is no “rotting material” left inside the body, a common misconception, Dr. Andrews reports. “UFE shrinks existing tumors, leaving tissue behind. This may bother some patients. There’s a very low risk of infection with UFE; it does however, take a period of time for the fibroids to shrink. We usually see a distinct difference in symptoms in a month, with tumors shrinking by 40 to 70 percent.”

As with hysterectomies and myomectomies, UFE is covered by most health insurance providers and many women return to work in a week. That aspect is a big advantage over surgical procedures, which can require several weeks of recuperation. Although not for every patient, uterine fibroid embolization offers Seattle women a choice in the treatment of painful fibroids and a chance for a quick return to their active lifestyles and more.

Susan Springer speaks softly as her twins take their afternoon nap. “I can’t stress this enough – ask questions! Understand what options are out there for you; I can’t imagine my life without my baby twins.”

Want to know more? Contact:

• University of Washington Health Sciences, http://depts.washington.edu/hsnews
• Society of Interventional Radiology, www.sirweb.org
• American College of Obstetricians and Gynecologists, www.acog.org
• National Uterine Fibroids Foundation, www.nuff.org

©2005 Caliope Publishing Company